Lupin 2023

Pharmacy Outlook: Tom Menighan, APhA

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The year 2020 will be a tumultuous one, within health care and everywhere else. We’re a deeply divided nation, and the upcoming elections mean that things will likely get more difficult before they get easier.

Tom Menighan

How the election affects pharmacy is still a major question mark — we get mixed signals across both sides of the aisle. What’s certain is a brutal campaign for the presidency. Clearly, high drug prices are a political target for both parties, and while there are plenty of federal legislative proposals, many are too partisan to get real traction. Unfortunately for pharmacists and their patients, despite bipartisan support for improving transparency around pharmacy benefit manager practices, the major legislative packages to address drug pricing have not included a key aspect of direct and indirect remuneration (DIR) fee reform. Still, we continue to stand united with our colleague organizations to drive for relief.

There are signs that the Centers for Medicare and Medicaid Services (CMS) and White House share our concerns about abusive PBM practices. Yet, we get conflicting messages, so we continue to seek clarity and support.

Pharmacists in the rough

Many pharmacies are struggling to stay open, particularly those that serve a disproportionate population of low-income, uninsured, and Medicare and Medicaid patients. These are precisely the patients who need pharmacists’ services the most. Increasingly, we’re seeing reports of pharmacy deserts developing as a result.

At the same time, the profession is facing a crisis of spirit. Pharmacists are losing their jobs and being forced to cope with administrivia, unending metrics and competing demands on their time. As a profession, we have worked so hard to advance practice through new services like immunizations and medication therapy management, but many pharmacists’ work life has only become more difficult. We’re burning out at an alarming rate, and patients pay the greatest price.

The American Pharmacists Association’s advocacy focus remains on provider status, and we’re investing significant energy and resources on pharmacist well-being. But we’re also looking upstream at warped payment models that force many pharmacies to close and impede pharmacists from giving their all to patients. This isn’t sustainable.

No one entity can handle this alone. We need engaged pharmacists, empowered pharmacy technicians, responsive professional associations, lawmaker advocates, open-to-change employers, active student pharmacists, and willing schools and colleges of pharmacy. I remain bullish on our future. The key is to keep showing up, saying yes to risks and opportunities, fearlessly facing rejection, and staying connected with your peers.

The heart of the problem

Well-being has become a priority for the pharmacy profession, but unsustainable reimbursement rates, lack of coverage for pharmacists’ patient care services, and PBM practices that pull precious resources away from patient care and into the “middle” administrative money pit are at the heart of the problem.

That’s a sentiment that was shared by the Illinois Pharmaceutical Task Force, which in October issued recommendations to improve patient safety in the wake of a disturbing 2016 Chicago Tribune story. The story found that 52% of the local pharmacies reporters visited failed to warn patients about potentially dangerous drug-drug interactions.

The task force wrote that mandatory breaks, whistleblower status and adequate time to spend with patients are important, but they will not resolve the existential problems caused by “insufficient reimbursement and virtually nonexistent remuneration.” These obstacles prevent full utilization of pharmacists’ expertise. “Fixing these other parts of pharmacy practice without altering current practices in payment will not solve the problems that drive risks to medication therapy in our patients,” the report states. “Without addressing the payment model for pharmacists, we continue to fail to take advantage of the significant contributions of highly trained health care professionals whose specific expertise is exactly what our system needs.”

We agree: APhA’s government affairs team continues to work closely with our pharmacy allies, including members of Congress and their staff, to raise awareness of the dramatic consequences of letting this untenable system continue ­unchecked.

We know that a healthy, functioning health care system will make full use of pharmacists — as members of the comprehensive health care team, medication experts, chronic disease managers, immunizers, and a critical source of information and guidance for patients. In such a system, patient utilization of pharmacists’ services will be commonplace, and viewed like care from other health care providers. I’m hopeful that this is our future and APhA members are ready to lead.

Well-being and resilience

APhA is also prioritizing individuals’ personal capacity to build resilience.

APhA launched the Well-being Index for Pharmacists (WBI) in July. The WBI is a validated screening tool developed by the Mayo Clinic to evaluate fatigue, depression, burnout, anxiety, and both mental and physical quality of life. This survey, customized for pharmacists, takes moments to complete and is totally anonymous.

Those who take the survey receive immediate individualized feedback on how their well-being stacks up to that of their peers and whether they could be at risk for negative consequences at work or home. The survey is available to all pharmacists — there’s no need to be an APhA member to take the WBI.

The survey allows participants to track their results over time. Survey takers are connected to tools and resources that address individual well-being. Participants’ anonymous results will be aggregated, analyzed and shared. The insights gleaned from survey results also guide APhA’s well-being initiative by providing objective data on pharmacists’ mental and physical state.

Research has shown that managers and administrators are particularly vulnerable to stress and burnout. Take the survey to find resources to help you cope, but also take it because this is one way to send a message that pharmacists are not alone.

Stress and burnout — no matter their source — affect pharmacists’ ability to do their job well. The WBI doesn’t just provide tools to build resilience and develop emotional intelligence, it also gives us the evidence we need to address the larger issues facing the profession and make our case to the people and entities we need on our side.

National consensus conference on pharmacists’ ­well-being

In July, APhA — in partnership with American Association of Colleges of Pharmacy, the Accreditation Council for Pharmacist Education, the National Association of Boards of Pharmacy and the National Alliance of State Pharmacy Associations — convened Enhancing Well-Being and Resilience Among the Pharmacist Workforce, a national consensus conference. This conference marked the beginning of candid conversations about opportunities for growth and improvement. The full spectrum of pharmacy stakeholders participated, including chain and independent pharmacist employers, frontline pharmacists, schools and colleges of pharmacy, state boards of pharmacy, and pharmacy ­organizations.

Conference attendees developed 50 recommendations for tackling both our specific and systemic obstacles. The recommendations were organized into seven categories, including data, information and research on pharmacist well-being, as well as well-being education and training. We’ve also included pharmacists’ work conditions and patient safety, payment models, and relations among pharmacists and employers. All of these are given equal weight, and that reflects the reality that it’s going to take progress on many fronts to fully ease the pain pharmacists are feeling. The APhA board of trustees has convened a task force to doggedly pursue ­solutions.

Yes, we’ve got problems. And opportunities.

We’re under siege by payers who seek to move every penny possible from patient care to their shareholders in the name of lower costs, yet it’s the consumers — our patients — who suffer. Yes, we will continue to oppose these practices. And there’s a good chance we’ll ­succeed.

Meanwhile, we must continue to pursue new opportunities emerging as our population ages, medication therapy becomes more complex, and the outcomes of mediation use are measured. Pharmacists are in the best position of all to ensure effective medication use. We own this body of knowledge and the keys to success.

The world is changing, and that rate of change will accelerate. To paraphrase the Gettysburg Address, it is for us the pharmacists who care to be dedicated to the unfinished work which they who fought before us have so nobly advanced. We remain committed to the great task remaining before us — to secure coverage for our services to benefit our patients.


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