Five Major Issues Facing Pharmacy

How these issues are handled will have a major impact on the future of pharmacy practice.

Two years ago, I wrote a column entitled “Megatrends in Pharmacy” in which I outlined the 10 key trends that I thought would transform the pharmacy profession during the coming decade. As I reviewed my 10 trends today, I felt pretty comfortable with what I suggested. If I were writing them now, I think I would keep most, if not all. Now, I want to discuss the future in light of 5 major issues I see facing pharmacy. How these issues get resolved will have a major impact on the future of pharmacy practice.

Issue #1: Too Many Employee Pharmacists

Change comes when someone does something different. When that activity meets a real or perceived need, it makes money for the innovator. In pharmacy’s history, it has been the pharmacy entrepreneurs who have been the practice innovators. These people are the risk takers. Employee pharmacists are generally not real risk takers, although they can sometimes be innovators within a system.

What pharmacy needs to help us prepare for tomorrow are “out-of-the-box” thinkers who are willing even to put their careers at risk to make the pharmacy advancements that solve real patient problems. That requires a different mentality not possessed by most employee pharmacists. Perhaps the entrepreneurial spirit can be taught, but probably it will require the recruitment of different personalities into pharmacy. Related issues associated with this are the growing oversupply of pharmacists; pharmacists’ willingness to let the current law dictate their practice rather than working to change it; and low pharmacy organization membership, especially at the state level.

Issue #2: Comprehensive MTM

Is comprehensive medication therapy management (MTM) different from what most pharmacists do when they get paid for MTM today? What occurs under the rubric of MTM today is often a focused intervention to solve 1 patient care problem. Comprehensive MTM puts that 1 problem in a broader context of the patient’s total drug profile and makes broader recommendations that change the patient’s drug therapy profile. Supporters of comprehensive MTM feel that only selected pharmacists can perform such a review, while acknowledging that focused MTM can be done by most pharmacists. To really impact a patient’s quality of life as well as assure health care cost reductions, comprehensive MTM is required. How payers and pharmacy address this issue can have real impact on pharmacy’s future. Related issues include pharmacist provider status; uniting pharmacy organizations; and the role of pharmacists in primary care.

Issue #3: Uniformity of Pharmacy Practice

Just because a pharmacist can do a particular function does not mean that all pharmacists can do it well. This issue has 2 components. Does pharmacy have in place the right programs, such as practitioner certification programs or practice site accreditation programs, to ensure that consumers will be able to experience similar quality when they receive services from different pharmacists or pharmacies? Clearly, pharmacy has been moving forward on these fronts, but at the community practice level we have few certified practitioners or accredited practice sites.

The other aspect of this issue reflects on the pharmacist practice model. Is drug dispensing the pharmacist end or is it just the means to a more important role? This is the way I would frame the issue. How the profession answers this question and how patients and payers respond will clearly have a major impact on pharmacy’s future. Related issues include the pharmacy technician role; training student pharmacists in the practice environment; and the need for community pharmacy accreditation.

Issue #4: Better Documentation of Pharmacist Activity

As health care responsibilities change, better documentation of what pharmacists do becomes critical. From an audit perspective, the adage “If it isn’t documented, it wasn’t done” applies even more today. But if we want to be able to see the pharmacist value proposition become truly accepted—“When pharmacists are involved, patient access and outcomes improve while patient care costs are less”—we have to keep documenting our contributions. As pharmacy changes, what pharmacists document and where they document it becomes important.

The profession needs a standardized documentation process that all pharmacists utilize, such as the “Pharmacist Workup of Drug Therapy.” Too many pharmacists use their own system rather than a uniform process in providing patient care. This lack of standardization for a pharmacist patient workup has impacted the broad acceptance of pharmacists as part of the team. As health care becomes interdisciplinary, pharmacists must become essential team members since drugs play such an important role in the care process. A standardized documentation system is critical to the pharmacists’ acceptance on the health team. Related issues are how pharmacists are recognized as contributors to a Medicare Plan Star Rating; how medication safety measures from the Pharmacy Quality Alliance are utilized; and even the role pharmacists will play in medication synchronization or adherence monitoring programs.

Issue #5: New Health Care Law of the Land

As everyone knows, there is a new law in effect that will have great impact on how health care will be delivered in the future. For the most part, pharmacy collectively has stayed out of the broad political fight about the issue, but has tried to have the profession positioned to function well within a transformed system. As the debate continues to play out in Congress and state houses, reform continues. It seems certain that reimbursement models will move from fee for service to some type of shared risk contracting. Where does a profession like pharmacy, primarily supported by (drug) product payments, fit into these new payment schemes that provide payment based on accountability for outcomes?

The way pharmacy addresses the previous issues will determine how well we do in a reformed health care system. It will determine whether most pharmacists can practice at the top of their license or whether the pharmacist continues to remain the most underutilized health professional tomorrow. I’m betting that pharmacy makes the changes to become an even more important team player in all settings.

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is interim executive director of the North Carolina Association of Pharmacists.