Has the Pharmacy Practice Transformation Started?

The pharmacy profession is on the cusp of major changes, but individual pharmacists must be willing to step up to the plate.

A Winston Churchill quote I frequently use in my remarks at graduation is, “This is not the end, nor is it the beginning, but maybe it is the end of the beginning.”

Churchill made this comment after a successful battle during the Second World War. I reflected on it after our state pharmacist association convention this fall because I left with the strong impression that pharmacy practice was finally at the “end of the beginning” of the change to a new practice model.

For a number of years, I have been suggesting that the pharmacy practice model needs to change to be more in line with the Joint Commission of Pharmacy Practitioners Organizations Vision of Pharmacy Practice in 2015, which states, “Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes.” I feel strongly about pharmacists assuming this role because I think this is what society needs most from our profession.

There are a lot of reasons why this change must happen. I know many pharmacists think they are “doing things right” (and generally, they are), but I am still concerned that some pharmacists are not doing the right things.

Recently, I participated in a Webinar in which the presenter tried to predict what prescription drug pricing schedule Medicaid would use in the future. He felt strongly that the actual acquisition cost would become the norm and many other programs would follow this lead. In my opinion, this will create even more pressure to reduce any extra margin from prescription drug reimbursement. Even if they increase the fee to what it actually costs to fill a prescription, keeping that fee in line with inflation will be difficult at best. A pharmacy practice model that does not include new revenue streams for clinical services may not last beyond the next decade.

The other reason I think our practice model needs to change is the growing recognition of how much nonadherence costs society. As we approach health care reform, the emphasis will certainly be on drug therapy outcomes. Pharmacists must be in a position to step up to the plate and make the right drug therapy outcomes happen. We don’t do this very well in our current practice model.

As I left the meeting, I had the feeling that this message had been heard, because there was so much energy present. We had more than 800 attendees, including 300 students. They heard Tom Menighan, chief executive officer of the American Pharmacists Association, open the meeting and tell the audience that pharmacists will be the solution to our nation’s medication use problems, provided that they take authority, function with autonomy, become accountable, and focus on outcomes.

The meeting closed with Troy Trygstad, pharmacy director for Community Care of North Carolina (CCNC), talking about the role of the pharmacist in the medical home.

As he described what has happened with this program in the past 8 years, I got a glimpse of how pharmacy practice might change as health care reform unfolds. He stated that we are 2 presidential cycles—that’s only 8 years— away from bankruptcy of our current health care system. Change is inevitable. As he described the expanding role pharmacists are assuming in the networks associated with CCNC, he mentioned that the model is not identical in each network, as each one experiments with the best ways to empower the pharmacist. Troy also emphasized how quickly the number of pharmacists employed has grown and how much growth he expects in the future. Tom Menighan said he was not too concerned by the pharmacist oversupply because he saw an opportunity for many more pharmacists to be engaged in drug therapy outcome management. The CCNC program demonstrated that this is really possible and can occur anywhere in this country.

What is needed are pharmacy leaders who acknowledge that the present pharmacy practice model is not achieving the needed results, are willing to think “out of the box,” and are able to take some risks to change what pharmacists do. I left this meeting feeling that our profession in my home state is well positioned to be part of the solution as we change our health care system over the next decade to focus on prevention and management of chronic diseases. No one is better prepared to execute this strategy than the community pharmacist.

Is pharmacy still at a “crossroad” or has the change process begun? Let us know your thoughts. PT

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