Rx’s voice must now be ‘louder than ever’

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Amidst the vicissitudes that have buffeted President Biden’s Build Back Better agenda, one constant has been widespread support for provisions that address health care. In the latest iteration of the bill, hammered out by Senate Majority Leader Chuck Schumer of New York and Sen. Joe Machin of West Virginia, both Democrats, the legislation would extend insurance subsidies under the Affordable Care Act for three years and, for the first time, allow Medicare to negotiate prescription drug prices.

Congress’ focus on health care, coupled with the pivotal role that pharmacy has played in the war against COVID, makes this a propitious moment for members of the profession to assert themselves. Nimesh Jhaveri, who began his career as an independent pharmacist, spent almost three decades at Walgreens, and is now president of community pharmacy and health at McKesson, understands the imperative to act.

“It’s up to us at the end of the day if we want to maintain the momentum that we’ve developed during the pandemic,” he says. “There is a lot of legislative activity, whether it’s on the DIR or the scope of practice front. It’s incumbent on us as pharmacists, independents and large companies to push this. We need to speak with one voice, and that voice needs to be heard louder than ever right now.

“In the past, the challenge has always been to convince legislators of the value that pharmacy provides. During the COVID-19 pandemic, when millions of tests and two out of three COVID-19 vaccines were given at a pharmacy, we have shown that the value is there. Now, with FDA approving the prescribing — with some caveats — of antivirals, we have to continue to do everything we can to convince legislators and regulators to let us expand our scope, expand the services we offer and expand our ability to deliver care to patients.”

Jhaveri is energized by recent wins at the state level, citing Georgia’s move to increase Medicaid dispensing fees and California’s agreement to forgive $142 million in clawbacks it sought from independent drug stores under Medi-Cal. He says that more such victories are needed at both the state and federal levels if pharmacy is to realize its full potential.

“Today, the primary engine of pharmacy is dispensing, but that may not be the case in the future,” notes Jhaveri. “It is going to be testing, treating, vaccinations, doing lab work.

“One thing I love about this new prescriptive authority is that it stipulates that patients present their health records for the pharmacist to review so that they can make sure the patient is eligible and actually need this medication. Now the pharmacist is doing true clinical work.

“That is a good indication of where the profession is headed — pharmacists playing a very large role in actually managing health care. The dispensing of medication is just one of the services they provide.”

To win the future, Jhaveri says McKesson (“you can’t ask anybody else to do something if you’re not leading by example”) and other pharmacy advocates must build support among consumers as well as government officials, payers and other health care providers.

“We need to do a better job of educating people about what pharmacists can do,” he says. “Those that have used a pharmacist know it. I hate to go back to the COVID-19 pandemic, but it forced almost everyone — from 15-year-olds to 85-year-olds — to see what a pharmacist does and what a pharmacy is. We’re already starting to see a shift in perception, but as we move into more health care services, as we move further into vaccinations and testing and treating, and things of that nature, we’ll need to inform and educate.

“The analogy that I’ll make is how the nursing profession has continued to evolve. If we were sitting here 10 years ago talking about a nurse practitioner doing primary care, we’d say, “Really?” Today that’s normal. But they’ve educated the public, they’ve put their message out there. That’s what community pharmacy has to do.”

As Congress considers Build Back Better, or, as the bill has been rechristened by Democrats, the Inflation Reduction Act of 2022, it is essential that members of the pharmacy profession mount a concerted effort to attach amendments to the legislation — or move separate bills in tandem with it — that would make the authorities granted under the PREP Act permanent and secure meaningful financial relief from DIR fees. Enactment of the measures would do much to move pharmacy closer to the future envisioned by Jhaveri.


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