Key trends point to a collaboration between pharmacies and healthcare stakeholders that will shape better delivery of patient education, adherence support, and financial assistance.
The U.S. healthcare system is in the midst of dramatic change. New technologies, medications, and techniques are revolutionizing how and where healthcare is delivered. Demographic, economic, and legislative forces are resulting in increased pressure to do more with less, with an intense focus on controlling costs and preparing for more integrated care delivery and value-based payment models.
Certain key trends are setting the stage for a collaboration between pharmacies and healthcare stakeholders that will shape better delivery of patient education, adherence support, and financial assistance.
While the Affordable Care Act enabled eight million Americans to sign up for health insurance, more than 275 million visit a retail pharmacy in a given week. The strength of retail pharmacy has traditionally been the connection shared with the local community, from the iconic soda fountain of the ’50s to same-day photo developing in the ’90s. Regardless of the strategy, these retailers have competed primarily on location and convenience.
However, as the healthcare landscape rapidly evolves, the definition of value also continues to change. Payers, now under tremendous pressure to lower costs, are leveraging a perceived oversupply of pharmacies to their advantage by creating preferred and limited pharmacy networks.
Under these models, payers are able to decrease their cost to provide drug benefits by contracting with a subset of pharmacies. In exchange for lower reimbursement rates, pharmacies that align with payers have preferred access to the plan’s members.
While “narrow networks” limit pharmacy choice, the benefit to the consumer comes in reduced cost or increased savings - a tradeoff it appears that many patients are willing to make.
Although trends such as narrow networks present challenges to traditional pharmacy-industry norms, they are also spurring a revolution in the practice of pharmacy. Innovative approaches are bringing pharmacy to the forefront of patient care, with new opportunities to interact and collaborate with healthcare providers to transform the quality and convenience of healthcare.
Healthcare providers are increasingly being held accountable for the quality of care patients receive. One point of impact, medication adherence, is gaining increased visibility, as research reveals a positive correlation between higher adherence rates and lower healthcare costs. As a result, when it comes to addressing financial and behavioral barriers to adherence, pharmacy is seen as an invaluable ally.
With the number of interested sponsors growing daily, a broad range of collaboration strategies has emerged to engage pharmacy in the management of medication adherence for chronic diseases. Below are just a few examples:
The increased focus on medication adherence is not news to manufacturers who have been focusing on outcomes-driven patient support - and generating results - for years:
· Medication synchronization programs delivered by independent pharmacies have been found to increase the likelihood of adherence by 30%.
· A recent manufacturer-sponsored behavioral coaching program that focused on outreach at first and second fill for diabetes patients showed an incremental 1.5 to 2 refills with an impact lasting as long as 18 months.
· Another payer-sponsored study of pharmacy interventions showed increase adherence from 3% to 5% across a range of drug classes, as well as potential to reduce annual healthcare spending by ~$250-$350 per patient.
In addition, while physicians remain a primary source for patients seeking information about medication savings programs, an increasing number of patients are turning to their pharmacists.
Addressing financial barriers is a challenge for pharmacists, as patients often do not know the amount of their co-pays until that “moment of truth” at the counter, when they are about to pick up their prescriptions. Some patients simply cannot afford to purchase their prescriptions and walk away without their medications.
To help pharmacists meet the needs of patients seeking offers of co-pay savings at the pharmacy, McKesson’s new LoyaltyScript@Retail gives pharmacists easy access to a growing list of online brand offers for medications, making possible more affordable prescriptions and ultimately improving patient adherence.
Beyond medication support, opportunities also exist for retail pharmacy to become a more valuable, tightly integrated part of the healthcare delivery system. In the past decade, pharmacies nationwide have expanded their capabilities to provide immunizations and other preventative services.
Although these services may have opened the door, emerging patient-centered, team-based models are further testing previous boundaries. These models steer the patient to the most appropriate clinician, depending upon the nature of the health problem; and most team-based-care pilot programs include a pharmacist.
Tony Willoughby, chief pharmacist of Health Mart, recognizes the impact community pharmacies can have on performance measures such as STAR Ratings.
“This is an opportunity for pharmacists to be recognized for the outcomes they drive beyond dispensing - it goes well beyond ‘the right pill in the right bottle to the right patient.’ Community pharmacists are very well positioned to support all stakeholders, whether payers, physicians, ACO groups, or patient-centered medical homes, to make sure that patients are on the correct therapy and remain adherent to that therapy.”
For example, a partnership between Rite Aid and Heritage Provider Network (HPN) in California has focused on improving coordination of care for patients with chronic diseases such as COPD, diabetes, and cardiovascular disease by offering access to Rite Aid’s medication, nutrition, and disease education and support.
Rite Aid pharmacists and HPN physicians share information on interactions with patients, and collaborate with specially trained health coaches located in select pharmacies to develop care plans focused on improving outcomes. Coaches focus on helping patients achieve physician-identified wellness goals and improve patients’ overall health and self-management abilities.
As the industry grapples with the shift from a transactional, siloed system to a highly integrated, value-based model, the role of the retail pharmacist, one of the most trusted and accessible community healthcare professionals, is evolving rapidly.
Retail pharmacy now drives innovation designed to better manage health and chronic disease, optimize patient outcomes, and lower healthcare costs. Expanded services range from wellness support, disease prevention, chronic disease management, patient education, adherence coaching, and provider consultation.
As the value of these contributions becomes more widely recognized by regulators, pharmaceutical companies, providers, and payers, the pharmacy of the future may look dramatically different, investing its current assets of access, trust, efficiency, and clinical knowledge in entirely new and powerful ways.
As pharmacies evolve to provide a viable platform for therapeutic alliance across the healthcare continuum, new opportunities emerge to interact and collaborate with other healthcare stakeholders in delivery of patient education, adherence support, and financial assistance. Under pressure to get more with less, prescribers and pharmaceutical manufacturers would be remiss not to make pharmacy a key part of a multifaceted care-delivery strategy.
Stacey Irvingis vice president, Strategic Channel Marketing, Sponsored Clinical Services Network, McKesson Patient Relationship Solutions. Contact her at Stacey.Irving@McKesson.com.