American Pharmacists Month: Pharmacist Barriers, Expansion of Scope Since the COVID-19 Pandemic

From the historical events and occurrences that have commonly held pharmacists back to the recent laws and expansion of their scope of practice, the pharmacist’s role in health care has evolved significantly in the recent past.

Discussing recently added pharmacist authorities in her state, as well as how the COVID-19 pandemic opened the door for pharmacy services, Alyssa Mack, PharmD, pharmacist at Gibbs Pharmacy and Compounding Center in Lebanon, Tennessee, joined Drug Topics to celebrate American Pharmacists Month.

“A good place to start with that would be with the COVID-19 pandemic,” Mack told us. “It was just a really pivotal time for pharmacists to show up and reinforce all that we can do as pharmacists. We really did that. You look at the statistics of how many vaccines were given by pharmacists and COVID testing, and it was millions to hundreds of millions of vaccines provided by pharmacies across the country.”

In part 2 of our interview with Mack, she discussed the recent events that have allowed her pharmacy to expand on its clinical service offerings and how pharmacists have been overcoming authoritative challenges in the greater health care industry.

READ MORE: American Pharmacists Month: Expanding Services Through Dedicated Pharmacy Clinic

Drug Topics: What are some of the key developments in recent history that have allowed pharmacists to expand their clinical offerings and truly stand out as medical providers?

Alyssa Mack: I think there has been a lot that's happened over the last several years that have made such a difference for us. A good place to start with that would be with the COVID-19 pandemic. It was just a really pivotal time for pharmacists to show up and reinforce all that we can do as pharmacists. We really did that. You look at the statistics of how many vaccines were given by pharmacists and COVID testing, and it was millions to hundreds of millions of vaccines provided by pharmacies across the country.

Having that opportunity to provide the vaccines, go into communities that might not have access to vaccines otherwise, and even expand that opportunity to our technicians too; that's something that we weren't able to do previously, but now we were able to get our pharmacy technicians involved and really reach all corners of the United States. That was thanks to those emergency authorizations that we were able to show up. I think as pharmacists, we know what we're capable of, but we're not always given that opportunity to prove it to everyone else who might not understand what we're trained to do. Even though the COVID pandemic came with a lot of hardship, it was a great opportunity and we've seen a lot of changes since then.

We are in Tennessee, and Tennessee is honestly a great state to work in as a pharmacist. We're pretty progressive with our laws, and they expanded our scope of practice last year. That has been really, really helpful to us for our clinical services. We are now, under our scope of practice, able to be the prescriber on vaccines; we don't have to worry about collaborative practice agreements anymore or getting a doctor's order. We have the authority to check a patient's vaccine history and make the decisions on what they're eligible for ourselves.

We can also do test-to-treat for flu and COVID—not just provide those tests but then be able to prescribe treatment based on the results. Then, we were given prescriptive authority to prescribe for things like EpiPens, post-exposure prophylaxis for HIV, hormonal contraceptives, fluoride. There's a whole bunch of things they passed for us that was really helpful. We can also do TB testing now too, which is pretty cool.

This has been really helpful for us because now we're able to expand access to care. What we see in the community we work in, we have suburbs but then we're also very close to rural areas. We have lots of patients that have a hard time finding providers or places to go for these services. By expanding our scope of practice, that has been a really big impact in helping us serve our local communities.

Drug Topics: Given these developments and the expansion of pharmacists’ scope as of late, what are some of the main reasons why pharmacists have been historically held back in their roles as health care providers?

Alyssa Mack: There's a couple of different things that we can pinpoint as why we've been held back in the past. The first one, I will say, I think [is] reimbursement. I know it's a hot topic; we talk about it a lot as pharmacists, but I do think that that has been a really hard barrier for us to overcome. Provider status, we talk about it at the state level, we talk about it at the federal level, and waiting for that to be nationwide will be really important for us. Reimbursement is really hard. We know we can provide these services to patients, we know what we're trained to do, but it's just not feasible to expect your pharmacist to be able to step away from dispensing, provide 1-on-1 care and all the services that we're capable of without having that reimbursement to go along with it. I think that is something that's really been holding us back, that provider status. Then even once you get it, navigating the contracting and credentialing of insurance is really difficult. That's one of the main things that I work on here at Gibbs Pharmacy. It's taken up a lot of my time to try to get all of our pharmacists credentialed and contracted to be able to bill and be reimbursed for our time anyway.

I also think that public perception has been another barrier for us that's held us back. I do think that has started to change lately, especially following the pandemic, where, at the worst opinion, people might say that we just put pills in a bottle. [That’s], of course, not what we do, but some people just perceive us as that and don't understand our knowledge and the skills that we possess. The more that pharmacies can offer, the more that people will start to see what we are capable of. I think we've seen that with vaccines, where, when they first allowed pharmacists to give vaccines, people didn't know that that was something we could do. There was a lot of hesitancy, and now, most of your vaccines are given in pharmacy. We're just at the beginning of doing that with things like point-of-care testing, education, [and] other types of services that we're able to provide.

The other big thing that I see a lot of the time is just the staffing and workflow demands being a barrier to these services. Depending on where you work, you just might not have time to step away and spend time providing these services. If you don't have the staff for it, then the rest of your day gets behind, and that can be really difficult to come back from. Finding that balance of staffing and time to provide the services or having a pharmacy that wants to invest in someone to develop the services is also really important. I think we're just trying to navigate how to redo the pharmacist workflow.

READ MORE: American Pharmacists Month Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips, straight to your inbox.