The political landscape that retail pharmacy advocates will have to traverse has grown considerably more complex in recent weeks with the surprising victory of Republican Scott Brown in the race for the Senate seat that had been held by Edward Kennedy, the Massachusetts Democrat, for 47 years, and the Obama administration’s proposed budget, a document that projects huge deficits and presages a period of austerity.

The electoral contest between Brown, a state senator, and Massachusetts Attorney General Martha Coakley was seen, in part at least, as a referendum on the health care reform bills passed by the House and Senate. Brown’s upset win deprived the Democrats of a 60-vote, filibuster-proof majority in the Senate, sapping momentum from the drive toward reconciliation and enactment of the legislation.

The prospects for the measure, which contain provisions that would have a direct impact on community pharmacy, are now, at best, uncertain. If the large-scale health care reform package sought by President Obama and the Democrats falls short, the issues confronting pharmacy — the reimbursement model for the profession and implementation of medication therapy management programs, among others — will remain.

Rather than one potentially decisive battle, supporters of retail pharmacy are likely to face a protracted war consisting of numerous clashes at both the federal and state levels. With the chances for health care reform dimming in Washington, activity in the states has already intensified. Bills are now pending in 11 states.

Fights over funding, such as the ongoing dispute about Medicaid reimbursements in Washington state, will spread, especially in light of the president’s budget, which projects a federal deficit of $1.6 trillion, or 10.6% of GDP, for fiscal 2011.

Although the administration wants $25.5 billion to extend temporary federal assistance to the states for Medicaid for six more months, the bleak long-term deficit picture will result in new economic pressure on health care providers.

Some might argue that tackling issues one at a time and accomplishing health care reform by increments is a better approach. Perhaps it is. The upshot for pharmacy operators is that they will have to maintain the high level of engagement in public policy that they have exhibited for the past year and be ready to take action on multiple fronts over the long term.