In the not-too-distant past community pharmacy was correctly perceived as a conservative business whose members were intent on operating within a well-defined set of parameters and not rocking the boat. A generation ago it wasn’t uncommon to hear members of the profession joke about what they did as “lick, stick and pour.” The industry as a whole was hesitant to assert itself with policy makers and payers.
Through the efforts of individual companies, perhaps most notably CVS Health, Walgreen Co. and Walmart; the National Association of Chain Drug Stores and other industry groups; and thousands of individual pharmacists, the profession today has not only adopted a proactive stance toward driving the expansion of pharmacy practice, with the attendant increase in its positive impact on patients’ well-being, but placed itself on the cutting edge of developments in the broader health care system.
Industry advocates have seized the opportunity created by the Affordable Care Act and the emergence of innovative business models in the private sector to highlight how community pharmacy can function as a catalyst for change.
The transformation of the industry over the past 25 years has been driven by trends that are currently affecting other health care providers. The importance of scale is a prime example. Many of the nation’s top pharmacy operators obtained the size needed to compete at the highest level through mergers and acquisitions. CVS, Rite Aid Corp. and Kroger Co., among others, benefited from that strategy.
The same tendency is now readily apparent in other health care sectors, including pharmaceuticals and biotechnology, hospitals and physicians groups, and it is still a big factor in pharmacy. The just finalized merger of Walgreens and Alliance Boots creates a global retail and drug distribution powerhouse, now known as Walgreens Boots Alliance, with a presence in more than 25 countries.
Technology is another area where community pharmacy has been out ahead of many other health care providers. Members of the profession have long relied on advanced systems to support their efforts in such areas as claims adjudication, prescription filling and patient safety. As the Virtual Technology Roundtable elsewhere in this issue shows, pharmacy operators, together with their supplier partners, are intent on building on that success by harnessing technology to extend their reach and augment already strong ties with patients.
The ongoing work of getting more physicians to adopt electronic prescribing is an indicator that other health care providers will have to play catch-up in terms of technology. All health care stakeholders, including retail pharmacy, must confront the bigger challenge of developing a standard for electronic medical records that can be shared by providers to improve treatment while at the same time protecting patient privacy.
Another major task facing the health care system as a whole is realizing the promise — in terms of both patient outcomes and cost savings — represented by accountable care organizations and other emerging models. In this new world compensation will be based on the quality of care, not the quantity of services rendered.
The shift bodes well for retail pharmacy, which for years has had to cope with relentless downward pressure on prescription drug margins. The move away from product-based reimbursement should alleviate the margin squeeze, even as it weaves community pharmacy more tightly into the fabric of health care delivery.
As these examples show, pharmacy is no longer a laggard when it comes to adapting to the interplay of forces in the marketplace and finding ways to improve access to health care, enhance patient outcomes and lower overall costs. Reform of the system will give members of the profession, which benefits from unmatched accessibility, the trust of patients and a growing roster of health care services delivered in the neighborhoods where people live and work, the chance to bring their medication expertise to bear in new and more meaningful ways.