Shift to Clinical Services Requires Pharmacies to Evaluate Workflow

In the 2 years since Congress passed the Inflation Reduction Act, much of the public debate has focused on how Medicare’s new drug price negotiation powers could lower costs for patients. Less attention, however, has been paid to what those same policies mean for the neighborhood pharmacies that dispense those medicines every day. As Medicare begins implementing “maximum fair prices” for a growing list of high-spend Part D drugs, independent pharmacies find themselves squeezed between federal policy goals and the financial realities of keeping their doors open.

Under the IRA, Medicare can now negotiate prices for certain expensive brand-name drugs, with new, lower maximum fair prices taking effect over time. For patients, that can translate into smaller out-of-pocket bills at the counter. But for independent pharmacies that must still purchase these drugs up front from wholesalers—often at prices that don’t immediately fall in step with Medicare’s negotiated rates—the math can quickly turn upside down. If the acquisition cost exceeds what pharmacy benefit managers and Part D plans reimburse, each prescription filled can become a money-losing proposition. Facing thin margins and volatile reimbursement, some pharmacies are already questioning whether they can afford to stock certain negotiated drugs at all, even when their patients need them.

In this interview, Eric Lee, PharmD, BCACP, assistant professor of pharmacy at Campbell University, discusses this change as well as clinical services such as test-to-treat. Many states are pushing pharmacies to move beyond the traditional dispensing role into more robust clinical care. Standing orders and collaborative practice agreements are expanding pharmacists’ authority to provide services like CLIA-waived point-of-care testing and “test-and-treat” programs for conditions such as influenza. These shifts promise better access and more efficient care—but they also carry new legal and documentation obligations. Pharmacies must now design systems to track adherence to protocols and maintain retrievable records that can withstand regulatory and reimbursement scrutiny.

“You need to have a way of documenting patients when they come in that you follow that statewide standing order,” Lee said. “You effectively and appropriately triaged that patient and treated them according to that protocol, and you need to have a way to store that and make that readily retrievable, just in case.”