Over the past 18 months, pharmacy has gone from one of the nation’s great hopes to one of the nation’s true heroes in the response to COVID-19.

Steven Anderson

At a March 2020 meeting, Centers for Disease Control and Prevention (CDC) officials told NACDS members they would be key to meeting Americans’ needs and urged them to do whatever it would take to stay open.

More recently, in June 2021, a senior Biden administration official told pharmacy industry personnel at a virtual meeting: “You answered the call; you always answer the call.”

These health and wellness destinations and their team members kept their lights on and doors open. Looking back, they are credited for relieving a stretched-thin health care delivery system; for ramping up COVID-19 testing; for helping to prevent a COVID-flu “twindemic”; and for vaccinating against COVID-19 — conveniently, efficiently and equitably.

The vaccines themselves are miraculous. The pharmacy teams deploying them — the faces of neighborhood health care — are trusted and tenacious.

Even as we celebrate the reopening of America that pharmacies are helping to bring about, it is worth reflecting and acting on five things that, for the good of all Americans, should not return to “normal.”

• Below-cost Pharmacy Reimbursement

It is time to ask the question: What if it were not the case that 90% of Americans live within five miles of a pharmacy? Pharmacies’ reach — expanded by their experience in going the extra mile in pop-up and mobile clinics — changed the complexion of the nation’s response to COVID-19.

Simply put, pharmacies are the sustainable vaccination solution. Participants in the Federal Retail Pharmacy Program provided about one-quarter of COVID-19 vaccine doses through mid-June. However, with many mass clinics closing around that time, the trendline increased to pharmacies providing half of all new doses.

Nonetheless, government policies and loopholes threaten pharmacies’ sustainability. It is outrageous that pharmacies ultimately are expected in many cases to sell prescription drugs below cost. The health care analytics company IQVIA estimates that the span from December 2017 to December 2020 saw a net closing of almost 2,200 pharmacies.

One example of the threats to pharmacies and the patients who rely on them is direct and indirect remuneration (DIR) fees. This is a complex situation that flows from a regulatory loophole in Medicare policy. These fees jeopardize pharmacies. They also jeopardize seniors by inflating their out-of-pocket prescription drug costs and by putting access to pharmacies at risk.

The situation is only getting worse. The federal Centers for Medicare and Medicaid Services (CMS) found that these fees exploded by 45,000% between 2010 and 2017. However, CMS this year found that DIR fees increased 91,500% between 2010 and 2019.

To address this, NACDS — along with pharmacy and patient-group allies — are advocating for federal legislation, the Pharmacy DIR Reform to Reduce Senior Drug Costs Act (S. 1909/H.R. 3554).

We also are proactively engaged as Congress considers other drug-pricing measures as part of larger legislative initiatives. It is imperative to ensure that any such legislation helps, and does not further disadvantage, the pharmacies relied upon by Americans in communities throughout the nation.

This work is under way at the state level, too, with many states now taking action to regulate some practices of pharmacy benefit managers that threaten pharmacies. A 2020 Supreme Court decision in a landmark case has paved the way for this crucial state action. NACDS engaged in the legal arena with a friend-of-the-court brief and remains highly engaged in state-government advocacy.

• Rolled-back Preparedness and Access

In addition to considering the ramifications of diminished pharmacy capacity, it also is critical to consider the effects of diminished pharmacy capabilities if government officials allow a roll-back of preparedness.

NACDS has focused intently over the past year and a half on advocating for changes in federal and state policies so pharmacies and pharmacy teams would be able to serve the public with COVID testing, with an array of vaccinations, and with other services.

As we look ahead to this coming flu season and to responding to any COVID variants, pharmacies have identified additional policy changes that are necessary to ensure pharmacy teams remain well equipped to meet the demands for crucial vaccinations. NACDS is advocating for that continued fine-tuning of policy.

In addition, NACDS and pharmacy allies are urging the federal and state governments to make permanent improvements to policies that empower pharmacy to serve Americans in times of emergency and beyond. We are urging the establishment of sound payment mechanisms; scope-of-practice enhancements for pharmacists; and enhanced and appropriate responsibilities for pharmacy technicians and pharmacy interns.

So far this year, NACDS’ work with state partners already has produced 55 pharmacy scope-of-practice victories — including instances in which more than one scope-of-practice expansion has been achieved in some states.

• Health Inequities and Disparities

Health inequities and disparities have been the focus of heightened attention throughout the COVID-19 pandemic due to the disproportionate effects of the virus on specific races, ethnicities and communities. NACDS is among the organizations that have been focused on these issues since well before the pandemic. We are committed to earning progress, rather than allowing these issues to revert to often-unspoken threats that jeopardize far too many of our neighbors.

Regarding COVID-19 vaccinations, the Biden administration notes that more than 40% of pharmacies in the Federal Retail Pharmacy Program serve in high-risk ZIP codes, and that pharmacies in the FRPP have conducted more than 8,000 pop-up vaccination clinics to help reach priority patient groups.

In addition, NACDS has worked in partnership with federal agencies and others for quite some time on the issues of health inequities and disparities and their ramifications for chronic disease and other threats. Studies have shown the importance of community-based solutions — including those available in pharmacies — for helping at-risk populations confront diabetes, HIV, opioid use disorder, mental health issues and more.

NACDS and the Johns Hopkins University Center for Health Security are releasing a new report about just how important it is to make meaningful change to address health inequities and disparities. That applies to preparedness to address public health issues like a global pandemic, as well as other issues that have a disproportionate effect on some in our country.

NACDS is eager to collaborate to keep these topics top of mind and the focus of meaningful action.

• Health Care Turf Battles

From emergency preparedness to chronic disease to health care inequities and disparities, our nation has many public health challenges to overcome. We cannot allow turf battles among health care professional organizations to stifle progress, and hopefully the sense of “we’re all in this together” will carry on after the pandemic.

The reality is that pharmacies are crucial to making a difference in communities nationwide. For example, an analysis of Medicare beneficiaries found that patients’ visits to pharmacies significantly outnumbered primary care encounters — 13 to seven — annually. The difference in rural areas — 14 to five — was even more pronounced.

Pharmacists and physicians collaborate vibrantly for the benefit of patients. That should continue to be fostered.

Unfortunately, some professional societies are more apt to take a “Doctor No” approach to any policies that would leverage the accessibility, trust, professionalism and education of pharmacists for the benefit of patients. We saw it again just a few weeks ago, when the American Medical Association took a shot at pharmacies and clinics through one of its policies. NACDS stood up to this attack — as we have in the past — and we will continue to do so.

The fact is that there are plenty of problems that need to be solved when it comes to health and wellness in America. There is plenty for all health care professionals to do, and we will benefit patients by doing our part and collaborating well.

• Criminal Attacks on Stores and Consumers

Recently, videos circulating online have shocked nearly everyone who has seen them — videos showing criminals brazenly and violently ripping off pharmacies and other stores. This is another tremendous risk to retailers of all formats and sizes that ultimately will harm the communities and individuals that rely on them.

A significant driver of organized retail crime is the proliferation of online marketplaces and the failure of some of them to do the due diligence necessary to prevent the sale of stolen goods, and also counterfeit goods. The Department of Homeland Security estimates the sale of fraudulent goods to be more than a $500 billion criminal enterprise.

NACDS is among those advocating for the Integrity, Notification and Fairness in Online Retail Marketplaces for Consumers (INFORM) Act to help crack down on this problem.

Crime issues stand to figure significantly in the political arena as we head into the 2022 midterm Congressional elections at the federal level, and also in upcoming state elections. Action on organized retail crime must be considered a priority to protect workers, customers, businesses and communities.

NACDS is proud to advocate for pharmacies — the face of neighborhood health care — and for the individuals and communities they serve. Together we can ensure that our nation emerges from the pandemic even stronger, and NACDS is committed to creating that reality.

Steve Anderson is president and chief executive officer of the National Association of Chain Drug Stores.