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The profession of pharmacy: A tale of two realities

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Pharmacists face opportunities and challenges going forward.

Editor’s note: This was part of CDR’s 2019 Pharmacy Outlook in the January 7 issue.

Today, pharmacists are facing a health care environment that presents both opportunities and challenges.

Tom Menighan

On one hand, there are opportunities as the health care system shifts to value-based payment and other health care providers increasingly recognize that utilization of pharmacists can help them meet the growing list of quality metrics and other payer requirements. Additionally, a greater number of pharmacists are partnering with physicians and other members of the health care team to better and more efficiently provide care to patients, offering services like medication management, chronic care management, Medicare annual wellness visits and transitional care management. While other health care practitioners are becoming accustomed to working with pharmacists, patients are reaping the benefits of pharmacist-provided patient care services, including increased access to care and improved outcomes.

Some of the advancements in pharmacists’ roles are being driven by health system efforts to meet patients’ and payers’ needs. Others, such as changes in laws, regulations and payment policies, are a result of the pharmacy profession’s advocacy efforts. Thanks to state pharmacy organizations and pharmacists throughout the country supplementing our national efforts, more states are authorizing the use of collaborative practice agreements, statewide protocols and standing orders to increase patient access to pharmacists’ services. Payers, including state Medicaid programs, are increasingly taking advantage of community pharmacists’ accessibility and relationships with patients to meet access-to-care needs and leverage pharmacists’ medication expertise.

These pharmacist-provided services and related changes are supported through the adoption of the Joint Commission of Pharmacy Practitioners’ Pharmacists’ Patient Care Process and interprofessional education that reshapes how individuals receive care from pharmacists. The American Pharmacists Association, too, has created tools and resources (e.g., Billing Primer: A Pharmacist’s Guide to Outpatient Fee-for-Service Billing; Questions to Consider when Expanding Pharmacy-based Patient Care Services; Leveraging the Appointment-Based Model to Expand Patient Care Services: Practice Guidance for Pharmacists) for pharmacists looking to transition towards new models of care delivery and coverage.

But there’s another reality pharmacists face amongst these positive changes.

Pharmacists are feeling growing pains

Pharmacists, like other health care practitioners, are experiencing challenges as they are expected to do more with less in a complex and pressure-filled work environment continuously undergoing policy, statutory and regulatory changes and reforms. All over the country, pharmacists tell me that their wages are falling, and support staff hours are being cut. The job market has become more competitive, and it’s not as easy to find full-time positions as it was for previous generations. Adding to the struggle, is many are burdened with student debt.

In some community pharmacy settings pharmacists are measured based on speed and volume of prescriptions filled, which adds pressure to meet goals that may not align with patient safety. There aren’t enough pharmacy technician hours allocated, and reimbursement for needed patient care services — especially in community pharmacies — is lacking. These constraints limit revenue streams, thus impeding service delivery and preventing pharmacists from fully using their skills and training. Consequently, pharmacists working in these environments can lose sight of why they entered the profession.

APhA is not OK with this situation and understands the need for change. We hear constantly that pharmacists want to focus on patients and practice using the full scope of their training.

We formally issued a public commitment statement that promotes well-being and resilience of all pharmacists, student pharmacists, pharmacy technicians and pharmaceutical scientists in all practice settings to preserve pharmacy’s efforts in optimizing health outcomes. APhA understands we need to collectively address several key factors related to the health system, practice site, coverage and personal needs to preserve the well-being and resiliency of pharmacists and pharmacy personnel. Achieving these goals will positively affect our profession and will allow pharmacists to provide better care to their patients. Resolution will not come solely from APhA — each and every pharmacist can join efforts in an area where you find engagement most fulfilling.

Balancing discouragement with action

APhA recognizes a major driver to achieving our desired future is the recognition of and coverage for our patient care services — provider status. APhA has been actively pursuing provider status and advocating for its importance for the last five years.

Our provider status efforts are multifaceted and focus on increasing patient access to and coverage of pharmacist-provided services at the federal, state and private sector levels. We appreciate the support and grassroots advocacy many of you have contributed for our federal legislation, which seeks coverage for pharmacists’ services under Medicare Part B. Despite Congress not passing our legislation, there have been countless other provider status-related successes occurring at the federal, state and private sector levels that have helped advance pharmacist-provided care across the country.

APhA is acutely aware that some of you may feel frustrated by the amount of resources APhA has devoted to provider status because you feel overwhelmed by current workload and question how you will have time to provide additional, more time-intensive services.

APhA believes attaining reimbursement for our services will create sustainable business models along with the dedicated time to provide the services we know can make a difference in our patients’ lives. The current lack of reimbursement often has pharmacists trying to provide services on top of their busy dispensing practices. Successful provider status efforts across all pharmacy practices will create new revenue streams and help better support dispensing activities, satisfy pharmacists’ passions to care for patients and help advance payer policies to more closely align with care models involving pharmacists.

Prioritizing pharmacist ­well-being

APhA recognizes provider status is not a complete solution. To improve conditions for pharmacists and pharmacy personnel, we also look to equip pharmacists and their staff with tools and skills needed to improve their well-being and professional satisfaction. Components include improving workflow, teaching coping skills, reducing barriers to care, and more effectively engaging with employers and other key decision makers regarding workplace expectations.

These efforts are underpinned by APhA policy that guides our organization, including 2018 policy supporting staffing models which prioritize patient safety and encourage the use of patient-centered quality measures over operational quotas or time-oriented metrics. APhA efforts include providing networking and mentoring opportunities and wellness-focused in-person education programming at the 2019 Annual Meeting. In addition, we are working to develop pharmacy technicians’ skill sets to fill emerging gaps as pharmacists’ time is devoted to providing more services and direct patient care.

Engaging with decision ­makers

As part of our efforts to address well-being, APhA has signed on as a Network Organization within the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience. According to NAM, clinician well-being improves patient-clinician relationships, a high-functioning care team, and an engaged and effective ­workforce.

APhA is also working to address onerous “administrivia” such as prior authorizations, the volume of DUR (drug utilization reviews) edits, and gag clauses — key sources of frustration for pharmacists. APhA was proud to be in the West Wing when President Trump signed two APhA-supported bills striking down so-called “gag clauses” in PBM contracts, which barred pharmacists from telling patients the cash price of their medications, even when the out-of-pocket cost was lower than their co-pay. Additionally, APhA is advocating to federal agencies and meeting with employers to discuss pharmacists’ workplace challenges and collaborating with other provider associations to reduce the administrative burdens associated with prior authorizations.

The big picture

APhA recognizes the opportunities and challenges facing pharmacists in today’s tumultuous health care system. We want you to know we fight every day to empower you in your role as a pharmacist in a professionally satisfying and rewarding work environment. I remain optimistic about pharmacy as a great career that advances patient care. We stand next to you to make sure your well-being is a priority and our patients and communities have access to pharmacists’ exemplary care.

Tom Menighan is the executive vice president, chief executive officer of the American Pharmacists Association.


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