Pharmacy Outlook: Scott Knoer, APhA

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2021 has finally faded into the rearview mirror. While it’s tempting to say, “Good riddance,” I will briefly reflect on this challenging year before moving on to my vision for 2022.

Scott Knoer

2021 started with hope. We finally had vaccines and, due to decades of advocacy from organizations like APhA, pharmacy was perfectly positioned to save the world. Our pharmacy teams have done yeoman’s work, which has earned sincere appreciation and recognition from public health officials and patients across the country. As health care professionals, we put the needs of our communities first.

Unfortunately, the hopes of quickly vaccinating our way out of the pandemic were paused when we ran into intransigent vaccine hesitancy and rapidly mutating variants. Across the entire profession our individual pharmacists and the teams they are part of are stretched and stressed. APhA’s tracking in the Well-being Index for Pharmacy Personnel Tool (pharmacist.com/wellbeing), social media postings on APhA’s platforms, Facebook groups such as Pharmacy Staff for COVID-19 Support, Accidental Pharmacist and Pharmacist Moms, and movements such as #pizzaisnotworking indicate that understaffing at a great number of pharmacies is negatively affecting the well-being of our frontline pharmacy heroes, driving good talent away from the profession, and putting patients at risk.

The issue of burnout is particularly challenging in our busy chain pharmacies. What seemed in 2019 to be an oversupply of pharmacists became a shortage as the demand for, and expectations of pharmacists significantly increased in response to the pandemic.

Yes, our community pharmacy teams are at their breaking point. The authorities we have sought for years were granted through PREP Act Amendments at a fast pace. These allowances were due to the changing health care needs of communities and widespread recognition of pharmacists’ expertise as well as the access we provide for patients. In addition to previous patient care services, pharmacists are now actively engaged in COVID, flu and routine vaccinations, as well as COVID and other testing and treatment services. The ever-changing vaccine recommendations for individuals of all ages have increased public needs and at times set unrealistic demands. Add these important tasks to the already significant daily demands in our pharmacies, and it can become a workload nightmare. This frustration is compounded when we see labor demands and pharmacy revenues increase, but no corresponding increase in staffing levels.

The labor issues aren’t limited to pharmacists. There is also an acute pharmacy technician shortage. This is exacerbated by the national labor shortage. Pharmacy technicians historically do not make a livable wage, and they can work at other businesses without the stresses of patient care delivery, high prescription volume and unrealistic metrics. Some pharmacies have found it necessary to intermittently close or reduce hours due to staffing issues. There have been reports of last-minute vaccine and testing cancellations without notification to patients.

It is time to change public expectations during COVID and beyond, making patient care services in pharmacy practices appointment-based, like our other health care system colleagues. Additionally, pharmacists need dedicated time to provide patient care services such as vaccinations and testing and adequate support staff and other resources to effectively deliver care. Further, organizations need to provide uninterrupted, compensated time for pharmacy teams to catch up or prepare for the day’s work and to take dedicated meal breaks. These are just some suggestions received through the work spearheaded by APhA and the National Alliance of State Pharmacy Associations with a goal to increase meaningful dialogue between employees and management. The Pharmacist’s Fundamental Responsibilities and Rights outlines pharmacists’ professional responsibilities and the foundational rights that are essential to fulfilling those responsibilities.

But all is not lost. While few will be sad to see the passing of 2021, and the short term of 2022 will be challenging for the same reasons, there is hope.

During the pandemic, even as exhaustion set in, pharmacy shined. The public, government agencies such as HHS, CMS, the FTC and the FDA, as well as countless legislators saw us answer the call.

We were given authorities to serve patients regardless of state law, such as ordering and administering tests and ordering and administering vaccines, including vaccinations for patients ages 3 to 18. We were allowed to “test and treat.” For the first time, regardless of state borders, we can prescribe and administer monoclonal antibodies, and soon oral antivirals.

Our pharmacists have delivered. We are at the forefront in meeting patient needs. This selfless service has changed public and policy maker perceptions. This is a positive advancement in the midst of the burden and stress pharmacists and our support staff are experiencing on the front lines.

Although these authorities are temporary and limited to the pandemic, we have shown our value, and it will be hard to take away this access from the public. We have an opportunity in 2022 to do what we have been trying to do for decades. To finally be recognized as “eligible providers” in Medicare, Medicaid and commercial health plans so that we can bill for our services, rather than just for dispensing medications. This will create the long-term financial support to fundamentally change the way pharmacies and pharmacists are compensated, with incentive realignment that will de-emphasize speed and volume, and better emphasize service, patience and care.

We are not on the sidelines, and we are acting. APhA has created collaborations of stakeholders including national associations, pharmacy employers and wholesalers, pharmaceutical manufacturers, government agencies and legislators to advocate for change.

So, what are we focusing on in 2022?

  • Keep the authorities that we received in the PREP Act that allow us to conduct COVID testing, vaccinate all populations, administer antivirals, and optimize technology and technician roles.
  • Expand these authorities to include strep, influenza and RSV.
  • End egregious PBM abuses that continue to suffocate pharmacy resources and hold our profession back.
  • Become recognized as “eligible providers” in the Social Security Act (i.e., obtain federal provider status).
  • Promote the use of APhA’s well-being tools and services by individuals and organizations, and inviting employers to engage with us.

Although we answered the call by serving society, and we are widely recognized for our role in team-based care, the payment system for pharmacists is still broken.

Changing the reimbursement system is just one of the issues that must be addressed. The way you utilize, engage and recognize the value of your pharmacy teams must also change for the value of the greatest assets in your pharmacies — your pharmacists and their support staff — to be optimized.

Scott Knoer is the executive vice president, CEO of the American Pharmacists Association.


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