Accelerated Changes in Pharmacy Make Advanced Practice Essential for Pharmacists, Technicians

In an interview with Pharmacy Times, Deeb Eid, PharmD, regulatory affairs advisor at CVS Health, discussed how pharmacists and technicians are working to advance pharmacy practice. The COVID-19 pandemic accelerated many changes in the pharmacy field, but maintaining that momentum and working together will be essential for the future growth of pharmacy.

Aislinn Antrim: Hi, I'm Aislinn Antrim with Pharmacy Times. I'm here with Deeb Eid, regulatory affairs advisor at CVS health, to discuss advancing pharmacy practice for both pharmacists and technicians. So, the entire pharmacy field has changed a lot and advanced a lot in the last 2 years or so. How does this really necessitate advanced pharmacy practice for pharmacists and technicians?

Deeb Eid, PharmD: Thank you so much for the introduction, I appreciate it and I’m really looking forward to chatting with you today. And thanks for the first question. You know, just to get it out of the way, obviously, you know, anything that I talk about today is going to be things from my opinions and things that I have either come across or researched.

And so, to answer your first question about the field of pharmacy changing in the past 2 years, you're absolutely correct. In the last couple of years, pharmacy has had an opportunity, really, to step up and showcase their value and importance in health care as a whole. And we've been shown generally speaking to the public, but also to other agencies out there, like the FDA and others, that we are a critical piece as the medication experts, and also beyond just the dispensing process. So, I think, as we have an aging population, we have changes in societal expectations, we're moving towards maybe more efficiency, cost effectiveness, and even some automation in the future pharmacy. And I think some of the other personnel that are involved in the pharmacy are really in a position to provide care or are in a position to provide service and communication. And really, I think, continue to work through the interesting environment that we're going to see in probably the next 10 to 20 years.

Aislinn Antrim: Absolutely. Gaining provider status has really been a centerpiece of all of these efforts, so what efforts are being made in this direction and why is this essential?

Deeb Eid, PharmD: Yeah, provider status is an interesting topic. And definitely, like you said, a real centerpiece in terms of pharmacy practice. I think it's super critical to ensure that we as a profession are recognized as providers and obviously to be paid for services, but the services that we are capable of, and also that bring patients value. I think that's a key piece to remember, is that patients do need to have the value in the services that we are providing. And as pharmacy and the profession move forward, I believe we are moving into those areas.

I think one of the things that I want to say is that it is a bit interesting. Now, this topic has been around for probably 10 to 15 years, you know, we've been talking about provider status, and it's probably been around for even longer than that. But it's a little bit ridiculous, in my opinion, that we're a doctorate level health care professional and we're not recognized as providers. In my opinion, it's a little bit challenging for us to move forward in some of the things that we're trying to get into, in terms of services and things that bring patients value. Unfortunately, we have a lot of politics involved in the process. There's some turf wars that are getting in the way. There are some states out there, I know, that have been working towards passing legislation or adapting some of their rules, and some of those states have been successful. So, that is obviously, you know, we're moving towards the right direction.

And one misconception that I do want to address, that I think a lot of people believe, is that gaining provider status possibly from the federal and even state level is going to be kind of like this resolution to all pharmacy issues. But I don't think that it is. I think it's part of a complicated puzzle, and it's one piece to the puzzle that needs to be resolved. But I don't think it's, you know, kind of a magic pill or a one-size-fits-all that's just going to magically solve everything that's going on in pharmacy. From the federal level, there's been a standstill and provider status. I think some of it has been due to challenges with lobbying. I've heard that scoring of the bills on the federal level has also been a challenge. I think that my best takeaway on this topic is we as a profession, we need to step up our game. We're being outspent by other professions by millions of dollars in the lobbying area and so that is a huge challenge for us. And we can't keep fighting the same topic for the next 20 years. It's already been about 10 or 15 years that we've been working on this. So, we really need to step up, we need to unite, and we need to put money and efforts into this topic to move it forward on the federal and even the state level.

Aislinn Antrim: Definitely. And, of course, advancing technicians is really essential in order for pharmacists to be able to step up and do these other responsibilities. So how are our technicians really stepping forward and taking on those responsibilities?

Deeb Eid, PharmD: That's an awesome question and I'm glad you asked this actually, it’s one of my favorite topics to talk about. So, I'll try to keep it brief on this one. So, you know, technicians have been stepping up taking on more responsibility and we've seen this across the board. The first thing that comes to mind is immunizations, administration of immunizations, and medications. Of course, if we look back to 2018, 2016, kind of, you know, the very beginning, and in the state of Idaho, where this originated from a state level, we went from about 3 states who had passed some sort of laws or rules and in 2018, to now over 20-plus states who have passed either laws or rules or continue to work on this. And then, the other piece that was very important during the pandemic, that has been important during this pandemic, is the federal PREP Act with, you know, the HHS Federal PREP Act, which has allowed for essentially all 50 states and DC for technicians to administer various types of vaccines and immunizations. And that has really moved the profession forward in terms of allowing another individual on the team to help out with, you know, the increasing challenges that we're having, and really to protect patients. So, immunizations is one piece.

Another piece I'm seeing out there is technician product verification. So having technicians be involved in the final product verification, within the dispensing process. A lot of people are a little iffy on the topic, you know, it makes some people nervous, but I can tell you that there's over 40 years of either evidence or published literature, over 25-plus pieces of published literature and posters on the topic that showcases with various amounts of training, with various amounts of sectors of pharmacy, that technicians are capable of doing this in a safe and effective way. That's very comparable to that of a pharmacist. And so that's another area where we've seen a few states out there and advancements. And of course, there's training programs and a lot of models of how to set that up.

Another area would be expansion of remote work or work from home allowances. So, you know, allowing technicians the flexibility to be able to help take off some of the workload that's happening in a lot of our in-person pharmacies. And so that's also been another advancing area to help with distribution of work.

And then the last piece is point of care testing, point of care, test-and-treat programs. So, it's crucial to have technicians being a part of this as we advance. Of course, we've seen this with COVID-19 and, again, the Federal PREP Act allowances, but really just having technicians be on the testing side of things. And then the pharmacist obviously is then able to treat in some states and in some states even prescribe off those test results.

Aislinn Antrim: Wonderful. Well, speaking of prescribing, can you discuss the Paxlovid authorization for pharmacists and how that could be a step in the direction that we're talking about?

Deeb Eid, PharmD: Great question. So, the Paxlovid authorization is a very positive step moving forward by the FDA. They revised their Emergency Use Authorization for Paxlovid, and it essentially allows the state licensed pharmacists to prescribe Paxlovid to eligible patients. And it has a positive impact on those patients because as we know, patients are out there, and they need these medications, or they might be looking for some relief if they've gotten COVID-19 or have contracted the disease. And so, it is a positive impact and another person on the team that can help patients in terms of their health.

Now, it is super important that the FDA from the federal level is recognizing pharmacists as a prescriber. This is definitely a huge step forward from where we've been. It does beg the question, though, of why not more? You know, if pharmacists are able to prescribe for a medication that was just released within the last couple of years for a fairly new disease, why can't they prescribe for other disease states that have been around for ages that we have data on, that we've been involved with treating for multiple years and multiple patients and we have a lot of studies. And so, I think that that's kind of the takeaway for me, is it's exciting to see that the FDA is recognizing pharmacists as prescribers. And I hope that with some lobbying efforts, and us stepping up and uniting as a profession, we can continue to move forward in other areas. And there's some states out there that have, like Idaho, for example, Utah, Colorado, they've moved into pharmacist independent prescribing, and I think that that's really the next big step for us.

Aislinn Antrim: Absolutely. And how is technology really being used and leveraged to advance pharmacy practice?

Deeb Eid, PharmD: Yeah, technology is super important in terms of advancing practice and not just advancing practice, but really make sure that we have models in place that are efficient, safe, and also bring something to the patient that's going to be keeping up with societal expectations, right? So, that's one thing that I like to think about as well. So, automation is in place to ensure that we can have a safer dispensing process, so when you have robots who are able to dispense medications, no matter what type of facility you're in, you're almost guaranteed that it's going to be as safe of a process as possible, as long as everything is set up and maintained correctly by those who are working on setting up the robots and keeping them up to date. Tele-pharmacy and telehealth is another area within automation that is, you know, allowing for more or additional people maybe out there who wouldn't typically be able to be seen, maybe be able to be seen from the comfort of their own home, who maybe need something urgent or need to see a pharmacist or need to see a health care professional, and maybe pharmacy’s tied into that. So, that's another piece where we're bringing health care into the patient's home and making it a little bit more accessible.

Of course, we have central fill and central processing, which allow for fulfillment of our products and processing of our orders, removing some of the work from the actual pharmacies. Obviously, you know, there's a lot of people who are going to pharmacies these days, and a lot of individuals out there who are struggling with the increasing workload. So that's another type of automation, where again, we're trying to kind of distribute the work in different ways. And then you have kind of a more personal level. Think of, you know, your personal device or your phone, you have apps, they're helping people where they're able to go in and refill their medications, they're able to request an appointment. We have kiosks that are being placed in certain states that a patient can go in, and maybe they need their antibiotic that they just saw the prescriber for and they're able to pick up. We have locker systems that are also coming out there, where again, you can have your prescription filled, and maybe you can't make it until after hours. So, that's the exciting piece of pharmacy, I believe, right now. And it's definitely helping with advancements, but also just I think safety and efficiency.

Aislinn Antrim: Definitely. And as we've kind of discussed, the COVID-19 pandemic accelerated a lot of these changes that, maybe they were coming down the road, but it really pushed it to the forefront. But now that we're kind of entering a new normal, we're kind of living with COVID-19 now, so how can pharmacists and technicians maintain the momentum that they've had over the last couple of years?

Deeb Eid, PharmD: Yeah, really great question. So, I think one of the big takeaways we've seen from COVID-19 and the entire pandemic and what has happened is that there are states out there who started using executive orders, there are states out there who started passing legislation, changing their rules, issuing emergency authorizations to allow for pharmacy to serve patients, right? And that's I think the big takeaway that people should have from this is that, really, what was in the way was the laws and the rules of the state. It's not that pharmacy isn't capable of doing more or isn't capable of advancing. I think that COVID-19 showed us that in times of need, we could and we were capable, it was just some of those pieces that were blocking us. And so, moving forward, how do we enter the new normal? How do we maintain that moving forward?

Well, I think number one, we have to embrace that pharmacy has been able to do more for quite some time now. But we have to realize that there is a lot. Once you keep adding to the plate, there's a lot to do, and that's where it becomes overwhelming. And that's where you may not have enough people to be doing these different things. And so that's where we need to continue to work on. How do we use automation to help us in those processes? How do we use things like remote work, work from home, central fill, central processing, some of these things that I just talked about with technology? How do we better use those to expand, you know, some of the increased editions that we're looking at? And how do we then utilize that to spread the workload out so that we are able to continue to keep up because it gets to a point where there's just too much on your plate, right? And no matter how many people you have, no matter how much help you have, etc., like there's just too much to do. And so, we have to make sure we're using those automations and technologies and processes to be more efficient. And to be able to keep up the momentum and not overwork ourselves.

Aislinn Antrim: Is there anything you'd like to add anything that I didn't think to ask about?

Deeb Eid, PharmD: The one thing I think I would mention is I think we're at a point right now in pharmacy where there's a lot of unknowns. Like we talked about today, we have increases in demands, we have potential decreases in the available people who want to either be in pharmacy or who wants to continue to work in pharmacy because of those high demands. I hear a lot of people talking about that topic that you just mentioned, you know, the workload and the burnout, and just things that are continuing to evolve. And I encourage people out there to talk about the topic, but let's talk about the solutions. How do we work creatively and together towards the solution? So, I think a lot of the times when I see the topic brought up, it's not necessarily being talked about in terms of solutions. It's more of there is the problem, which we have to recognize that obviously, there is a problem. But I think moving forward, we need to work together to figure out what are the solutions and realize that the solutions may be things that are not necessarily things that would be the first thing that comes to mind. When you think of the topic like we talked about today, automation can be a huge deal in terms of helping, being able to delegate, being able to work remotely, doing some of these things. You know, as we talked about in terms of advancements, those are the types of things that as we continue to move forward, we need to make sure we're taking care of our profession, taking care of our people, and we need to make sure that we're using our resources properly so that it's not just relying on the backs of everybody, right? You know, a lot of a lot of professions out there have moved towards automation and that's on purpose, not to take away jobs from people but to help with the efficiency and help to relieve some of the challenges that we're having in terms of a workload and conditions and that sort of thing.