COVID-19 Changes Pharmacy Practice Forever

A Public Health Official Perplexed

Recently, I was privy to a call during which a national public health figure was praising pharmacy for all it had done during the past few years of COVID-19 response, from vaccinating to testing to infusions to education and community support. This person then said they were very much looking forward to turning their relationship and attention to other diseases and future public health crises.

Then an attendee asked the obvious: “How will pharmacists and pharmacies do these activities without payment?”

The public health official was perplexed and asked what they meant. The attendee explained that the Public Readiness and Emergency Preparedness (PREP) Act and the pandemic has led to expansions in both the scope of practice and expanded abilities to get paid for services. Without those expansions, pharmacists would not be able to bill for diabetes or high blood pressure services.

“What! You can’t bill for your services?” the authority responded. He had never known that pharmacists couldn’t bill across the board.

Prescribing Paxlovid and Charging for the Service

For the federal government and public health officials at all levels, lesson 1 from the pandemic response is that pharmacists can reach an incredible number of people very quickly, efficiently, and safely. Lesson 2, after looking closely at the data, came in the form of demonstrated superiority in reaching rural, underserved, and vulnerable communities. Community pharmacies generally serve the patients in their own neighborhoods, and they are effective at increasing uptake of necessary services.

However, what went right with the PREP Act went horribly wrong with Paxlovid (nirmatrelvir-ritonavir) because the FDA stepped in and prevented pharmacists from prescribing it. And, surprise! Very little uptake ensued, as patients had to navigate a complex and frustrating health care system that often involved testing, office visits, and dispensing in 3 different settings of care, at 3 different times, and often with 3 different types of payment. So the federal government decided to allow pharmacists to prescribe.

Now, appropriately, pharmacies are testing, assessing, prescribing, and dispensing Paxlovid in a timely manner and with full drug regimen awareness and management, which is needed for the therapy to work correctly. And, encouragingly, pharmacists and pharmacies are charging for the service.

Changes in Patient-Consumer Expectations and Preferences

The pandemic has catalyzed a movement among government entities and policymakers to embrace pharmacists and pharmacies as a new “go-to” provider. Yet the most powerful agent of change remains the patient-consumer. They are speaking very clearly with their feet, choosing pharmacies as their preferred setting for COVID-19 vaccinations at a rate of 4:1 and for point-of-care COVID-19 testing at a rate of 2:1 in many places.

Pharmacists-to-Be Have a Lot to Look Forward To

As government agencies, policymakers, and patient-consumers begin to move from skeptical to comfortable and to prefer pharmacists and community pharmacies as an effective, efficient, and safe site of care, more service opportunities will become available. The 3- to 5-year horizon is bright for rapid growth in the number of pharmacists that are supported by the services they provide, rather than the pills they dispense. As pharmacy practice rapidly evolves, a career full of growth and lifelong learning awaits new and soon-to-be pharmacists.

ABOUT THE AUTHOR

Troy Trygstad, PharmD, PhD, MBA, is the executive director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received a PharmD and an MBA from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation.