Looking forward: Executives size up the state of retail pharmacy in 2022
The pandemic has brought seismic changes to the pharmacy industry. And the second year of the pandemic has brought new obstacles and uncertainties, adding to the challenges that already exist for pharmacy, including DIR fees, declining reimbursement and the requirement to quickly fill a higher volume of prescriptions.
Yet, despite these daunting challenges, the industry has been outperforming. As we bid adieu to a year that played havoc with expectations and look forward to the pandemic fading in the rearview mirror, the role of the pharmacist and pharmacies has never been more crucial.
DSN asked several pharmacy industry executives and those who provide products and services to pharmacies to weigh in on the state of the pharmacy business. Their answers illustrate that the glass is indeed half full.
Drug Store News: How would you describe the state of pharmacy?
Sandra Leal: There have been incredible flexibilities granted to pharmacists during the public health emergency that has created acute awareness of the vital role we play in equitable access for patient care. We are a key part of the public health infrastructure that needs to be supported to extend beyond the pandemic for the secondary crushing wave of deferred care, mental health needs and chronic conditions that will follow.
Steve Anderson: NACDS members and their teams — in traditional drug stores, supermarkets and mass retail — have proven themselves again throughout the pandemic as the face of neighborhood health care. They have stayed open; filled gaps in care; rolled out COVID testing; vaccinated against COVID, flu and other diseases; and leveraged and enhanced pharmacies’ ongoing focus on health equity.
Government reporting shows that, as of mid-July 2021, 92% of all COVID vaccines were getting to Americans’ arms through the Federal Retail Pharmacy Program. Pharmacies’ vaccinations through state programs take that percentage even higher. Pharmacies continue to lead the way with COVID boosters, expanding to pediatric COVID vaccinations and giving flu vaccinations and other shots.
Douglas Hoey: Policymakers and patients are increasingly turning to pharmacy teams as healthcare resources, whether for point-of-care testing services like SARS-CoV-2 diagnostic testing, blood glucose, influenza or rapid strep, or to receive immunizations like flu or COVID-19. With around 200 million doses of the COVID-19 vaccines having been administered and reported by pharmacies in the Federal Retail Pharmacy Program (in addition to the millions of additional doses administered by pharmacy teams through state distributions), pharmacy teams have proven to be an effective, dominant force.
Jenny Bryant: Like many parts of our healthcare system, pharmacists are experiencing unrelenting pressure in the face of this pandemic. Yet they remain on the front lines, providing heroic service as we battle COVID-19 by operating both testing and vaccination sites.
Given their unique position in communities, pharmacists are often acutely aware of the struggles patients can experience. For example, many pharmacists know what it’s like to have patients show up at the pharmacy counter and find they are either unable to afford their medicine or face access restrictions on the treatments their doctors prescribe.
Reforms are needed to ensure that patients benefit directly from the rebates, discounts and other payments negotiated on their behalf.
Mike McBride: Pharmacists are figuring out many ways to make money beyond dispensing medications. They’re now focused on how they can make money on dispensing care, which will depend a lot on technology that allows not only connection but also coordination for patients. Pharmacists and other healthcare professionals are figuring out the complexities of technology, so they can bring simplicity to health care for their patients. Health care itself isn’t getting simpler, but I think it can be presented as simpler.
Clay Courville: Pharmacies continue to experience market pressure from lingering pandemic recovery. Pharmacies are also facing increasing pressures to respond to evolving patient expectations about quality, cost and convenience. This has contributed to growth in digital pharmacies as well as mail order and home delivery services.
Eyad Farah: The challenges of managing a pharmacy over the past two years have been significant. Pharmacists continue to manage their business operations despite labor shortages and front-line worker burnout. In addition to these demands, they are meeting the needs of their patients in new ways through COVID-19 testing and vaccines.
Debbie Weitzman: Pharmacies need to navigate the shortage of front-end staff and skilled pharmacy technicians with tools and services that help meet the patient demand for clinical services in the most time-efficient and cost-effective manner possible while maintaining quality service.
Advocacy for provider status legislation under Medicare Part B remains a top priority to ensure Medicare beneficiaries can access critical point-of-care services from their community pharmacist.
Danny Sanchez: Because of COVID-19, retail pharmacy is now expanding as a new epicenter of health care. We believe the recent pharmacy industry trends will continue strongly in 2022 and beyond. A major factor fueling these shifts is the other historic trend that has been transforming both the practice and business of pharmacy — digitization.
Ken Whittemore Jr.: In my 40-plus years in the pharmacy profession, the opportunities that have been presented in the last 18 months are unparalleled. The increased professional demands of COVID-19 have spotlighted areas where technology can help create a more streamlined and efficient workflow while also improving patient care.
Amy Baxter: The past year saw slower retail prescription growth due to a lag in patients seeing clinicians for routine wellness and delayed elective surgeries. By providing vaccinations and point-of-care testing, pharmacies are drawing consumers/patients into stores.
DSN: How would you describe challenges for pharmacies and pharmacists?
Sandra Leal: Historically, the public health infrastructure has been woefully underinvested. Pharmacists too, as part of this infrastructure, have not received the level of support and recognition to sustain clinical practice models in a way to allow for them to expand and create more reach. It is time for this to change.
Steve Anderson: A key takeaway is that, if pharmacies had not been successful in urging public policy that is critical for pharmacies’ operational efficiencies, today’s challenges amid a lingering global pandemic would be even more daunting. With virtually all industries confronting employee shortages, and particularly challenging environments throughout all healthcare settings, government actions urged and secured throughout the pandemic are proving essential. These include enhanced roles for pharmacy technicians and interns, the ability to put patients over paperwork, opportunities to leverage technology and more. Pharmacy flexibilities and authorities put into place during the pandemic should not be rolled back but rather expanded.
Douglas Hoey: The growing market trend for pharmacist-led offerings will help support NCPA’s aim of changing the pharmacy payment model to a system that includes fair payment for the drugs we dispense and recognition for pharmacists’ contributions to better health care. It also would result in simplicity for consumers, who are currently forced to navigate the complex, convoluted covert payment model to get their prescriptions and access care.
Jenny Bryant: Growing consolidation in health care has increased the market power of a few insurers and PBMs, often at the expense of patients and front-line providers. Restrictive pharmacy networks and the closing of local neighborhood pharmacies can result in patients losing access to the longstanding relationships built with a pharmacist they trust. This growing emergence of “pharmacy deserts,” particularly among communities of color, can exacerbate healthcare disparities and create access challenges for patients.
Mike McBride: Many pharmacists are exhausted from “running hard and fast” since COVID hit almost two years ago. And new hires are hard to find, due to the state of the U.S. labor market that’s affecting almost every industry. But besides staffing shortages, there also are bound to be shortages of certain generic drugs, as pricing gets compressed to the point where companies opt to stop making certain unprofitable products. Pharmacists are going to be on the front lines of solving this challenge.
Clay Courville: According to the 2022 Medication Access Report, 77% of pharmacists now regularly give immunizations, 37% have newly taken on helping patients find affordable options, 42% now perform patient follow-up calls and 44% are managing a prescription home delivery program. Increased workloads due to patient care duties, extended hours during the pandemic and inadequate staffing have contributed to a surge in pharmacist burnout.
Eyad Farah: Yet one of the biggest challenges to pharmacists today is being fairly reimbursed for the quality care they provide patients. As pharmacists routinely counsel patients on medication and health issues, new payment structures are needed to support pharmacists’ role as healthcare providers, allowing them to receive consistent reimbursement for disease state management, medication optimization and other valuable preventive services.
Debbie Weitzman: Patients value the personalized, high-touch care from their community pharmacist but also want the convenience of on-demand services. Cardinal Health is developing innovative solutions that provide pharmacies the ability to outsource costly and time-consuming compliance packaging prescription fulfillment, expand digital services to provide online shopping for over-the-counter products and utilize digital workflow tools for the scheduling of point-of-care appointments.
Danny Sanchez: Powerful digital technologies that automate everything, from patient engagement and clinical operations to financial management and population health programs, are empowering pharmacies to thrive and grow amidst these new healthcare challenges and opportunities.
Other challenges on the horizon include expanding provider status for pharmacists and streamlining pharmacy workflows. Pharmacies can only meet today’s growing healthcare challenges if they have the right technology. An example of that is EnlivenHealth’s new Personalized IVR solution.
Ken Whittemore Jr.: Patient needs will always continue to evolve, as will the number of questions and demands that are directed at pharmacists and pharmacies. This will especially be the case during a health crisis like COVID-19, but it can be expected during calmer times as well. These growing administrative burdens often detract from pharmacists’ expanding role as care team members.
Cecelia Byers: Inefficiencies in the specialty prescribing and fulfillment process can spread administrative and financial burden throughout the patient’s care system and increase the risk of patient nonadherence. But technology exists today that can help simplify the process and help get patients started on much-needed medication faster.
Amy Baxter: Supply chain constraints and increasing costs will challenge operational efforts to keep shelves stocked while controlling margins. Attracting new employees and retaining talent will be a priority to ensure continuity of service and care from the register on through to prescription fulfillment.
DSN: How would you describe your expectations for the industry in the future?
Sandra Leal: We need to create the future we want to see. I personally see a bright future for pharmacy because of our evolving roles and our impact on patient care. I hope that one of the silver linings of this very dark time is that everyone had an opportunity to see exactly how pharmacy unequivocally contributed.
Steve Anderson: Government leadership is sorely needed to ensure pharmacies can continue to be there for Americans in times of need from family emergencies to global pandemics. Much has been made of the statement: “There is a pharmacy within 5 miles of 90% of Americans.” However, unworkable and unsustainable pharmacy reimbursement models, which jeopardize pharmacies of all sizes and formats, risk the public health assets that came through when the nation needed them most.
Even as the industry advocates for the public policy that is needed for pharmacies’ viability and to leverage their full value for all Americans, the industry continues to innovate.
Douglas Hoey: The CPESN USA clinically integrated network of pharmacies is a solution and in many ways is the future of pharmacy. It improves quality, lowers costs and can negotiate pharmacy provider services with payers, as opposed to the middlemen who continue to make things difficult for independent pharmacies and patients alike.
Among our priorities has been ending retroactive pharmacy DIR fees. With a recent rule proposed by the Centers for Medicare and Medicaid Services, we’re closer than ever to accomplishing that goal.
There’s a lot to do to ensure the best possible rule is finalized for plan year 2023. We will be working with our partners, members and champions in Congress toward that end, and to continue changing the pharmacy payment model.
Jenny Bryant: As treatments for COVID shift from hospital administration to more accessible retail options, many patients will have the convenience of going to their local pharmacy to pick up their prescriptions. Pharmacies will continue to play a significant role in helping to end this pandemic by providing the first line of treatment against the disease.
Mike McBride: Technology, again, will be key. Pharmacists are finding new ways to monetize the dispensing of care.
In general, the future will be bright for those who are willing to innovate and collaborate well with others. But overall, pharmacists will continue to benefit from their unique, historic relationship with patients.
Clay Courville: Pharmacists have proven their value as a member of the patient care team, especially while delivering critical front-line care throughout the pandemic. As pharmacists continue a path to practice at the top of their license, optimizing operations and reimbursements are paramount.
Pharmacy automation can help simplify virtually every task that doesn’t involve direct contact with a patient — including prescription intake and dispense.
Eyad Farah: Fortunately, the industry is moving more and more to value-based reimbursement and we are at a stage where community pharmacy must prepare for value-based care. We need to focus on demonstrating the impact pharmacies have on patient outcomes and reducing total cost of care.
Debbie Weitzman: We see patients connecting with their pharmacist seamlessly in the pharmacy aisle, in their home or travel destination via a simple scan of a QR code from their mobile device, with the patient receiving a consistent experience from their most trusted healthcare provider regardless of location.
Danny Sanchez: Pharmacies now have an unprecedented opportunity to move to the Main Street of health care. This new era of pharmacy will be an essential player in advancing the necessary transformation of healthcare access, quality outcomes and affordability.
Ken Whittemore Jr.: In 2022, I expect to see greater adoption of new health information technology tools that allow pharmacists to remain focused on being caregivers.
Cecelia Byers: The future of specialty prescribing and fulfillment is here, thanks to the help of advanced technology. In 2022, we’ll see greater adoption of solutions simplifying the inherently complex process of these promising and pricey medications.
Amy Baxter: As automated prescription filling processes free up pharmacist bandwidth, opportunities will emerge to expand patient care services, for patient monitoring, vaccinations/immunizations, chronic disease management and patient education.