Now is the Time to Advocate for a New Pharmacy Model

A recent New York Times article is putting a spotlight on the pharmacy profession, giving us an opportunity to articulate our value and make big changes to our industry.

The article outlines the dangers chain pharmacies are creating through the practice of hitting refill targets, understaffing, and placing the emphasis on volume-related metrics, like speed of transaction time. 

Of course, this was no news to pharmacists or pharmacy technicians, like this Reddit post from 2018 (which cunningly states CVS is an acronym for Company that Values Statistics) explains, we’ve known this was a population health issue for years.

One pharmacist is quoted as saying, "I am a danger to the public working for CVS."

Another says, "I had two misfills in three years with the previous staffing and now I make 10-12 per year (that are caught)."

Pharmacists are concerned about patient care and patient health in these chain drug stores, but they are being set up to fail both themselves and their patients due to understaffing and a focus on metrics.

We need to take our power back.

We have the license, we took the Oath of a Pharmacist, we should be able to act in the patient’s best interest.

It doesn't matter if you are a retail, hospital, academic, or any other specialty. Pharmacy needs to stand together in this spotlight.

We can do more for our patients, but we need the media to hear a unified message coming from us, not from the corporations responsible for this perilous situation.

Dangerous Health Risks

One of the jolting realities from this article is the unnecessary health jeopardy created due to understaffing and pressures being placed on pharmacists to fill prescriptions quickly.

When corporations began applying the “fast food” model to a pharmacy in order to boost profits, the patients and the pharmacists became the ones to pay the price.

If you haven't read the article here’s a few examples of the scenarios we pharmacists are all too familiar with:

• One patient refilled his antidepressant and suspected something was wrong when he felt short of breath and extremely dizzy. It turns out he had received estrogen instead of the antidepressant.
• Another patient went to take an asthma pill when she realized she had actually be supplied with blood pressure medication.
• A third patient ended up in the emergency room because his eyes were burning after putting drops in them for five days. It turns out he had received ear drops instead of eye drops.
• The most severe example is Mary Scheuerman, who refilled what she believed was an antidepressant, but was instead provided a powerful chemotherapy drug. She died five days after entering the hospital.

And that is just the patient risks. Nevermind the risk of burnout, substance abuse and the higher than normal suicide rate of the profession.

Until recently, pharmacist services have traditionally been tied to a product.

Like any other commodity, product prices are subject to market pressures.

In order for Pharmacy to move forward, we must uncouple our profession from profitability related only to the dispensation of a commodity (medications) and instead build business models based around clinical services like medication therapy management.

Pharmacists are highly trained in the management of chronic disease states, yet we are shackled to dispensing medications as our only revenue model because nationally, the Centers for Medicare and Medicaid (CMS) does not currently recognize a licensed pharmacist (a Doctorate level degree since 2000) as a healthcare provider.

Even though individual states are beginning to recognize pharmacists as providers in 'medically underserved areas,' on a national level, pharmacist provider status has been blocked due to cited "increasing healthcare costs."

Though, CMS, in a response to a letter from the American Academy of Family Physicians, responded they would allow for pharmacist services to be billed to CMS under the "incident to" billing requirements (meaning under the direct, in-person supervision) of a physician.

Unfortunately, there is also a law called the Stark Self-Referral Statute that was originally intended to prevent patient 'steering' and kickbacks between physicians and pharmacists.

Because of this "Stark Law" many pharmacists have shied away from partnering with physicians, even though there is a Personal Services and Management Contracts safe harbor.

What Can We Do?

The national spotlight on Pharmacy should motivate us to articulate our value and change the pharmacy model from what it is today.

Tom Menighan, CEO of the American Pharmacists Association writes in his CEO blog, "It's perverse that we pharmacists are begging for the opportunity to practice the kind of pharmacy we were extensively educated and trained to practice."

I wholeheartedly agree.

Pharmacists are extensively trained in the areas of pharmacotherapy, non-drug lifestyle modification, and patient education.

Unfortunately, pharmacists have not been "extensively educated and trained" in the self-promotion of these skills.

I recently made three predictions for what I hope the next 10 years will hold for the profession of pharmacy: 

• Dispensing will become increasingly automated and there will be less demand for pharmacists in retail settings.
• Pharmacists will dominate the preventative services niche.
• A large part of pharmacy revenue and pharmacists’ salary will be based around clinical services, with medication therapy management being at the epicenter.

These three predictions support a new model that will create a higher emphasis on patient care and unchaining us from dispensing medications as fast as humanly possible.

Instead of setting up pharmacists to fail, we should be relying on them to provide patients with continuous, quality care.

One of the many pharmacist-led service opportunities extensively studied within the Pharmapreneur Academy is chronic care management services.

The reason chronic care management (CCM) is such a great opportunity is because it provides continuous, quality care and CMS says it doesn’t have to be billed under 'incident to' billing requirements.

That means it can be billed under general supervision requirements (off-site - as in a community pharmacy) as long as there is a ‘relevant financial relationship’ created between the billing physician and the pharmacist.

Again, not as simple as having stand-alone provider status for pharmacists at a national level, but a move in the right direction none the less.

With only 9% of Medicare beneficiaries currently receiving these services, the more exciting part about CCM is that CMS is begging physicians to offer it to patients.

Like TCM, however, CCM "continue[s] to be underutilized." One industry blog shares, "CMS notes that CCM is 'increasing patient and practitioner satisfaction, saving costs and enabling solo practitioners to remain in independent practice.'"

What is Chronic Care Management?

Chronic care management (CCM) is the oversight of patients with ongoing conditions such as diabetes, depression, and high blood pressure. 

Within CCM, pharmacists provide the following care plan elements:

• Problem list
• Expected outcome and prognosis
• Measurable treatment goals
• Symptom management
• Planned interventions and identification of the individuals responsible for each intervention
• Medication management
• Community/social services ordered
• A description of how services of agencies and specialists outside the practice will be directed/coordinated
• Schedule for periodic review and, when applicable, revision of the care plan

When pharmacists are woven into the care of these patients, they can provide high-quality management of chronic conditions.

It has been proven that pharmacist involvement equals better patient adherence to medications and reduction of hospital readmissions.

It has been proven that pharmacists save the healthcare system money.

Why then, are we still treating pharmacists as incapable of anything other than filling prescriptions quickly and accurately?

Let’s Speak Up

The New York Times article paints an uncomfortable picture of the current reality for pharmacists in chain establishments, but it doesn’t have to be that way.

Let’s speak up and make a change now. It’s time for pharmacists to not only be set up for success within their own careers but to provide significant benefits to patients in the ways in which they are truly capable.

Here’s what you can do to help:

1. Support your national pharmacy organizations. They are the people who advocate for our profession at the national level.
2. Urge your patients and your representatives to support legislation related to recognizing pharmacists as providers.
3. Understand the value we can provide and be able to speak knowledgeably about it.  

We have an opportunity to rebuild the pharmacy practice model, but we need clear, unified messaging across all specialties and practice settings.

This is not a "retail" pharmacist problem, it is a Pharmacy problem.  

Let us provide a unified front that represents better opportunities for patients, providers, payers, and pharmacists.

To learn more about these and other pharmacist-led clinical service models and understand the value of pharmacists, visit pharmapreneuracademy.com.

About Blair Thielemier, PharmD

Blair is an independent consultant pharmacist living in Arkansas with her husband and two children. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She hosts and produces the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center, is the author of How to Build a Pharmacy Consulting Business, and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country.