Expert: Pharmacies Play Key Role in Health Equity, But Reimbursement is Necessary

Pharmacy Times spoke with Jason Ausili, PharmD, head of Pharmacy Transformation at EnlivenHealth, during the National Association of Chain Drug Stores (NACDS) 2022 Total Store Expo. Although pharmacies have repeatedly proven their value and continue to be essential to providing equitable health care, Ausili said commensurate reimbursement is necessary to move forward.

Q: Pharmacists and pharmacies have always been front line health care resources for patients, and that has only become more important during the pandemic. Can you discuss the importance of access to health care and the role that pharmacies play in that?

Jason Ausili, PharmD: Absolutely, and being the nation's most accessible health care providers, 90% of the population lives within 5 miles of a pharmacy. You take that another step and 74% of community pharmacies are in populations of less than 50,000. So, when thinking about the role that pharmacists played, I know we're going to talk about COVID-19 a bit, because it's really shined a bright light on the value that pharmacists bring to health care. But you know, now pharmacists are expanding the services that they're providing. COVID-19 really opened up the door to vaccines, testing, and also therapeutics. But now the world is really open to more public health services being driven at pharmacy locations.

Q: Do you think the pandemic limited or expanded health care access?

Jason Ausili, PharmD: You know, it was challenging, right, because all of a sudden, you've got the entire population that needs more health care than they used to. But pharmacies were uniquely positioned, like I mentioned, being the most accessible health care providers. It's not to say we didn't have health equity issues and access problems. But of the more than 263 million vaccines that were administered, COVID-19 vaccines are administered in pharmacies, you wonder, well, what if the pharmacies weren't there to rise to the occasion and step up to the plate? Health equity would have taken a much greater hit if pharmacists weren't there to help the country here.

Q: Over the last 2 years, there has been increasing focus on health care equity. What does equity mean in this context?

Jason Ausili, PharmD: Equity really means allowing everyone, every person, to achieve their optimal health. And the cards are stacked differently for different people. Whether you live in a dense, urban environment or a rural location. Not everyone might have the same access to care. So, it's really understanding what the specific barriers are that are preventing each person from achieving their optimal health. And then really leveraging the pharmacist to create personalized solutions to those barriers. Pharmacists are ideally prepared to work with social determinants of health, like we all know that health isn't just medical care, right? A lot more of that is entailed with where people live, work, and play and pharmacists have the most touchpoints with their patients. Pharmacists see their patients 2 to 9 times more than their primary care physician. And with the growing primary care physician gap, it even provides more importance of pharmacists connecting with their patients regularly. Because they are the most accessible, they're uniquely prepared to battle health equity, health equity problems, and really move the bar forward.

Q: How are pharmacists responding to the calls for improved equity?

Jason Ausili, PharmD: So, I would say we saw it with COVID-19, right? I mean, the vaccinations, over 263 million, as I mentioned, that is an amazing amount of vaccinations that pharmacist have delivered during the pandemic. But it doesn't have to stop there, right? There's some really important legislation that's in the house right now, that's going to further expand how pharmacists can reach their communities. There's one particular bill in the House currently that's still in the introduced phase, so we need to move that along. But it's the Pharmacy and Medically Underserved Areas Enhancement Act, which would give pharmacists privileges under federal provider status and equitable reimbursement at 85% of the physicians’ fee schedule. That's really important that we recognize pharmacist on that front. Otherwise, scalability and viability of the services are going to be at risk if we're not getting equitable payment. So, there's so much more that pharmacists can do on not only just public health services like tobacco cessation. We have, you know, I mentioned vaccines, testing, and therapeutics, but also you think of disease states like diabetes. The pharmacists are highly skilled and educated at training patients on how to manage better manage their disease states, diabetes, education, but also diabetes prevention. Those are 2 really big areas that are impacting our country and pharmacists are uniquely prepared to help solve those problems.

Q: Health care deserts have also become a significant concern. What role do independent pharmacies in particular play in alleviating these deserts?

Jason Ausili, PharmD: Well, as I mentioned, 74% of community pharmacies are in populations of less than 50,000. So, when you think about rural and medically underserved areas and medical deserts, probably the only convenient access to care is your local pharmacy. And I recently spoke and interviewed a pharmacist in rural Nebraska who lives in a community where the nearest hospital is over 80 miles away. And during COVID-19, he would travel to small towns around his community and set up COVID-19 clinics where he would do testing and vaccinations, and hugely important services that he was bringing to those communities. Because otherwise where would those patients get access to care? If not for him, they wouldn't, they probably wouldn't have access to care. So, it’s critically important that pharmacies continue. We [must] leverage our community pharmacist in these medical deserts, to really bring the care that people need.

Q: What do you predict for the future of health equity and pharmacy’s role in it?

Jason Ausili, PharmD: It's going to grow as pharmacists’ scope of practice grows, right? So, you think about, there's a lot of parallels there. And the privileges that we got during the pandemic, we must ensure that those do not go away. Some of the privileges that were offered by HHS and the PREP Act are at risk for expiring when the public health emergency ends. We need to ensure that pharmacists have expanded vaccination capabilities, testing, and therapeutics for not just COVID-19, but also flu, strep, and other communicable diseases. So, moving forward, other services that that fit into the pharmacist scope of practice are also going to be beneficial when you think of the accessibility that pharmacies provide. The accessibility of pharmacies, all of those services are going to be more accessible to their patients as well.

Q: Is there anything you would like to add?

Jason Ausili, PharmD: Yeah, absolutely. So, as I mentioned, I want to reiterate that immediate legislative action is needed in order to solidify pharmacist privileges that we gained during the pandemic. But it's that's not the stopping point. We need to make sure that the legislation that's in the house right now—there's the Equitable Community Access to Pharmacy Services Act, which is also in the introduced phase, it's currently sitting in the house—would also recognize pharmacists as providers at the federal level, so under Medicare, and reimburse pharmacies equitably for pandemic-related services. Now's the time to get that bill through. As we learned with COVID-19, will there be another pandemic? Well, I don't have a magic 8 ball. But at the same time, we have to be prepared for another pandemic. Now's the time to do that. It’s not when you're already in the middle of it, right? So, let's make sure that we further position pharmacies for the long term, to be this key role that can help fight pandemics and also really aid health equity and public health services overall. Equitable reimbursement is mandatory, right? Because for these services to be scalable and viable for pharmacies, they must get equitably paid for those services. So that's the other thing that goes along with these bills that we must have in place is equitable reimbursement.