Keith Loria is a contributing writer to Medical Economics.
How will a change in administration, a vaccine for COVID-19, and other factors change the industry in the year ahead?
At the end of 2020, the biggest buzz in pharmacy—and the world—were the Pfizer and Moderna coronavirus disease 2019 (COVID-19) vaccines. At press time, both vaccines have received emergency use authorizations by the FDA and began shipping in the US.
Tom So, PharmD, clinical pharmacist/manager of the Meducation Group at First Databank, which provides drug and medical device databases that help health care professionals make precise decisions, noted that these vaccines will present challenges to pharmacies due to the special storage requirements and handling issues with ultracold freezing needed for the Pfizer vaccine (–80 degrees °C to –60 degrees °C). Additionally, these vaccines are 2-dose regimens, so medication adherence will be crucially important to their effectiveness.
Another challenge will be vaccine hesitancy as a result of the rhetoric that surrounds the vaccines and their rapid development to date. Will patients trust the safety of these rapidly developed vaccines?
“All of this remains to be seen, but it’s certainly an area where pharmacists can make a big impact,” So said. “Pharmacists are one of the professions that patients truly trust. As pharmacists, we should follow the science and convey this information to patients in language they can understand, to boost the number of Americans that get vaccinated, in an effort to hopefully help end this pandemic.”
Calvin Knowlton, PhD, MDiv, BScPharm, CEO of Tabula Rasa Healthcare and former president of the American Pharmacists Association, believes one of the biggest trends in 2021 will be a focus on the safe use of medications.
“We have been talking about this for more than 5 decades, but it seems that this will become the future of the pharmacy practice,” he said.
Reasons for this shift are many. For one, dispensing margins continue to shrink, which will reduce a pharmacist’s involvement and increase the responsibilities of pharmacy technicians. Additionally, society, via government mandates, is moving the industry to value-based payment versus fee-for-service health care models.
In Knowlton’s opinion, pharmacists are uniquely suited for identifying and mitigating adverse drug effects. “Pharmacists fully understand and have been educated on the sciences underlying drug disposition,” he said. “If one compares the curriculum of pharmacy school education to medical school education, pharmacy education focuses on pharmacokinetics, pharmacogenomics, pharmacodynamics, etc, and medical education focuses on patho-physiology of organ systems and differential diagnoses.”
Among the trends to keep an eye on for 2021, said George E. MacKinnon III, PhD, MS, RPh, FASHP, FNAP, who is founding dean and professor of the Medical College of Wisconsin School of Pharmacy, are continued adoption of virtual, telehealth, and digital health services and the electronic health record (EHR) becoming more accessible digitally to pharmacies, nontraditional sites, and patients.
“Additionally, the ongoing shortage of primary care physicians and the fact that many patients have not been seen by providers due to COVID-19 for their chronic medical conditions that most often require medications and dosage adjustment to achieve goals, presents a unique opportunity for pharmacists to be reimagined as the ‘Front Door to Health Care,’” he said. “Bidirectional access to the EHR is critical.”
So noted a key priority for pharmacists will include helping patients with medication adherence. Because comorbidities are risk factors for COVID-19, it is important that patients be adherent to their medications, especially for chronic conditions such as heart disease, diabetes, and COPD. Other priorities will include pharmacists taking on more responsibilities such as ordering and administering COVID-19 vaccines, making medication therapy recommendations to optimize patients’ drug regimens, and making drug substitutions when drug shortages occur.
Giuseppe Aragona, MD, general practitioner and medical advisor at Prescription Doctor, sees more pharmacies turning over to a more advanced click and collect system in 2021, where patients will book in to collect medicine at specific time slots, rather than just show up.
“This is likely to stop masses of people arriving at the same time, helping to keep a more controlled environment for prescription pick-ups,” he said. “Secondly, and slightly more difficult, will be a more common move towards delivery. Dealing with prescription drugs is a lot more sensitive than delivering somebody’s meal, so whether this could feasibly be done on a larger scale, with privacy and safety front and center, will be a big part of whether we see this happen more commonly.”
The COVID-19 pandemic of 2020 has brought forward the challenges of an overwhelmed health care system and a need to embrace all essential health care providers, and that embrace needs to include pharmacists. The pandemic has changed society and the way that individuals go about their daily lives.
“For the major pharmacy retailers and even independent pharmacies, making home delivery an option may cut down on in-store purchases, but it could retain existing business and bring in new sales by alleviating concerns from patients who are seeking ways to limit their potential exposure to the virus through similar options such as grocery deliveries,” So said.
With the pandemic, many patients were directed to stay at home or shelter-in-place, severely disrupting the previous paradigm of in-person receipt of care. “Perhaps the greatest fundamental shift was the acceleration in the acceptance of telemedicine,” said Jesse C. Dresser, Esq, a partner and head of the pharmacy group at law firm Frier Levitt.
“Previously viewed with skepticism by regulators and payers alike, telemedicine prescribing has become a central aspect of care delivery, and will remain in 2021.”
With President-Elect Joe Biden set to take office on January 20, 2021, pharmacists should see some impact going forward.
“We may see legislation that could result in pharmacists being granted widespread provider status that may enable them to gain reimbursement for specific services such as pharmacogenomic testing evaluation and drug therapy recommendations,” So said. “However, gridlock on Capitol Hill could stall these changes.”
Although the Trump Administration has long been pushing to remove manufacturer rebates in the Medicare Part D space, this does not appear to be a high priority on President-Elect Biden’s agenda. “Instead, Biden has emphasized that his administration will reduce drug prices through various avenues including, without limitation, repealing laws that prevent Medicare from negotiating lower drug prices with drug companies, setting reasonable prices for new drugs that don’t face competition, prohibiting companies with ‘abusively priced generic drugs’ from raising their prices and impos-ing tax penalties on these companies, allowing people to buy safe prescription drugs from other countries, improving generic drug supplies, and eliminating tax breaks for drug company ads,” Dresser said.
Biden has hinted at revoking the non-interference clause, the Medicare Part D provision that has long prevented the government from taking a direct role in negotiating drug prices.
Kok-Hong Tan, BSPharm, a pharmacist at EHR Pharmacy, an independent community pharmacy in Fort Worth, Texas, said the pharmacist profession and practice will continue to evolve in 2021, driven by the changing needs of society, pharmaceutical markets, advancements in treatment, government regulations, and so on.
As the pharmacy landscape evolves, health care technology standardization and advancement will also need to progress.
“When one of these factors above creates a ripple, the pharmacy practice landscape will be affected in a different magnitude,” Tan said. “Pharmacist-provided patient care will be the future of pharmacy services, as the pharmacist profession slowly gains full provider status in the health care world.”
So noted that Amazon’s entry into the pharmacy services space will have a potentially big impact on the market in 2021. “They will offer direct competition to major pharmacy retail chains,” he said. “People are so used to using their Amazon app to purchase other essentials, whether it is household products, face masks, clothing, or electronics—it will be interesting to see if they will also use the service to order prescription drugs.”
And although there’s no question that COVID-19 has altered pharmacy, Knowlton argues that Amazon and its subsidiary, Pillpack, will have larger lasting effects on the pharmacy landscape in the future. “This is all the more reason that community pharmacists must position themselves as the medication regimen quarterback or coach, and charge for it as a concierge pharmacist,” he said. “To move from the 50-year-old, 1-drug to 1-drug interaction construct that is based on what has been reported in the literature, to a multidrug simultaneous drug interaction system based on pharmacotherapy science, with COVID-19 drugs or without, is the future for the profession.”
In 2021, Knowlton encourages fellow pharmacists to use their pharmacokinetics, pharmacogenomics, and pharmacodynamics background and put it to use.
“This is our real value proposition as pharmacists,” he said. Pharmacists assist in management of chronic conditions through comprehensive medication management services in community pharmacies. Yet, reimbursement models from many commercial insurers and government (Medicaid and Medicare) have not caught on to fairly compensating pharmacists.
MacKinnon feels the pharmacy profession in conjunction with medicine, needs to step forward to accept this challenge and make changes for patient and provider benefits alike.
“Keeping a patient on their medication and out of the ER/hospital saves money,” he said.
Looking ahead, MacKinnon would like to see more emphasis on pharmacy partnering with medicine. “The explosion of high-cost specialty pharmaceuticals and growing use of biomarkers with the soon-to-be future of precision medicine at our doorstep, as deployed via pharmacogenomics, it only makes sense that pharmacists emerge with a more appreciated and expanded role,” he said.
“Frankly, the addition of a pharmacist to most physician group practices will be clinically and financially prudent if not essential in time.”