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Pharmacy Outlook: Susan Cantrell, AMCP

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Susan Cantrell

2020 has been defined by unparalleled tragedy. The global pandemic has magnified and amplified the weaknesses and failures of our current health care system, delivering a clear mandate that the health care industry must improve and expand care for the American people. As we look to 2021 and navigate a health care landscape that has never demanded — or threatened — more, I also see unprecedented opportunity for innovation and real change to improve patient outcomes. I look to the role of pharmacists to build a better health care system in the year ahead.

COVID-19 has taken more than 300,000 American lives, but we are finally seeing what could be a turning point. As we see promising progress on vaccination development, hurdles with manufacturing and distribution still threaten our ability to immunize the population quickly. Fortunately, an untapped resource already exists for distribution — frontline pharmacists are trusted and trained, and the infrastructure of existing pharmacies provides a network of locations around the country.

Pharmacists are already trained in vaccinations and are readily accessible — whether that’s in a local clinic, corner-store pharmacy, a rural pharmacy or your local retail drug store. As we look to 2021, we should utilize existing infrastructure and take advantage of pharmacists around the country, making the process less expensive and more timely. Pharmacists are also familiar with state demographics, guidelines and laws — meaning they are more equipped to understand the patients they will be vaccinating. Congress and the administration can authorize pharmacists to receive reimbursement under Medicare Part B for COVID-19 testing and vaccinations. Congress can include this provision in the next round of COVID-19 relief legislation to authorize this reimbursement, and the administration, under the Department of Health and Human Services’ Centers for Medicare and Medicaid Services, would release guidance for the methodology of reimbursement — easing the logistical challenges ahead of mass distribution of a vaccine. HHS is making progress on this front, which ultimately facilitates more efficient vaccinations.

Utilizing pharmacists who are already known in their communities also lends itself to peace of mind for the patient — a process that feels similar to a known norm, like an annual flu shot, inherently eases stress on the patient during an already challenging time.

As we see progress with a number of vaccines, it’s critical we maintain conversations around prioritizing the communities hit hardest, and provide immunizations accordingly. It’s critical we vaccinate our first responders and essential workers, and take care of who is at most risk. The data are clear: Black and brown communities have disproportionately been ravaged by this virus. The Washington Post did a recent analysis, and the results were alarming — “Black, Asian, Native American and Hispanic patients still die far more frequently than white patients, even as death rates have plummeted for all races and age groups.”

We have long recognized that many communities of color lack equitable access to health care and medications; COVID-19 has magnified long-standing and devastating gaps in care. This knowledge furthers an imperative to prioritize these communities — once the vaccines are available, we have a moral mandate to ensure equitable distribution and prioritize those being hit the hardest first.

This mandate extends farther than a vaccine. As we reflect on the pandemic and shift our health care system accordingly, we have the opportunity to intentionally center the communities that have historically had the least access over the next year and beyond, and work to close the disparities that have long existed in our health care system.

The same data that reflect racial disparities can also help maximize care. By understanding how patient outcomes vary under different treatments and medications, the medical community can make progress in understanding best therapies. Elected officials must prioritize passing a legislative safe harbor that allows pharmaceutical manufacturers to proactively share clinical and economic information on medications in the FDA pipeline with payers and other population health decision makers. There is a growing consensus recognizing the need — allowing this pharmaceutical information exchange has an ultimate goal of getting patients the medications they need at costs they can afford.

A welcome health care trend for the upcoming year is the continuing realignment of care from volume-based to value-based. For decades, we have operated under a fee-for-service model, charging by doctor’s visits, filled prescriptions and per procedure. In shifting to a value-based care model, which rewards the use of medications and treatments that lead to better patient outcomes, providers are able to better serve patients holistically and preventatively while increasing affordability. Harnessing and analyzing health data to demonstrate outcomes and comparative effectiveness relative to other medicines optimizes patient outcomes, avoids expensive unnecessary prescriptions, helps reduce costs to our health care system and promotes use of the right medicine at the right time.​

Another defining feature of managed care pharmacy in 2021 will be the utilization of biosimilars, which have grown significantly in the last couple years and will account for further market share next year. An IQVIA analysis highlighted that biosimilars becoming more common in our pharmacies are projected to lead to more than $100 billion in savings over the next five years, meaning more patients are able to access medications they need at an affordable cost. Biosimilars promise more access and less expensive care for patients. That’s why the Academy of Managed Care Pharmacy created the Biologics and Biosimilars Collective Intelligence Consortium in 2015 — to evaluate the safety and effectiveness of biologics, including biosimilars, and provide the assurance needed to determine which medications deliver the best health outcomes. We’re working to ensure the promise of biosimilars becomes a reality for patients. AMCP is working to share best practices, including with our Partnership Forum last month, bringing together payers, pharmacists, integrated delivery system leaders, health economists and analysts, academicians, patient care providers, pharmaceutical manufacturers, and other key decision makers.

During this AMCP Partnership Forum, we discussed the policy, practice and post-marketing surveillance activities that support treatment and coverage decisions for biosimilars. We also analyzed the barriers to biosimilar adoption, including gaps in provider knowledge and the need to generate more real-world evidence to inform treatment and coverage decisions. Stay tuned for proceedings documenting findings and recommendations from the Partnership Forum in the Journal of Managed Care + Specialty Pharmacy.

Throughout 2021, we will also see more competition in pharmacy delivery. Amazon recently announced Amazon Pharmacy — a mail-order service and the clearest competitor to local pharmacies in a long time. The pandemic pushed many pharmacies to quickly scale their mail delivery. Before the pandemic, around 5% of prescriptions filled in the U.S. were through mail order channels. But a recent consumer survey conducted by AMCP and the Alliance of Community Health Plans found that nearly a quarter (24%) of respondents shared that they depend on the mail for their medicines during the pandemic. For the millions of Americans who rely on mail-order medications, Amazon Pharmacy could offer competition to current providers.

Due to the pandemic and a number of smart innovations, we are on the cusp of significant shifts in pharmaceutical issues and trends, and the next year promises unique challenges and successes. We look forward to continuing our work — we’ll push the new administration and Congress to lower drug costs for American families. As we plan for the future, pharmaceutical executives ==and providers alike need to be more patient centered in order to succeed — what are the best new practices to ensure that most patients can access the medications they need at an affordable cost? On behalf of AMCP and our members, I look forward to working with you to find out.

Susan Cantrell is the  CEO at the Academy of Managed Care Pharmacy.


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