What’s in store: Pharmacy execs size up the industry in the wake of 2020

Steve Anderson, president and CEO, National Association of Chain Drug Stores 
This year stands as perhaps the most vivid example yet of the professionalism, dedication, trust and accessibility of the teams that comprise NACDS chain member companies, and that together creates one of this nation’s truly essential industries. This year also is a testament to the supplier partners whose products and services have been relied upon by Americans and by NACDS chain members alike. 

This story drives it all home, in my view. On March 13, NACDS hosted an important conference call with NACDS members and the Centers for Disease Control and Prevention to confront the emergence of COVID-19. We now have had a total of seven of these calls — and many, many other government interactions on pretty much a daily basis. On March 13, the CDC urged NACDS chain members to do whatever they needed to do to stay open; to keep customers and staff safe so they can stay open; and to stay in close contact with community leaders so everyone could learn from each other about how best to meet the public’s needs. Since that time, NACDS members have served their communities — lights on, doors open. The federal and state governments have turned to pharmacies, pharmacists and pharmacy teams for COVID-19 testing, for expanded childhood vaccinations, to prepare for the administration of safe and effective COVID-19 vaccinations when available, and to perform an array of health-and-wellness services needed to help prevent the overwhelming of the healthcare delivery system. With every formal decision by the U.S. Department of Health and Human Services and by state authorities, pharmacy has been empowered to serve patients, communities and the nation at a critical time, and pharmacy has proven to be prepared and determined.

We continue to see challenges, though in the complexities and contradictions of public policy. The work of identifying and removing federal and state barriers continues to this day, so pharmacy can fully meet the needs of the American people at this critical time. We continue to point out the ways that government needs to act to help pharmacies staff wisely and safely, to conduct their operations efficiently, to help patients stay on their medications, to offer expanded options for delivery of medications and consumer products, to put patient care over paperwork, and to ensure that pharmacy reimbursement sustains and does not threaten further patient’s critical access to pharmacies and pharmacists. 

This year also showed, yet again, the need to take seriously the disparities in health care and the social determinants of health that disadvantage some races and ethnic groups more than others. We certainly see that with COVID-19, as we have seen it previously with chronic disease. Pharmacy has demonstrated the ability to help build trust and bridge the divide of health care in this nation, and pharmacy will continue to do so as we help all Americans defeat this insidious virus together. That will be particularly important as we ultimately administer safe and effective COVID-19 vaccinations when they are available.

More and more decision-makers in government are recognizing the amazing preparedness of pharmacies; the heroism, education and training of pharmacists and pharmacy teams; the power that comes from having a pharmacy within 5 miles of 90% of Americans; and the proof points, such as the CDC’s finding that our nation can vaccinate 80% of Americans seven weeks sooner when pharmacies are part of the model.

Pharmacy is standing united to help patients, communities and the nation at this critical time.

Michael Hogue, president, American Pharmacists Association
Pharmacy as a profession experienced some very bright spots in 2020, with practice expansion in nearly every state allowed for by executive order or legislative action. This was further bolstered by executive orders from HHS Secretary Azar, who overrode state practice authorities to even further expand pharmacist authority to prescribe and administer vaccines across the lifespan and COVID-19 tests. The profession has stepped up strongly and shown consumers and regulators alike that pharmacists in local communities are essential, indispensable partners in health care.

While the opportunities have been bright, there have also been continued downward pressures on pharmacists across the healthcare system. In community pharmacy practice, PBMs further restricted their contract networks, often to pharmacies owned or financially affiliated with the PBM. The assessment of DIR fees ramped up further as well. The result is that the pandemic saw further acceleration of closures of community pharmacy, both independent and chain drug store, across the United States. This consolidation has led to a further tightening employment landscape for pharmacists in the community sector. There were decreases in staffing for community pharmacies resultant from these economic pressures, leading to increases in stress and burnout among pharmacists. Additionally, hospital pharmacy has not been untouched by the changes. As COVID-19 hit, hospitals were asked to shutter all operations outside of pandemic response. In parts of the country where COVID-19 did not surge as quickly, this resulted in many pharmacists and pharmacy technicians being furloughed or placed on significantly reduced hours. Only towards the end of the year has the hospital sector begun to rebound as more comprehensive care services have reopened. 

As we prepare to enter 2021, there is optimism that the gains pharmacy made during 2020 in terms of scope of practice authority and demonstrating value to the healthcare system will be made permanent.  Further, we are hopeful that the shining light of pharmacists during the pandemic will remove any remaining objections of congressional leaders to granting provider status for pharmacists as part of the Social Security Act. Clearing the way for consumers to have full access to pharmacist services under Medicare and Medicaid programs is essential, and the pharmacy profession needs to hold the new administration and Congress accountable to do the right thing in health care by passing the provider status legislation. 

Doug Hoey, CEO, National Community Pharmacists Association 
As terrible and challenging as the coronavirus pandemic has been, it also re-emphasized the importance of community pharmacists, accelerating opportunities for pharmacy to demonstrate value and define itself. Community pharmacies are essential businesses that stayed open when other healthcare providers were forced to shut down. Pharmacists and their pharmacy teams provided essential care on the front lines when their communities needed them most. NCPA has been working very hard with outreach to government officials and industry partners to make it known that most independent pharmacists are eager and willing to administer COVID-19 vaccines when they come out, and we’re being heard. Pharmacists are being included in early rollout plans and have been granted authority to order and administer COVID-19 tests and vaccinations. These are major advancements in just a few months that normally would take years and, as a result, community pharmacy is in a position to be recognized for the value it provides, in addition to (not instead of) dispensing services.

A highlight is October’s Supreme Court hearing of the Rutledge versus PCMA case, which was a long time coming. Not only because the pandemic delayed its original April hearing date, but for PBMs to finally have light shone on them from the highest court in the land. I was glad to hear Chief Justice John Roberts describe PBM drug pricing procedures, calling them “byzantine” — a word I’ve used hundreds of times to describe their overly complex payment system. Changing this pharmacy payment model drives NCPA’s efforts. We don’t know how the Supreme Court will rule, but we do know that the ruling will provide clarity and less ambiguity for PBMs to hide behind.

Stephen Ubl, president and CEO, Pharmaceutical Research and Manufacturers of America
Throughout 2020, as pharmacists and pharmacy techs joined other front-line healthcare workers to provide care to patients, the biopharmaceutical industry worked around the clock to research and develop safe and effective vaccines and treatments for COVID-19.

In a few short months following the first sequence of the virus, we began conducting clinical trials that meet the highest scientific and ethical standards, and include tens of thousands of participants. And recently, we’ve started to see the fruits of these labors; the U.S. Food and Drug Administration has already approved the first antiviral treatment for COVID-19 and granted emergency use authorization of an antibody treatment. Further, several vaccine developers have reported positive interim results from their ongoing Phase 3 clinical trials.

But while beating COVID-19 is one of our industry’s top priorities, we also continue working to help patients access their medicines. In response to the pandemic, many biopharmaceutical companies have expanded their assistance programs to help more people. And PhRMA has made it easier for patients who are struggling to afford their medicines to find patient assistance programs available to them through the Medicine Assistance Tool.

We are also working on long-term solutions to patient affordability and, as we enter a new year, our commitment to fixing the healthcare system so it works better for patients remains the same. We will keep advocating for policies that make sure more of the $175 billion in rebates and discounts given to insurance companies, the government, pharmacy benefit managers and other entities in the supply chain are shared with patients at the pharmacy counter. We’ll also keep working towards policies that would eliminate barriers to innovative payment arrangements and make insurance work like insurance again through out-of-pocket caps, smoothing costs over the course of the year and counting co-pay assistance toward deductibles and out-of-pocket maximums. These policies can help improve patient affordability, ensure access to medicines and protect the work being done to end COVID-19 and other diseases.

But we know that in 2021, we’ll continue to face policy proposals that could chill innovation. These policies include foreign reference pricing, an irresponsible and unworkable policy that will delegate how America values treatments and cures for seniors to foreign governments. And drug importation policies that ignore the strong safety standards we demand in the United States and invite counterfeit and dangerous drugs into the states will continue to be debated in both Washington and state capitals. We remain committed to policy solutions that will help patients, but we refuse to sacrifice access to safe medicines and future innovation in the process.

Our industry was able to act swiftly in response to the challenges of 2020 through collaboration and because of our decades-long investments in new technology, research and treatments. As we enter the new year, we look forward to bringing this same collaborative experience and expertise to our work with policymakers and regulators to put the COVID-19 pandemic behind us, advance policies that lower patient costs and protect our robust innovation ecosystem.

Kirk Kaminsky, president, McKesson U.S. Pharmaceutical 
Our industry’s response to the pandemic — and I’ll use the word of the year here — was unprecedented. I am very proud of how the pharmacy industry responded and served as critical front-line healthcare providers. Prior to COVID-19, the role of the pharmacist, as one of the most accessible and trusted healthcare providers, was already transforming. Pharmacists were already evolving from dispensing medications to a more meaningful responsibility for patient care. But the value pharmacies bring to the healthcare system became even more apparent in 2020. As preventive shelter-in-place orders swept across the country to reduce exposure, many hospitals and doctors’ offices stopped or delayed nonemergency appointments. However, pharmacists in all settings transformed their practices to provide safe and efficient care. They have been leaders in providing access to COVID-19 testing in their communities, and we expect their excellent patient care to continue as vaccines become available.

What we all experienced in 2020 will become the foundation of how pharmacies will serve customers in the future. Right now, changes to normal procedures are designed to speed care delivery and reduce exposure. Some of these steps are likely to change the practice of pharmacy forever. Pharmacists have an opportunity to build on this difficult time to create the pharmacy of the future and improve patient outcomes. It’s indeed a silver lining we can all look to beyond 2020. But ultimately, looking back on this pivotal year, we’re not surprised this industry stepped up and stepped in to help because it’s what we do. We care.

Mike McBride, vice president of partner relations, Upsher-Smith Labs
In 2020, nothing has been “business as usual” for the pharmaceutical industry as it faced numerous challenges presented by the pandemic — and found opportunity in some of these challenges as well.  Whether it was ensuring consistency in the supply chain in the face of increased demand, leveraging a new, remote sales environment, or recognizing new opportunities for telepharmacy and collaborative care, the industry has experienced many changes that will alter its collective future.

Perhaps most critically, the entire pharmaceutical supply chain demonstrated its efficiency and resiliency as it worked collaboratively during the pandemic to minimize, mitigate or avoid shortages of nearly all medications. At Upsher-Smith, we helped to ensure business continuity by expanding investment in our product inventory and by taking great care to protect team members on our production lines and in our product release laboratories. Thanks to similar efforts like ours, the industry was collectively able to support not only the usual demand for medications, but also the surge created by additional 90-day prescriptions allowed by payers. As a result, 90-day refills saw expanded adoption, particularly during the early days of the pandemic — either via mail order or at retail — and many will likely remain in place going forward.  

At the retail level, both independent and chain pharmacies saw the rapid adoption of telehealth and telepharmacy, particularly during local shelter-in-place phases of the pandemic. This rapid adoption curve, while driven by necessity, has allowed both practitioners and patients to get comfortable with this technology and its benefits, as well as to learn how to manage its limitations. For pharmacies participating in local collaborative care networks, the challenges of the pandemic have created many new opportunities to provide coordinated patient care. As more patients experience the care that pharmacists can provide, and as local regulations become more accommodating, in-pharmacy patient care will become the new reality, from the simple and obvious expansion into vaccinations to even more complex forms of care.  

On the sales side of the industry, the experience of Upsher-Smith is also telling. Our field sales teams, which support our branded epilepsy and migraine products, quickly leveraged our history of utilizing an efficient virtual approach to reach prescribers across the United States rather than only in secondary markets and geographies. This approach is in our DNA. We expanded our virtual capabilities to ensure that patients have access to our products and the many benefits they offer. The industry will likely continue to see increased remote sales and marketing efforts post pandemic.

The pandemic has obviously presented a host of challenges to the entire pharmaceutical industry. However, it has also enabled us to demonstrate the strength and resiliency of our country’s supply chain, to expand our sales and marketing efforts in the virtual realm, and to accelerate the acceptance and use of in-pharmacy patient care. The effects of COVID-19 will be felt for many years across the industry and its affiliates, as many new trends in prescribing, medication marketing and patient care originate from the industry’s pandemic response.

Dan Leonard, president and CEO, Association for Accessible Medicines
The generic and biosimilars industry drives the competition that lower patients’ out-of-pocket costs at the pharmacy counter. 

Balance between patient access and scientific innovation means that manufacturers can thrive and patients can afford treatment. According to AAM’s Access and Savings Report, created with data provided by IQVIA, generics saved patients and taxpayers $313 billion in 2019 and close to $2.2 trillion over the past decade.

Last year saw several noteworthy steps forward for patient access, including passage of the CREATES Act, which allows generic and biosimilar manufacturers to purchase the drug samples needed to seek FDA approval. 

The FDA was granted transparency onto information on potential disruptions, on manufacturers’ contingency plans and on the volume of medicines manufactured.

The United States-Mexico-Canada Agreement was a significant victory for generic and biosimilar competition and set the gold standard for future trade agreements. These important steps will contribute to the sustainability of the generics and biosimilars markets, enhance the security of the U.S. pharmaceutical supply chain, and lower prescription costs for Americans, although more action is necessary on each front.

The biggest difference between the pharmaceutical marketplace of today and that of just a decade or so ago is the prominence of brand name biologics. 

According to an IQVIA study from October, 10% of the prescription drug market is driving 80% of the costs. Most of the top-selling medicines are brand name biologics and specialty drugs, with spending growing at more than 14% annually over the past five years.

The new reality demands new policies. The following are potential game changers:

• A modest increase to Medicare Part B reimbursement, establishment of a Medicare shared savings demonstration program and reduce cost sharing for patients in Medicare Part B would all increase patient access to biosimilars;
• The Protecting Access to Affordable Medicines Act would fix the misguided application of the Medicaid rebate on generic medicines known as the Medicaid Generics Penalty;
• The Ensuring Access to Lower-Cost Medicines for Seniors Act would lower prescription drug costs in Medicare Part D. Furthermore, Medicare Part D should be updated to incentivize the use of lower-price, high-quality medicines; and 
• Congress should consider addressing patent abuse by providing a date certain for generic and biosimilar entry, accelerating the biosimilar “patent dance” and strengthening the inter partes review process.

In 2021, as the nation and the world recover from this deadly pandemic, improving patient access to affordable medicines is more urgent than ever. Many patients in the United States, even those who never got COVID-19, have delayed seeing a doctor and getting prescriptions for other conditions. 

Ensuring a robust and efficient pharmaceutical supply chain means they can obtain their medicines when and where they need them.