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Health care outlook 2024: Michael Hogue, CEO, APhA

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In the first of a two-part series, leaders of industry associations present their expectations for pharmacy operators for this year. The views of other organizations will appear in the next issue of Chain Drug Review.

Michael Hogue

As the oldest national professional association for pharmacists, pharmacy technicians, student pharmacists and pharmaceutical scientists, the American Pharmacists Association touches a wide range of subjects and practice interests from across the profession. The confluence of challenges and opportunities over the past year has resulted in some of the most rapid changes our profession has experienced. Here are a few of what APhA believes will be big-picture changes in 2024 impacting pharmacists and pharmacies.

Paramount among those changes will be the industry’s need to come to grips with the perfect storm hitting community pharmacy practices. Rock-bottom Medicare Part D reimbursements from plan sponsors (i.e., PBMs) combined with the assessment of final 2023 direct and indirect remuneration (DIR) fees will result in a cash flow crisis in community pharmacies. This cash flow crisis is already being felt by independent pharmacies and chains, with Rite Aid’s bankruptcy, the loss of Winn-Dixie pharmacies, the pending merger of Kroger and Albertsons, and announced closures of both CVS and Walgreens locations. In total, a contraction in the access to care through community pharmacies will result in a worsening of pharmacy deserts, particularly in areas already experiencing health care shortages. This will worsen health disparities and lead to congressional leadership in Washington finally taking action to address the reimbursement problems inherent in the Part D program.

Whenever there is a significant challenge, there is always opportunity. On the positive side, squeezed reimbursement on pharmaceuticals has forced pharmacies to explore rapid integration of clinical care services into community practice. While the infrastructure for medical billing for pharmacist services is nascent, models are emerging which enable meaningful payment that is significant enough to sustain practices. Thanks in large part to innovations implemented through the Community Pharmacy Enhanced Services Network (CPESN) and the APhA Foundation’s decades of work in value-based payment models, pharmacists have proven we reduce costs, improve access and quality of care, and improve patient satisfaction with care. The medical insurance industry is now working with the profession to credential pharmacists as providers, and Pharmacy Profiles, a subsidiary of APhA, is providing the platform for doing so at rapid speed to bring as many pharmacist providers as possible online for clinical care as soon as possible.

The implementation date for the final requirements for the Drug Supply Chain Security Act (DSCSA) arrived in November 2023. Most pharmacies, as well as many others in the drug supply chain, were not ready to be fully compliant for electronic exchange of traceability information about prescription drugs and their chain of ownership. APhA led advocacy efforts for the dispenser community, educating the Food and Drug Administration on the state of readiness and urging the agency to give the supply chain more time to comply. This advocacy paid off. FDA announced its intent not to take action to enforce certain DSCSA requirements until November 27, 2024. This one-year “stabilization period” will give trading partners more time to implement, troubleshoot and mature their electronic systems and processes. In early 2024, pharmacies should conduct due diligence and explore their options and vendors who have solutions to manage their information and help them comply with DSCSA.

At the same time we are seeing the entrepreneurship of the profession shine through. Early career pharmacists are taking charge and creating opportunities for career pathways that just five to 10 years ago didn’t exist. For example, pharmacists are working from home to provide wholeness and well-being services as a part of comprehensive medication management through concierge and cash-only models of care. Pharmacists are increasingly embedded within physician-based primary care and specialist practices as part of a team-based approach to care.

However, driving much of the entrepreneurial approach by pharmacists is a frustration over the working conditions in community and hospital outpatient pharmacies. Inadequate staffing and stress-inducing situations involving incivility and violence toward pharmacy staff made 2023 the year of the pharmacy walkout by many in our profession. APhA’s position is that pharmacists must do whatever they determine necessary to maintain a safe environment for the patient care process to occur.  If 2023 was the year of the walkout, I predict that 2024 will be the year that pharmacists take charge of their profession and change the system to support pharmacist care services. Already we are seeing innovations in technology, expanded roles for pharmacy technicians and workflow solutions which are freeing up pharmacists’ time in hospitals and in community pharmacies. Innovations are under way from large corporations, health systems and wholesalers supporting independent owners. Boards of pharmacy need to view the implementation of these advancements not as a threat to the profession, but as a public health improvement that will ensure patients have a safer medication use environment. Pharmacists, when empowered to provide care in the way they were trained, can and will have fulfilling careers. This will fundamentally change the face of how community pharmacy is practiced, once again ensuring patients have access to the care services they need right in their neighborhood.

Beyond the surface of practice, there are also other trends in our health system that will impact pharmacists and our entire industry in significant ways. Artificial intelligence (AI) will not replace the role of the pharmacist in ensuring appropriate medication use; its use can help us to work smarter and make better decisions. Innovations in the application of both machine learning and AI will undoubtedly drive changes that today we can’t fathom. At APhA’s 2024 Annual Meeting & Exposition in March, the APhA House of Delegates will take up policy considerations to guide the profession, aligning with federal guidelines and White House principles for the use of these technologies.

Pharmacists are increasingly vital in solving the nation’s shortage of mental health professionals. Board-certified pharmacists in psychiatric pharmacy and in pain management are seeing opportunities skyrocket. A lack of psychiatrists and psychiatric nurse practitioners will only expand new opportunities for pharmacists to step in and provide medication management services that keep patients from developing substance use disorders, treating those same disorders, and treating the broader range of mental health and pain management conditions.

It’s also important to note that the public health role of the pharmacist will continue to be amplified. With solutions to drug distribution systems on the horizon, pharmacists will have more time to provide life-saving vaccines; conduct testing and expedite treatments for infectious diseases like influenza and COVID-19; and improve access to HIV pre- and post-exposure preventives, bringing the end of the HIV epidemic within reach. And this is just the tip of the iceberg, as the Centers for Disease Control and Prevention (CDC) and state public health officials see pharmacists as key to addressing the crisis of cardiovascular disease. This means initiating and modifying therapies, and otherwise ensuring patients reach their treatment goals for diabetes, hypertension, hyperlipidemia and a host of other contributing factors for the nation’s top cause of death.

Finally, the profession has an image problem. Young people are seeing many pharmacists as burned out and dissatisfied with their career choice as the result of some of the challenges we’ve discussed. However, these same young people have not seen the evolving positive role of pharmacists in emerging areas of practice. Even pharmacists who walked out of pharmacies in Kansas City told me that they love their profession and love community pharmacy practice — they simply found themselves in a situation where they didn’t love their environment. With good dialogue, those pharmacists were able to work with their employer to find sustainable solutions. This story must also be told so that we can continue to build a pipeline of well-qualified individuals prepared to care for an aging population. 

Michael Hogue is the CEO of APhA


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