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The U.S. pharmacy perspective

The U.S. pharmacy perspective | Image of promotional banner for the webinar containing headshots of presenter, moderator and two panelists - The Canadian Foundation For Pharmacy

The U.S. pharmacy perspective

MARCH 2022 – Pharmacy leaders south of the border shared their vision for the profession in a post-pandemic world at CFP’s February Forum event. The overall message was hopeful that a significant shift forward in pharmacist scope during the pandemic will become permanent in spite of looming barriers along the way.

Moderated by Bruce Winston, Head of Alberta Pharmacy Strategy and Pro­fessional Affairs at Alberta’s Neighbourly Pharmacy, webinar viewers heard perspectives from two independent pharmacy owners as well as Hannah Fish, Director of Strategic Initiatives at the National Community Pharmacists Association.

In looking to what’s ahead, Fish pointed to a real shift in the way pharmacists took care of patients during the pandemic. She said many pharmacists took extraordinary measures to make sure patients had vaccines, including socially vulnerable populations. “The increase in delivery and drive-through services…those will be around to stay because of the convenience factor and the health and safety of staff and patients, “ said Fish.

The fact that pharmacists have been successfully prescribing and administering COVID-19 tests and vaccinations also opens the door to “a laundry list” of other testing potential in pharmacy, she said. “So, when COVID wanes, there’s still the opportunity to test for flu, strep throat and other infectious diseases, as well as A1C and cholesterol monitoring.” (Pharmacists were also granted authority to prescribe and administer other COVID therapies such as monoclonal antibodies.)

In a country with 50 states and 50 different ways of providing pharmacy services, Fish said measures enacted under the Public Readiness and Emergency Preparedness (PREP) Act (i.e., allowing pharmacists and pharmacy techs to administer COVID-19 vaccines) have helped standardize processes across the board. “One thing we are pushing going forward is to make these PREP Act authorizations permanent,” she says. “All of this ability to order and administer vaccines is getting to the crux of the provider status that we’ve been fighting for.”

However, Fish stressed that sufficient pharmacist reimbursement is an ongoing battle, especially now that pharmacists have taken on extra roles throughout COVID-19. “We’ve been recognized [as providers] but now we need the payment to back it up.”

Like Canada, staffing issues and burnout are prevalent in community pharmacies south of the border. Deborah Bowers, owner of Yorkville Pharmacy in York, South Carolina, said finding pharmacy technicians has been particularly taxing during the pandemic. “At one point, I was paying pharmacists to do technicians’ work,” she said, noting that she’s paid more overtime in the last two years than she has over 20 years of running her business.

Hashim Zaibak, CEO of Hayat Pharmacy in the Greater Milwaukee area, said it was hard to compete with other retailers in the area offering signing bonuses. “We now have nurses with us helping out with [COVID-19] testing,” he said. “I’m optimistic things will get better but I don’t think it will go back to where it used to be.”

While pharmacists seek greater authority in non-dispensing roles, Fish said sufficient support staff in the pharmacies will be a priority. “While we sort ourselves out there will be shortages…and we’ll see the pain points of this before we see the benefits,” she said, as evident through recent CVS pharmacy closures. The advantage independent pharmacies have, she added, is the ability to pivot direction more easily than the big chains.

With greater scope of practice for pharmacy techs too, the panelists expect there will be more interest in those roles going forward. “Our techs are making significantly more money now than before the pandemic and that will shift to more people thinking of this as a career,” said Zaibak.

Yet it all still ties back to determining a reimbursement model that isn’t tied to dispensing. “How can I reconcile paying my techs more when insurers are pulling money back, noted Zaibak, referring to direct and indirect renumeration (DIR) fees. (DIR fees allow payers to take back money paid through Medicare prescriptions more than six months later and are often tied to performance metrics and quality). “Pharmacies can do a lot more than dispensing so what can we do to open more doors [for] new revenues not linked to DIR fees, like point-of-care testing for example.”

Being in a high Medicare area, Bowers said the incentive is high to make pharmacy services at least 50% of her revenue model. “Service revenues now are at 15% so we have a long way to go,” she said.

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