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AAP: Pharmacists Must Band Together and Advocate for a Seat at the Table

At the conclusion of American Associated Pharmacies (AAP) Annual Meeting, chairman of the board David Dingman, RPh, joined 

to discuss the importance of pharmacy advocacy work, the biggest issues facing independent pharmacists today, and his top takeaways from the recent meeting.

 Thanks for joining today. My name is Dave Dingman. I’m currently serving as chairman of the board for American Associated Pharmacies Cooperative Group. I’m a graduate of Albany College of Pharmacy, 1993, and that date gets farther back every time I do one of these. Thanks for having me.

 Why is it important for pharmacists to get involved in legislative advocacy work?

Traditionally, over the years, pharmacists have not done a good job of grouping themselves together as 1 professional entity, and we've been left grabbing what's left over from the other the other [health care] professions, both in services and in compensation.

Now more than ever, with reimbursements shrinking and the cost of medications going up, our margins are just evaporating; many of [us are] actually losing money on prescriptions. Who would have thought that that would even be possible? I know my accountants scratching their head wondering how this business model works. But now more than ever, it's important to get involved, be active, and have a voice at that table saying, “Hey, enough is enough. We need to be viable; we need to be compensated to continue to do what we do.”

What kind of advocacy work is AAP supporting to improve the practice of independent community pharmacy?

AAP does support advocacy groups and organizations as far as legislation. We don't do it on our own, but a perfect example would be [the National Community Pharmacy Association] NCPA. We support NCPA, we continue to donate, we do membership drives for them in order to advocate their agenda, rather than create one of our own. We're good at what we do, but as far as supporting the profession in general, we support the groups that are good at what they do.

What is the biggest challenge that you think independent pharmacists and pharmacy owners are facing today?

The biggest challenge that pharmacy owners are facing today… That's a big barrel to choose from.

Right off the top of the head, [the answer] is reimbursement. We have these shrinking margins and these big, huge [pharmacy benefit managers] PBMs just kind of push in, bullying us around, with take-it-or-leave-it contracts. Traditionally, pharmacists are pleasers. Everybody who walks through the door, we want to help them out—regardless of what their insurance is, or their background is, or anything like that; we're here to help and we're here to serve our communities. Over the last few years, as a business owner, you have to make some decisions… [such as], “Look, if you take this insurance, every customer that comes walking through the door is a liability to your business and you cannot afford to continue to fill their prescriptions.” It's absurd that it's come to this, and we need to advocate to fix it, sooner rather than later, because more and more of us independents are going by the wayside. [Many of the] seniors in our group are just throwing up their hands and saying “enough is enough.” We don't have any place to turn; It's getting desperate out there.

Pharmacists have been integral to the COVID-19 vaccination effort, and the recent test-to-treat initiative includes pharmacies as a part of the strategy. Are you hopeful that this expanded practice will become standard for pharmacists?

COVID has, without a doubt, expanded the horizons of what the community pharmacy can do for their communities. I think we've been tremendous with the access, the speed with which we can deliver the care, and the affordability of the care. This is this has been a big bailout for pharmacies that have participated in both testing and in [providing] COVID-19 shots. I think it's a shot in the arm; we're all scrambling through the middle of a pandemic to get this thing up on its feet.

Unfortunately, community pharmacies and the independent pharmacist were kind of left out of the first wave in most parts of the country. Once we got involved, we really shined, and I'm super proud of my peers for doing that.

Now, depending on the state you're in, that has a drastic effect on what you can do and how expansive the rules are. I'm excited about the prospects of the future—new revenue streams, obviously—but it's just 1 more step where we can benefit our communities individually, [and for example,] take some of the what the [physician’s] offices would consider to be a menial task and streamline them into our tasks. I think if we if we work together, as opposed struggling with this turf war, our communities will benefit, ultimately.

This year’s AAP Annual Meeting took place at the end of April in Tampa, Florida. Are there any high-level takeaways that you’d like to share?

The AAP [Annual Conference, held this year in Tampa, Florida from April 21 to April 23], it's a very intimate thing to me, being chairman of the board [and being as] involved and as engrossed with AAP as I am. I'm excited to showcase what the executive staff and the board have come up with for the year. I'm excited to see our members; I get much more out of [the meeting] than I can ever bring to those [meetings], just talking to the other owners and operators and [learning] what they're doing and find out what their solutions to the problems have been. It's been tremendous.

The speakers were high energy, very engaging. It wasn't just number crunching [CE sessions] where you’re kind of half nodding off; it was exciting, it was uplifting. I really praise the AAP executive staff for putting such a great program together.

We do things the way we do, whether it's your ordering, how you fill a prescription, the smart sync program… It's not changing the way the business is done, it's just tweaking a little to accommodate how to become more profitable. It’s taking shipping dollars and putting them into health care dollars. Those are the kinds of things that I've taken away [from the meeting].

As far as the conference personally, I've been exposed to it all year long. So, there wasn't really [much that was] new to me, but I got fired up listening to new our members get fired up—they're like, “Oh my lord, you guys found a fantastic solution to this problem.” Or maybe they didn't understand the problem, but in standing around and having a discussion with them, and explaining it to them, [now they do].

It's great to interact; it's been a few years since we've been able to, and we're looking forward to kind of hitting the ground running and moving forward together.

Do you have any final thoughts you’d like to leave with our audience today?

At the conference, we got to meet a couple of gentlemen who are running for office that are some of our own members. One is a local assembly candidate for Florida. Florida is in a big hotbed battle legislatively to help our members down there. We also have a couple of congressional candidates who are pharmacists. I would encourage you to listen to their platform. Obviously, they have very similar interests being pharmacy owners like yourself, and seriously consider supporting them, or at least hearing their platform.

Get involved: call your local guys, call your local legislators at both the state and federal level, and get involved. It's simple to send an email; if you just ping them once a month, it's not hard to do. In New York, I’m a member of PSSNY, the Pharmacists Society of the State of New York. They give you a cookie cutter [template that you can use to] ping your legislators and just let them know you're there. I think the majority of the problem that we're facing as independent pharmacies today is our problems are so complex, and we're going up [against] such a behemoth of an opponent with these PBMs, and there's so much money coming from the other side, that they don't know how to fix it. And that's mainly because they don't know what the problems are; they don't understand the problems. We have to do a better job of explaining our problems, addressing our problems, and getting legislation through to level the playing field and ultimately take care of the customer.

Expert Interviews

In today’s practice landscape, Dingman’s advice for independent pharmacists is simple: “Get involved.”

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As a society and a healthcare system, we have waited a long time for advancements in care that biologic medicines offer. These drugs, made from living cells, have dramatically changed how many serious conditions – such as certain cancers, diabetes, rheumatoid arthritis and others – are treated.

For example, whereas older treatments for autoimmune conditions may reduce symptoms, biologics work differently. They are designed to modulate the immune responses that lead to conditions like rheumatoid or psoriatic arthritis in joints, atopic dermatitis in the skin, ulcerative colitis in the intestines, and many more.

These immune responses trigger inflammation in certain organ systems and are difficult to treat effectively. In the 40 years since the first biologic medicine was approved in 1982, innovative biologics and related, lower cost biosimilars have profoundly expanded the existing options for managing many different diseases.

But for individual patients, the wait to access these advanced options continues. Payer policies mandate they must step through treatment with older, potentially less effective options before trying the treatments that may be better suited to the biology of their condition. While patients continue older treatments for months or even years, the disruptions to their quality of life and the disease-related burdens of anxiety and depression can deepen.

Some of the obstacles preventing quicker uptake of biosimilars can be eased through awareness and education – but not all. Policy and economic action are required to shorten the time patients spend waiting. Biosimilars already offer some financial benefits to payers, and they could offer more. Payers themselves can magnify that benefit by allowing broader use of biosimilars.

We are already seeing steps to educate providers on biosimilars so they may integrate them into their therapeutic approach. With the December 2021 launch of its curriculum toolkit for educators of healthcare professionals (HCPs), the FDA’s Center for Drug Evaluation and Research (CDER) took an important step toward supporting the integral role that biologic medicines should play in today’s healthcare system.

As a component of the agency’s Biosimilars Action Plan, the toolkit is designed to help students in HCP degree programs develop a deeper understanding of biosimilars. It provides a wealth of information to encourage the cultivation of informed perspectives about biosimilars. Students will learn how biosimilars relate to reference products, details about the approval process for biologic products, standards related to interchangeability and implications for substitution, and information related to prescribing. This important curriculum is particularly valuable to providers and can be especially indispensable to those caring for patients with immuno-inflammatory conditions.

However, understanding biosimilars and how they can be employed in treating chronic disease will only improve care if patients can actually access these medicines. Unfortunately, even with more than 30 biosimilars approved in the U.S., the rate of adoption has lagged behind that of other countries.

We could take action to accelerate both the pace at which patients progress to the treatments that will serve them best, and the competition that could, over the longer term, drive down the overall cost of biologics. Policymakers could take several steps to help increase the uptake of biosimilars in the U.S. It can begin with a reduction of patient out-of-pocket costs for biosimilars to make these medicines more affordable and increase their usage. Adjusting add-on payment policies to increase reimbursement can provide more incentive for prescribing biosimilars.

A “shared savings” model that includes prescribers can also drive better access. Finally, implementing a Star Rating system to measure biosimilar access can encourage Medicare Advantage programs to support their use. Some of these measures have already been proposed in legislation being considered by Congress, such as S1427 and HR2869. The sooner they are adopted, the more quickly patients’ wait for treatments that could help them will shorten.

Given that biologics account for a large share of total medical spending , patients, payers and industry would all benefit from policies that expand the market for these medicines and increase competition to encourage lower costs.

In the short term, biosimilars have the potential to offer the efficiencies that payers need while allowing patients the opportunity to access advanced treatments. Taking a longer view, expanding the pool of patients who have access to biosimilars can spur competition among biosimilar manufacturers – and create economic incentives to further decrease the cost of biosimilars.

Payers can be our partners in accelerating this process by using the tools at their disposal to foster the changes that can shorten the time patients spend waiting for biologics, and by doing so, more quickly bring about cost savings that can benefit the entire healthcare system.

This article originally appeared on Managed Healthcare Executive.

Articles

Efforts to improve education on biosimilars are a start, but payer policies must catch up to ensure real change.

Biosimilars

Total Pharmacy

Pharmacy Finance

Payers Need to Make Effort for Improvements in Biosimilars 

While only 5% of older adults lacked prescription drug coverage in 2021 – down from 32% in 1998 – 20% reported financial hardship from prescription drug purchases, according to a study.

Those without prescription drug insurance, requiring multiple daily medications, and reporting a low annual household income struggled the most. Even those with insurance from lower income households still struggled when needing multiple daily medications.

The researchers said that among older adults in the United States, policies that reduce the out-of-pocket expenditures for prescription drugs appeared to reduce the burden of these expenditures, and suggest that managed care policymakers should consider policies that reduce out-of-pocket costs for older adults in an effort to promote medication access. Such policies may enable older adults to reallocate funds for vital expenses like food and shelter, especially for older adults from vulnerable populations.

The report states that the inability to pay for prescription drugs is an important determinant of medication adherence that may lead patients to ration or split doses, delay refills or new prescriptions, and even stop taking medications altogether. Cost-related nonadherence compromises the therapeutic effectiveness in managing most chronic diseases, persists even when patients cut back on basic health-related social needs, and consequently leads to higher preventable health care expenditures.

The data were from four nationally distributed, cross-sectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs.

This article originally appeared on Medical Economics.

Olson A, Schommer JC, Mott DA, Adekunle O, Brown LM. Financial hardship from purchasing prescription drugs among older adults in the United States before, during, and after the Medicare Part D “Donut Hole”: Findings from 1998, 2001, 2015, and 2021. 

. 2022 May;28(5):508-517. doi: 10.18553/jmcp.2022.28.5.508. 

Lower household income and requiring multiple medications play large roles

Practice Management

Prescription Drug Insurance Out of Reach for Many Older Adults

Hello, and welcome to Over The Counter, a podcast from 

®. I’m your host, Lauren Biscaldi, managing editor of 

®. Today I’m joined by Lani Bertrand, RPh, senior director of clinical consulting at Omnicell to discuss pharmacist burnout during the COVID-19 pandemic and how technology can ease some of the burdens that pharmacists face.

Lani, thank you so much for joining us today. Could you please give viewers an introduction and tell me about your role at Omnicell?

 Sure, and thanks for your time today, as well. I appreciate it.

I am a pharmacist with a unique blend of both clinical pharmacy practice and healthcare industry experience. I have had the pleasure of working with various health systems across the country. Through my role, I have been able to assist them in addressing operational efficiency, medication utilization and inventory management, as well as pharmacy automation and technology adoption.

At Omnicell, I enjoy applying my experiences to my current role, where I am the senior director of clinical consulting. I lead a great team of both clinical and technical subject matter experts. They work with our sales team to help support our customers as they look to enhance their pharmacy operations and ultimately improve patient care.

Great, thank you so much for that. Since the COVID-19 pandemic has begun, we have heard a lot about heightened burnout in the health care community, particularly among pharmacists. Would you be able to discuss some of the ways that burnout has manifested within the pharmacy profession over the last year and a half?

 Absolutely. While it is important to highlight the fact that the pandemic has brought attention to the impact on pharmacy and healthcare staffing, I think it is equally notable to call out that burnout was rising prior to the pandemic.

It is likely that COVID-19 exacerbated those challenges. If I look at a recent pharmacy workforce survey, almost 70% of pharmacists reported that their workload was heavy, if not excessively heavy, and their frustration levels were reported as high.

Also, more recently, researchers at the University of Michigan conducted a survey and published their findings on this topic. Those findings were from the beginning of the pandemic, but even then, pharmacists were reporting an average of 50% burnout rates.

Part two of that study is underway. I had more recently noticed this survey and it will be interesting as we move further into the pandemic what those findings will be.

Unfortunately, with recent shortages and labor challenges, I am wondering if those numbers of burnout might tick upward?

 Yeah, I was just reading something recently about how they're anticipating the Bureau of Labor Statistics is anticipating a 10-year shortage in the healthcare workforce, which was just incredible to me. I wonder how much of that was the pre-burnout, that the pandemic exacerbated.

We were already experiencing shortages, especially for primary care providers. This explains why some of this recent legislation aimed at provider status is getting more attention to help close that gap as well.

Yeah, it is nice to see that they're taking steps on a legislative level to address it. Great. Do you envision technology solutions as a way that pharmacists can alleviate burnout or do these solutions stand to add on to the current pharmacist’s workload?

 That is a great question because I think that at one point in time, technology was viewed as a burden. It was something that pharmacy had to add additional FTEs to help get it going so to speak and to shorten learning curves. I think that has since changed.

If we look at the technology that is even offered with additional services (such as assisting sites in ramping up quickly and allowing an expert to provide ongoing monitoring), technology can be the best thing that we can do to enhance workflow to bring about increased medication safety.

Certainly, job satisfaction is a component. For example, if I am a pharmacist and I am allowed to do more of what I love through being closer to my patient, that is beneficial. Therefore, if done correctly, technology can make a big difference.

To give a couple of examples, I can cite a health system in Ohio where they implemented robotic technology in their central pharmacy to address medication dispensing needs for a few hospitals.

They utilized technology to remove manual processes at other sites and instituted a barcode scan and scan out concept, which in turn reduced medication errors, and certainly again, put clinical workforce closer to the patient clinical duties.

I think another area to call out that is important, is the rising use of technology. For IV medications and sterile compounding, we want to do everything we can to ensure medication safety and accuracy of those preparations. Additionally, we also want to look at the individual. There are even studies demonstrating manual fatigue for doing some of those procedures repetitively, over again and again. There are lots of ways to improve pharmacy operations and to help with that job satisfaction by removing some of the workload from those individuals in the pharmacy.

Yeah, it sounds like it's a really great opportunity to streamline a lot of efficiencies for pharmacists, and take away the burden of those manuals. It sounds like it would allow them to care for their patients, which is what you signed up to do.Is there one area in particular that you can mention, in which pharmacists can really optimize their workflow through technology?

 Certainly, I think most of us pharmacists, whether we were practicing in retail community or in a hospital setting, we are very familiar with how technology can help us with repackaging through filling vials with large scale, mirror mail order operations, and so forth.

I think the new areas to look at (in terms of technology) would be along the lines of inventory management. This is because it is beneficial to have a broad system of visibility, in addition to utilizing real time insights, and the potential for benchmarking. With that said, nothing has highlighted that greater than the recent pandemic.

If you think about how we had an influx of patients who needed a higher acuity level of care, the medications that they were demanding or needing for that care are also sometimes difficult to come by. They're unfortunately at the top of a drug shortage list at time.

If I am the leader of a health system it is beneficial to know what I had, where it is, and how I could move that to that new area of acuity. Additionally, I would have the opportunity to take better care of patients, minimize my risk, or even my additional spend to accumulate additional drugs. That is really where we should focus in as far as finding efficiencies.

That's very interesting, particularly how it relates to the whole supply chain issue with medications. I don't know that there are easy solutions to that, but it's nice to see that there are options out there to help mitigate, where it can be mitigated.

 Exactly. I think, and that can apply to all aspects of pharmacy, because the supply chain impact is so great. Everyone needs to become a little bit more shrewd, and on top of their game, as far as knowing what they have and how to get it quickly.

Yeah, for sure. If you could leave our listeners with one piece of parting advice for addressing burnout, through technology or through other means, what would that piece of advice be?

 Well again, I am very glad that we're talking about this important topic as it impacts not only pharmacists, but all health care workers. It is unfortunate that the rate of burnout in this industry is probably greater than in other industries.

So, it is important that we look for ways to lessen that and technology is the answer. I think the key takeaway here is to embrace the use of technology, to not see it as a burden, to look for ways where technology with services added to help you implement and ramp up quickly is truly the way to go. Further, to look at technology across all aspects like we covered.

It is not just a matter of serving as a packaging alternative, but it's your true hub of the pharmacy ecosystem so that we can use those important clinical players in the areas where we need the closest to patient care. This allows them to achieve better job satisfaction because they are doing what they signed up for. We did not go into this to manage manual reports and spend hours tracking things down. We wanted to do this to provide the best clinical service for the best patient care.

Thank you to Lani for taking the time out of your busy schedule to have this fascinating discussion on burnout technology, and the pharmacy profession.

If you enjoyed this episode, check out our other podcasts, available on drugtopics.com or wherever you listen to podcasts. As always, thank you for listening and I hope to see you next time at the counter.

Podcasts

Lani Bertrand, RPh, joins the latest episode of Over The Counter to discuss the role of technology in easing burnout during the COVID-19 pandemic. 

Easing The Burden of Burnout With Technology

: Hello and welcome to Over The Counter, a podcast from 

We have a very special episode for you today: It's the final episode in our ThoughtSpot 2021 series. Our guest hosts is Jenni Zilka, President of Good Neighbor Pharmacy, who will be leading a conversation with Brian Nightingale, President of Community and Specialty Pharmacy and Long-Term care at AmerisourceBergen, and Giulio Burzacca, Managing Director of Alphega Pharmacy. They'll be comparing independent pharmacy industry trends in the US and across Europe, including global legislation, drug shortages, top priorities for the future, and more.

 Hello, everyone, and thank you for tuning in to today's discussion in partnership with drug topics. I'm Jenni Zilka, President of Good Neighbor Pharmacy, a network of locally owned and locally loved independent pharmacies across the US. I'm so excited today to be joined by my colleagues, Brian Nightingale, President of Community and Specialty Pharmacy and Long -Term care at AmerisourceBergen, and Giulio Burzacca, Managing Director of Alphega Pharmacy, the leading network of independent pharmacists in Europe. Thank you both for being here.

I'm excited to have the opportunity to speak with these 2 industry leaders as we reflect on the evolution of independent pharmacy across the globe, how we've responded to the new challenges over the past year and a half, and where we go from here. So, before we dive into this global conversation, Giulio, would you take a moment to share an overview of what Alphega is, and how you support independent pharmacies in Europe.

 Thank you, Jenni, I’m really pleased to be here with you and going through and explaining a little bit more about the European market.

But let's start with what Alphega is. Alphega Pharmacy Europe is a comprehensive membership service to independent pharmacists, and the provider of added-value services to pharmaceutical and healthcare manufacturers. Our aim is to improve the health and well-being of communities by delivering a future vision for independent community pharmacy and supporting our pharmacists in their role as recognized health care professionals—and not just retailers of medicines. Alphega and its associated networks now count close to 10,000 independent pharmacy members, making it to the largest European network of independent pharmacies. It is present in 10 countries: the Czech Republic, France, Spain, the Netherlands, Germany, the UK, Italy, Turkey, Romania, and Portugal.

In brief, what does Alphega Pharmacy do for the member pharmacies? Well by joining Alphega Pharmacy, a pharmacy business retains its independent status, but gets a access to a wide range of support services, such as branding, business management training, professional services, digital solutions, and IT support—all of which provide competitive advantages to its members to support an increase [in] revenue and profits through improved customer footfall, increased basket size, and improved operational efficiencies. Additionally, every pharmacy member benefits also from all the personal and online coaching offered by the network.

 Thank you, Giulio, so interesting to hear you share the services that Alphega offers, as we in the US are always looking to improve upon and evolve the services that we provide with Good Neighbor Pharmacy.

To set the stage a bit more, Giulio, would you share a little overview into how your pharmacies operate in Europe? What makes them similar or different to the independent pharmacies in the US?

 Sure, Jenni. The European pharmacy retail market is very diverse. And, although of course we have the European community, we cannot really talk about the European market. As an example, out of the 10 countries in Europe in which we operate, 5 countries have regulations allowing retail chains, while the other 5 don't. So, as you can see, it's a very different situation.

Also, the penetration varies a lot. On average, a pharmacy serves, in Europe, just a little bit more than 3000 citizen in their community area, but the coverage is not equally spread across the different countries. And, for example, you have up to 46 pharmacies per 100,000 inhabitants in Spain, while in the Czech Republic and Holland, you have only—respectively—7 and 8 pharmacies for the same number of inhabitants. So, as you can see, [there is] very diverse coverage.

But the key point is that almost two-thirds of European citizens can reach their nearest community pharmacy within only 5 minutes distance, and 98%—the vast majority of the population—can reach a nearby pharmacy within 30 minutes. The level of services allowed by country regulations is also very different, with some countries—like the UK and France—at the very forefront of health care services provided.

Many European countries have introduced changes in legislation to expand the role of pharmacies and relieve pressure on the rest of the health care system. As a result, in 8 European countries, community pharmacists have been involved in the administration of COVID-19 vaccines. We are very proud to mention that the very first 4 pharmacists to vaccinate in the UK—and overall to vaccinate in Europe—were all Alphega pharmacies. And this was thanks to the fast approval process in which we supported our members to get the authorization to start vaccination.

In almost all countries, people can now access authorized COVID-19 self-sampling kits from pharmacies or get tested directly in pharmacies. In France, more than 12 million rapid antigen tests for COVID-19 have been carried out since October 2020. In Italy, we also had our Alphega testing mobile vans going around the country and offering testing capacity just in front of our member pharmacies. A study conducted across Europe has mapped 30 pharmacy interventions on COVID-19 by community pharmacy, from symptoms-based referral to home delivery of medicine [and] pharmacy telephone support to vulnerable patients.

And if we look at the issue of medicine shortages, in 6 countries, community pharmacists have been now granted the opportunity to provide alternative solutions for occurring medicine shortages during the pandemic.

 It's amazing, amazing work. I'm glad you brought up COVID-19 specifically, and all of the services and the care that your pharmacies provide to their patients. It's really astounding, especially when you are operating in multiple countries.

Brian, I'm going to shift over to the US. Here in the US, the pandemic has truly been at a time of immense change for independent pharmacies, not only in Europe, but also here in the US. What have you seen over the course of the past year and a half that's really demonstrated the resilience and the adaptability and the value of independent pharmacies in the US?

 Thanks, Jenni, and thanks for hosting today. If you don't mind, before I dive into that, I would just like to kind of respond to some of the commentary that Giulio just mentioned.

We've gotten to know each other over the past several months, quite a bit; our organizations have been learning from each other and it's just amazing to me how many similarities there are between those independent pharmacies across Europe and the independent pharmacies here in the United States, especially in terms of purpose, passion, care for the community, customized service, going above and beyond… A lot of those examples that you just provided, Giulio, are really amazing and, I think, resemble in a lot of ways similar stories that we have here.

It's just really exciting to see how these entrepreneurs and these community providers across the globe have arisen in big ways to address this global pandemic, and I think it's across both continents. It just shows what more independent pharmacies can do in their communities to serve in times of need and in times of normalcy—whatever that looks like these days.

It's just really enriching to hear, again, how Alphega pharmacies have responded. And it's also really exciting to see a lot of the innovations and different things that come out of the different countries in Europe and perhaps identifying ways that we can do things different over here in the United States. So, again, it's interesting and super exciting to learn about the similarities, and certainly the innovations and the best practices that we can share with each other.

Just kind of diving into a little bit of the US perspective, again, I think what I've seen—what we've all seen here—is similar to what Giulio just said: a doubling down of what makes independent pharmacy so special, right? A doubling down on their personal service and the care they provided, even before the vaccines were available. Obviously, pharmacies response, and being part of the vaccination solution is front and center… But I think what a lot of people don't necessarily realize is that before the vaccines were even available, independent community pharmacies evolved; they transformed rapidly. Many of them in the United States had to shut their doors and go to only home delivery or only a curbside pickup, so they had to completely change their workflow patterns in order to continue to serve their patients, whether that was through COVID-19 testing, or just continuing to care and provide medications and counseling for their patients.

We saw very rapid changes in very unique ways, that in a lot of cases had nothing to do with medications. So, for example, many independent pharmacies in the US—and certainly most of the Good Neighbor Pharmacies—have offered same day home delivery for years and years and years. We saw examples of, those drivers, those technicians, delivering medications to a home, calling that person knowing that they were shut-in and saying, “Hey, can I stop off and pick up some groceries? Is there anything else that you need that I can stop off and pick up before I get there with your medication?” We saw pharmacies who rallied school kids to hand write and hand design thank you cards and thinking of you cards to be delivered with the medications to elderly shut ins who couldn't see their family anymore because of COVID-19. So again, those little micro touches that independent pharmacies do every day really kind of came to the forefront before the vaccines were even available.

And then, of course, the rapid response and participation of these pharmacies in providing vaccines when once they were available was key. I think we've seen statistics now that well over 80% of all vaccinations in the United States had been provided through a community pharmacy. That's important for several reasons. One is, many of our pharmacies are located in underserved and economically disadvantaged communities, and that's been a huge focus of the vaccine efforts here in the United States. I think the latest numbers that I saw within our network was that well over 50% of all vaccines that were provided by our member pharmacies were provided to individuals who resided in underserved and disadvantaged communities.

That access to care, that access to providers, is key in those communities. And then also, the pharmacist’s role in being a trusted adviser and an expert on these vaccines, and help[ing] people get more comfortable with receiving the vaccine, has been key as well. So, again, I think you're hearing a lot of what I'm saying in terms of similarity to what Giulio was saying: they just stepped up and really did what they did best, and continue to do what they do best, and that is care for their patients.

Quickly, the other thing that that I think has challenged our pharmacies—and again, they have adapted greatly—is how they engage with their patients and their communities during a pandemic where a lot of folks were not traveling, not driving, and staying at home. They've really embraced digital engagement. We launched our digital platform a couple years ago—about 3 years ago—and we saw a gradual adoption of that; there's a lot of these pharmacies that are more traditional, and kind of stuck with the traditional print, TV, and radio, which is fine. But over time, they started to embrace digital platforms and digital engagement. And then once COVID-19 hit, we saw a rapid uptake of that. And I think that's a positive that has come out of this: the innovation and the adoption of different ways to engage patients, whether through telepharmacy, social media, outbound call campaigns, all those types of things [that] I think are going to be mainstays moving forward. So again, could not be more proud of the response that community pharmacy has had over the last 2 years, and I think there's lots of opportunities to leverage that moving forward.

 That's great. Brian, thank you for highlighting all the amazing work that our pharmacies do. You [talked about] feeling proud, and I think that there really aren't words for how proud and honored I feel to be able to work with independent pharmacies day in and day out, especially as the value of independent pharmacies is on display like never before, because of COVID-19.

I would like to shift and focus kind of on the year—or years—ahead, I'm certainly seeing some common threads as I listen to Giulio and Brian share the state of independent pharmacy in the US and abroad. With the pandemic encouraging regulators and professional bodies to accelerate digital evolution, vaccine programs, and—in the US—the position of pharmacists. Brian, I'd love to hear from you on where kind of where you think independent pharmacy can go from here. What are some of the core priorities you have in your mind as we think about pharmacy customers in in the year ahead? And how [can we] take this moment this this unprecedented moment that we're in and carry that forward?

 Thanks, Jenni. I think I'll kind of tie it into what I just left off with: if you think about the opportunity, that that the COVID-19 vaccine has provided in terms of consumer engagement.

I think all of our independent pharmacies have a great relationship with the patients who already know them, who have been coming there for years; there's that loyalty, there's that relationship… That's always been there. I think what I'm really excited about is the ability to participate so heavily in the vaccine response has opened up the awareness of many, many consumers out there that, quite frankly, didn't know that an independent community pharmacy was right down the street, or didn't know about the level of experience and personalized service that they provide. And now that they've been into that pharmacy, they've seen an experience that that relationship… I'm hoping that that these pharmacies will continue to engage those consumers and those patients and bring them back in and keep them. I think it's going to be critical, again, to tap into the digital platforms, to tap into the ability to engage with those consumers in a different way in order to say, “Hey, remember the great service and the great discussion we had when you came in to get your vaccine? Let us take care of your entire family, now and beyond.” I think that's number 1, to leverage those new consumers and to leverage the new technologies to attract and retain patients.

I think secondly—and this is a big priority for us as a service provider—is helping to promote diversified patient services beyond that traditional dispense, and to help our pharmacies offer and expand clinical offerings, again, beyond that dispense. They've got the time, they've got the relationships, [and] there's so much more that these pharmacies can provide[to] these patients and communities, and we just need to help them expand their businesses in that way, and to advocate and help for appropriate reimbursement and payment for those services.

Right now, our reimbursement model is pretty much focused 100% on the dispense of that drug; we've got to change that. We've got to advocate for fair and adequate reimbursement and payment for that drug and the dispensing services that go along with it, but also advocate for expanded scope of practice, and fair and appropriate reimbursement for clinical services beyond that dispense. Vaccination is a perfect example of that: pharmacies have stepped up and proven they can deliver, and now it's time to expand that to other avenues and areas as well.

That's the enablement part. And then on the advocacy piece, it's taking a strong approach within the industry to advocate for comprehensive reimbursement reform, expanded scope of practice through provider status, and increased awareness of the opportunity that lies within community pharmacies to really impact and increase access to care and reduce overall costs.

Pharmacies and pharmacists are part of the solution, they're not part of the cost problem. And advocating and educating legislators and regulators, at both the federal and the state level, is key, and it's a top priority for us as well. That has started to intensify very rapidly at the state level, because of the Supreme Court ruling in Rutledge vs PCMA in Arkansas.

So, again, those are really key priorities: it's helping our pharmacies engage in new ways with their new customers and their existing customers, it’s helping them diversify their business beyond the traditional dispense, and it's advocating very strongly for a comprehensive reimbursement reform and expanded scope of practice.

 That’s great, Brian, thank you so much, there’s so much to be excited about as we look to the future.

Giulio, I'm going to shift back over to you. How about Alphega? What are some of your top priorities for independent pharmacies moving forward?

 Thanks, Jenni. First of all, I would like to really echo what Brian just said, because it's so fundamentally true across our all our markets in Europe.

The first observation is—and I couldn't agree more with Brian—is the evolving positioning and image that the community pharmacy has taken during the pandemic and how, really, the normal person out there, the normal citizen, has really realized the relevance and importance of community pharmacies.

We really need to build on these evolving imagined positioning of the pharmacies and definitely advocate for recognizing the value of pharmaceutical services that have proven to improve the quality of people’s lives and also to help the health care systems that were really under, tremendous stress, by offering their services at the community level. It is huge work that we need to do all together.

The other big thing that came up is how to better manage the personalized care part. There is knowledge on a 1-to-1 basis by community pharmacists in the mastering of all the digital tools that are now available. And this is where, really, there is the right marriage between community pharmacies and the support that we can offer as a network and offering those tools that are more innovative [to help] reach the final patient.

In Alphega, what we really defined as our key priorities—to answer your question, Jenni—is really offering programs and campaigns to encourage preventive care and wellness, like we are already doing—for the cardio campaign, obesity, the diabetes—all those campaigns encourage preventive care.

The other big area—and Brian was also referring to it—is really to continue to expand on our vaccination and all our testing services, and expanding the scope of community pharmacy practice, to maximize their contribution to patient and health systems. Together with, and I was just mentioning before, defining the new models of care delivery. Really taking advantage of digital technology and offering several services like home delivery, consultation, et cetera, that really enhances the way that we can reach the final patient.

We are very active at Alphega in offering a digital platform to all our members, so that they can leverage it to know how [to be a] large provider while maintaining their personal independence and touch. Those data are for Europa, but I'm sure they could even be a probably as—if not more—relevant for the for the US. If we look at the latest IQVIA survey, when they asked industry executives what percentage of their sales they think will come from a pharmacy in the next 2 years, the answer was really between 15% to 30%—and even up to 50% in specific categories—will come from the pharmacy. So, it's really a way to offer community pharmacists the possibility to be present in different touchpoints to their final patients.

And last but not least, always continuing to reinforce the role of the pharmacist in his or her community, with all the support that we give, including all the social media support that we are offering.

 Thank you, Giulio, and thank you both for such a great discussion today. This was really fun. I have so enjoyed working with Giulio and his team and learning about independent pharmacy in Europe, and as I'm sure you're learning, there are so many similarities and so many opportunities to collaborate and learn from one another.

As we close, it's very clear that we are at a pivotal moment in the pharmacy industry globally. And the time is now for independents to use their increased visibility and trusted positions within their communities as a springboard for reaching new goals. It's been wonderful, wonderful to speak with you both. Are there any any closing comments from either of you as close the podcast?

 Sure, I just want to close by saying Giulio, I too have really enjoyed getting to know you and your team and could not be more excited about our path forward together, and sharing best practices and bringing many of the great things that you and your team are doing across Europe over here to the United States so that our member pharmacies here can take advantage of a lot of the things that you've built and execute them here. It's been a pleasure and I look forward to more collaboration.

 Well, Brian and Jenni, I can only really be extremely glad for all your word. It's absolutely a tremendous pleasure to work with you, and also to get all your learning and all your knowledge and be able to share all our best practices across different continents.

What is really relevant is also that we have a common culture, and—most importantly—that we have really the same passion, for the pharmacy and for the patient health, that is really at the heart of everything you do and that we do in in Europe. And that's really the strongest commonality that we have.

One point I wanted to mention, in addition to everything we said, is what else we can do for the other big player in the market, and that is the manufacturers. We can also provide manufacturers with instant access to all the different members of our networks across all those different markets—European countries as well as, of course, the very large market of the US. We are the perfect platform for new product development, placement, testing with consumers, clinical trials, in terms of acquisition of the patients… really, [there are] an infinite number of a solutions that we can really offer them. And on top [of that], we can get the real-time product performance and offer all of the results and the return on investment performance on all of the activities and programs that are run in all our pharmacies across the US and Europe.

 Thank you to Jenni for being a phenomenal guest host, and to Giulio and Brian for a really interesting discussion. We had a great time collaborating with AmerisourceBergen and Good Neighbor Pharmacy on another ThoughtSpot conference and trade show series, and look forward to partnering with them again for the latest and greatest pharmacy insights for independents.

If you liked this episode, check out the other episodes in this year's ThoughtSpot series. We have an uplifting and hilarious discussion with 3 independent pharmacy owners who shared their unique experiences navigating the COVID-19 pandemic, and an informative conversation with 3 inspiring experts who are dedicated to addressing health disparities and leading the conversation on racism in health care.

And as always, thank you for listening, and we hope to see you next time, at the counter.

ThoughtSpot

As part of our ThoughtSpot 2021 podcast series, guest host Jenni Zilka, President of Good Neighbor Pharmacy, leads a conversation on global trends in independent pharmacy across the US and Europe. 

ThoughtSpot 2021: Global Independent Pharmacy Trends 

 Hello and thanks for listening to Over the Counter, the podcast from 

This podcast series was created in partnership with AmerisourceBergen and Good Neighbor Pharmacy (GNP), as part of 

 coverage of the 2021 ThoughtSpot conference and trade show, hosted by GNP. 

For more exclusive coverage of ThoughtSpot 2021, including more podcast episodes, go to DrugTopics.com.

In this episode, special guest Lonie Haynes, senior vice president and chief diversity and inclusion officer at AmerisourceBergen, will be hosting and leading the conversation on reducing health disparities and caring for underserved communities. He’ll be speaking with Ryan Marable, president of the National Pharmaceutical Association (NPhA), and Chichi Ilonzo-Momah, owner and pharmacy manager of Springfield Pharmacy.

Hello, everyone. Thank you for tuning into today's discussion in partnership with Drug Topics. I'm Dr. Lonie Haynes, senior vice president and chief diversity and inclusion officer at AmerisourceBergen. 

I'm joined today by Dr. Ryan Marable, president of the National Pharmaceutical Association, and Dr. Chichi Ilonzo Momah, owner and pharmacy manager of Springfield Pharmacy in Springfield, Pennsylvania, which is part of our Good Neighbor Pharmacy network. 

Thank you both for being here. I'm excited to have the opportunity to speak with these 2 leaders in the pharmacy community on an important topic that has been exacerbated by the COVID-19 pandemic: health care disparities.

Discussions like these are critical, and they're important to AmerisourceBergen's ongoing commitment to diversity, equity and inclusion, as well as our purpose, which is creating healthier futures. 

Before we dive into the conversation, I'd like to pass over the mic to Dr. Marable and Dr. Chic

hi to briefly introduce themselves. Dr. Marable, please take some time and introduce yourself to the audience.

 Hi everyone, my name is Dr. Ryan Marable. I am a pharmacist with the drug information and medical communications team. Definitely excited to be here. 

I'm currently the president of NPhA, which is the oldest Black pharmacist association with an overall mission to provide service to underserved and underrepresented populations throughout this country. So, definitely excited to be here for this very, very important topic on health inequities and health disparities and looking forward to a great discussion.

And Dr. Chichi, if you would, share a little bit about yourself. 

My name is Chichi Ilonzo-Momah. I am a clinical pharmacist and also the owner of Springfield Pharmacy, located here in Pennsylvania. 

I have been practicing as a pharmacist for over 15 years now. I started off with the pharmaceutical industry. And for the last 10 and a half years, I have been running Springfield Pharmacy. I have a passion for helping the underserved population, and thank you for having us here.

 Thank you for those introductions. To get started, we know that community pharmacies are uniquely positioned as trusted and accessible providers with long standing community connections to create opportunities for quality care, increase prescription adherence, and, of course, reduce health disparities.

But before we start, I really want to unpack the term health disparities. We know clinically it means a difference or an outcome differentiated between different groups of people. I'd like to hear from you, Dr. Marable, your thoughts around the term health disparities, and can you discuss some of the causes and complexities in that space, from your perspective at the NPhA?

 Absolutely, so, the term health disparities, it is definitely a very complex subject, but just trying to simplify it as best as possible and just get a basic understanding of what health disparities are, really in its essence, it's a situation where groups or populations of individuals have a disproportionate effect as it relates to their outcomes of their care.

You have situations where groups of individuals may experience negative outcomes as it relates to their overall health and wellness that can't necessarily be just explained by the level of care that they're receiving. So, typically, these are systematic approaches - so it's not an individualized situation where someone is experiencing a negative outcome, but you have to think about the bigger picture.

One of the main areas as it relates to health disparities can be impacted by groups of individuals, their overall socioeconomic status. You can have gender disparities; you can have disabilities as it relates to sexual orientation; you have situations where access and availability to care and medications can create impact. And there's so many different areas that can lead to health disparities. 

But I feel like some of the more important ways, as pharmacists who are interfacing with these with patients, and other health providers in the community, is to just take time throughout your professional journey and to educate yourself, because things do continue to change, sometimes for good, sometimes for bad. But at the essence of it all, as long as you're continuing to educate yourself, that's one way that we can continue to address these health disparities and try to break down some of those barriers that we just mentioned previously.

 Thank you, Dr. Marable. Dr. Momah, you have that unique position of not only being a clinician, but also a practitioner with boots on the ground. And you support many different patient populations in Springfield, PA and throughout the Delaware County. Can you describe some of the disparities that you experience and those barriers that you've seen in the patient population you happen to serve?

 Absolutely. We are fortunate and blessed to be located in Springfield, where it's almost like in the middle of Delaware County, where we can reach the underserved, as well as a lot of people that are experiencing health care disparities.

One of the major things that I've noticed is accessibility. A lot of patients are not able to have access to a certain level of care that should be easy to get. And most of them are due to, some people might say ignorance, some people might say hesitancy, but it comes down to education and communication.

And I've seen a lot of language barriers, where people, we just assume people understand English or can read English, but because they can't understand or read, they're not able to be served what they need.

And we've also noticed fear. A lot of people are afraid to ask questions. A lot of people are afraid to admit that they don't know some information. And that causes a lot of gaps in our system. And as pharmacists on the front line, we are the liaison between other providers and these patients, so we have to be able to - some people might say dumb it down - but it is what it is. We have to be able to speak the language that they understand and meet them where they are to explain it to them better.

And being able to empathize with this patient and be approachable. Being able to be accessible to them is important and the pharmacy is the place where you can walk in without really making an appointment. We are training our staff to be more empathetic, so that when the patient sees you, they're not afraid to even talk.

We’ve had situations where patients can come in with a problem, but are afraid to even voice out the problem because of fear of being judged, fear of not being understood, or the fact that they don't see anybody that look like them in the pharmacies.

I am very passionate about patients I serve. I'm going to give you an example. We ran a COVID-19 clinic, where everybody there spoke Spanish and I do not speak Spanish. Being able to have an interpreter say some of these medical terms in Spanish, but in a very easy and understandable way, so I can communicate with this patient and tell them, ‘You're going to be okay. Are you having any symptoms?’ Explaining it to them in their language so that they can feel comfortable in their own skin to express how they feel.

 Excellent. As you were speaking, Dr. Momah, I did think about what is coined as cultural competency. Being able to, to your point, speak the language for those patients, whether it is a different language, whether it's sign language, if you're dealing with deaf individuals, or whether, as you said earlier, the LGBTQ population. Race, ethnicity, gender - all these are critical when engaging with patients.

And Dr. Marable, I wanted to ask you if you could describe some actionable ways that pharmacists can address these disparities, and also how to best engage with a diverse patient population and within their own communities?

 Yes. With pharmacists, we're uniquely positioned to really create positive change and to interact with patients from diverse backgrounds, communities, and socioeconomic backgrounds. I always am a champion of pharmacists to be able to really put our best foot forward and to try to address these various barriers and try to break them down.

So just a few unique ways to accomplish that is to try to engage with other like-minded organizations in your area to try to create unique partnerships and to build off of each other. You have various organizations in whatever respective community that you're in: you have religious organizations, you have public health and public safety organizations. It will be in your best interest, as a health care professional and leader within the community, to really try to align with them and see what services that they offer that could assist you and how you interact with your patients, and vice versa, because you have a professional level of service - from immunizations, to medication counseling, point of care (POC) testing - all of these different services you already have readily available, but you may not have that unique connection with those patients.

And by aligning with those organizations, that can help facilitate those relationships. Really being able to build relationships with the individuals within your community, that is more than half of the battle. And if you can accomplish that, that will help you in delivering the best level of care that you can and create those positive outcomes in the health and wellness lives of the patients that you serve.

 Dr. Marable, you mentioned some great points. And as you were discussing that, I thought of one of the most challenging populations that we're facing as a country and when it comes to health care and would like if you could expound a bit on our elderly population, especially in urban communities.

 Yeah, absolutely. During this COVID-19 pandemic, I feel like this has been an exposing moment for everyone that's involved, most specifically with our elderly patients.

Having a background and working in community pharmacy and interacting with patients who come from that elderly population - it can be situations where they have limited access to come into your pharmacy, they may have situations where they may not understand their full regimen of their medications.

The benefit previously, before the pandemic, was you would be able to communicate with them in person and to be able to interact with them face to face. But now, we're in a situation where those opportunities can be few and far between.

So, being able to utilize resources that you have at your disposal is going to be critical. Not only using them for yourself, but also ensuring that those patients have the understanding and ability to use those as well, because if they're not engaged in their health, and they don't have that interaction with their health professionals, with their physicians, with their nurse practitioners, then the likelihood of them disengaging and not fully understanding their care increases.

That puts them in the position where they're already a part of a vulnerable population, and that makes the situation compounded to be even worse. As pharmacists, we have the ability to utilize technology and our resources to best interact with our patients who come from that elderly population to make sure that their care is kept that priority number 1.

 Thanks for that, Dr. Marable. Dr. Ilonzo-Momah, can you share with the audience things you're doing within your pharmacy to better understand the patients? And if you could describe some recent experiences during COVID-19, during George Floyd, where that engagement and interaction really stood out?

As part of our ThoughtSpot 2021 podcast series, guest host Dr. Lonie Haynes leads the conversation with diversity experts on how pharmacists can work to reduce health disparities. 