Expert: Pharmacists Are a Part of the Solution for a More Sustainable Health Care Model

Pharmacy Times® interviewed Scott J. Knoer, MS, PharmD, FASHP, EVP and CEO of the American Pharmacy Association (APhA), on how the recently introduced Pharmacy and Medically Underserved Area Enhancement Act may impact pharmacy and health care outlooks.

Alana Hippensteele: How about this act in relation to other parts of the developed world. Do you know if other countries have already granted pharmacists some form of provider status? Maybe it's potentially not by that name, but some form of it? Is this something that's happened elsewhere, but just not here yet?

Scott Knoer: Yeah, it varies dramatically, and this is really the area that you can tell I'm pretty knowledgeable and speak to a lot. There are other countries. So, Cleveland Clinic was building a hospital in London, and with their national health care model, they are more aligned rather than being turfy with having more providers.

They can—I don't know exactly what they can do—I know hospital pharmacists have more leeway in the UK. I think they have to have special certifications, I'm not the detail expert here.

So, I believe Switzerland's got some stuff as well. I can't point to one model that says oh my god if we did that. Payment is different in every country.

We've got kind of a messed up model, quite frankly. We have misaligned incentives. If you try to design the worst model you possibly could for sustainability, I think you would design ours.

Alana Hippensteele: Well, I think then there is a lot of room for improvement for sure. So, in terms of today, what is holistically the value of the pharmacist on patient care teams and how would you like to see this value enhanced in the future whether it be provider status or things like that?

Scott Knoer: Yeah. So, when you look at health care, there's lots of things. You got surgeons—they cut things off, that's super important, if you need something cut off. But almost every patient who has a medical problem has a medication, right?

We touch so many people. So, the real value of pharmacy is that there are more and more medications, and they're more and more expensive. So, using cost effective medications is absolutely what pharmacists add to the equation here.

As far as next steps, it's all about, again, payment reform, payment reform, payment reform. That covers pharmacists’ wellbeing, that covers unsustainable practice in communities of color or in rural areas. There's lots of patients without it.

So, it's the triple aim of federal, state, and insurance, but it's getting the laws passed, it's not over until you get the laws passed. Then Ohio passed the law, and they had the pressure through the media for Medicaid to actually get off the dime and create billing codes.

So, we have a lot more work to do. So, the other is PBM reform. PBMs are horrible. They used to do the switch, you give an insurance card, you get paid—they still do that, that's valuable, maybe some formulary stuff. But the spread pricing, the DIR fees are absolutely killing us with theoretically quality metrics, but there's no correlation between quality—they're just stealing money. It was 244 million dollars in one year in Ohio Medicaid alone, and spread pricing the PBM stole from me as a taxpayer in Ohio to pad their own pockets. So, we've got to reign in the PBMs; it's an oligopoly.

There's 3 big PBMs. If I'm a community pharmacist, I have to take their patients or I can't survive because it's a third of my business. It's a little more complicated than that, but what we need to do is attack it, and APhA is doing that with our legislative team.

We're helping states. APhA has always been focused on federal. I came from Ohio, I see what they can do. APhA is focusing on states, APhA is focusing on insurance companies—no one has it figured out like APhA for what the problems are and what the solutions are, and we're attacking it relentlessly. We're putting our resources there. Again, more margin, more mission.

Stay tuned, I'm announcing probably next week an incredibly powerful addition to our team that's going to help the states. Two weeks after that, I plan to do another incredibly powerful addition to our team. We're putting our money where our mouth is, and that's what we need—we need payment reform, payment reform, payment reform.

Alana Hippensteele: Yeah, absolutely. Thank you so much for taking the time to speak with me today, Scott.

Scott Knoer: Alana, thanks so much. This is important, and what you do is important. Getting the word out is important.

Everyone listen to this: If you're not part of the solution, you're part of the problem. If you aren't helping your federal national association and your state societies, all the state work getting done there—if you're in Kansas, be a APhA member, if you're in Tennessee, join. You can't sit on the sidelines.

As pharmacists, we are the solution. We're going to do this together, my friends. Let's do this.

Alana Hippensteele: Absolutely, well said. Thank you.

Scott Knoer: Thanks, Alana.