The new year promises to be pivotal for retail pharmacy, with internal and external factors coalescing to shape the profession’s future direction.
The likelihood that the health care reform legislation now being hammered out in negotiations between the House and Senate will be signed into law by President Obama is, understandably, the industry’s top priority. How differences in the bills that narrowly passed in the two chambers are resolved will have a significant impact on the way pharmacies are compensated, what services they provide and patient access.
Concerns remain about the reimbursement model for prescriptions filled under Medicare; accreditation and bond requirements for sellers of durable medical equipment, including diabetes supplies; and provisions designed to encourage more widespread use of medication therapy management.
Pharmacy advocates think it is probable that, in the wake of health care reform, the industry will be faced with lower reimbursements for Medicaid scripts. The expectation of offsetting that loss through an expanded pool of insured patients will not materialize until all of the provisions of the legislation take effect several years down the road. In the meantime, pharmacy operators will have to learn how to cope with the changed playing field.
The focus on cutting reimbursements is not a new phenomenon. Government officials have struggled for years to rein in costs, and third-party payers in the private sector have tried to keep downward pressure on pharmacy margins.
The trend has brought a degree of commoditization to the profession, with many retailers offering $4 generics and other drug discount programs and some of them even giving away select medications.
The tension between that movement and the bid by pharmacists to take on a bigger role in the management of patients’ health is all too apparent. How it is resolved will go a long way toward determining the status of retail pharmacy going forward.
The industry is fortunate to have leaders who will not settle for the status quo. As the extended excerpts from a recent roundtable discussion sponsored by Chain Drug Review demonstrate, retail pharmacy executives and their counterparts in the supplier community are rethinking the profession and what more it can do to improve patient care and help limit overall health care costs.
Their vision involves the expansion of services to fully capitalize on the unmatched medication expertise of pharmacists and the industry’s infrastructure, which reaches into almost every neighborhood in the country.
During the current flu season, retail pharmacy has proven that it can shoulder substantial new burdens, providing information, immunization and treatment for both seasonal influenza and the H1N1 virus. In the process, the industry has highlighted some of its considerable strengths — chief among them ease of access, efficiency and effective interaction with patients.
That performance has helped open the eyes of government officials and positioned pharmacy as a primary resource in future public health emergencies. Taken together with the ongoing efforts of industry leaders, it offers reason to believe that pharmacy will succeed in enhancing its scope and its standing.
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