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NCPA 2024: In Spite of Challenges, Independent Pharmacies Are Continuing to Serve Patients
Key Takeaways
- Independent pharmacies dispense over 1.1 billion prescriptions annually and are expanding clinical services like immunizations and point-of-care testing.
- They represent 35% of U.S. retail pharmacies, but their numbers are declining, with a loss of more than one pharmacy per day.
Nearly 19,000 independent pharmacies continue to work across the country, with more than 200,000 employees and millions of patients.
Independent pharmacy staff continue to be driven by the desire to improve patient outcomes in their communities, according to the 2024 National Community Pharmacists Association Digest, sponsored by Cardinal Health.
Nearly 19,000 independent pharmacies continue to work across the country, with more than 200,000 employees and millions of patients, according to the Digest. In addition to dispensing more than 1.1 billion prescriptions in 2023, these pharmacies are continually expanding their clinical services, including point-of-care testing, immunizations, blood pressure monitoring, diabetes management, smoking cessation, weight management, and more.1
Two smiling pharmacists | Image credit: Drazen | stock.adobe.com
The survey information for the 2024 Digest was collected between January 1 and December 31, 2023, from surveys of pharmacy owners or their designees. Independent pharmacy owners who have completed at least 1 full year of operations were invited to participate.1
Independent pharmacies are a significant portion of the pharmacy market, with 18,984 locations as of June 2024. This is compared with 19,075 traditional chain pharmacies, 9152 supermarket pharmacies, and 7225 mass merchants. The Digest emphasized that no single pharmacy chain has more stores than all independents combined, representing 35% of all retail pharmacies in the US and a $94.9 billion marketplace. Importantly, however, the number of independent pharmacies is down from 19,432 in the 2023 Digest, representing a loss of more than 1 pharmacy per day.1
Cost savings are an important benefit of independent pharmacies, where 83.1% of prescription drugs are filled with a generic, on average. However, this number trended down in the 2024 digest, potentially due to the explosion of glucagon-like peptide-1 (GLP-1) agonists, which currently have no available generic options.1
Patients also visit independent pharmacies for the crucial clinical services they increasingly provide, particular in areas where the pharmacist may be the only health care provider in the county. Although dispensing prescription medications is a significant part of pharmacies’ business model, the Digest emphasized that growing the bottom line is going to rely on products and services that do not have a National Drug Code number.1
Independent pharmacies are one of the leading destinations for vaccines, with influenza vaccines offered at 91% of independent pharmacies according to the Digest. Most locations also offer at least 1 other vaccine such as COVID-19, pneumococcal, respiratory syncytial virus, zoster, or travel vaccines.1
Independent pharmacists also frequently partner with staff in long-term care (LTC) facilities in their communities to provide medications and medication-related care for residents. They also provide many essential services for this patient population, such as adherence packaging, nutrition assessment and support, home infusion therapy, durable medical equipment, ostomy supplies, and pain management.1
According to the report, 52% of independent community pharmacists provided LTC services in 2023, serving an average of 27 beds for skilled nursing facilities. This number was down from an average of 44 beds in 2022. Among pharmacies providing LTC services, they also reported an average of 80 patients receiving LTC-at-home services.1
Most independent pharmacies also offer adherence services such as medication synchronization. Appointment-based models for medication synchronization can be particularly beneficial, both for patients and pharmacy staff. In the Digest, 94% of independent community pharmacies reported offering medication synchronization services to synchronize all chronic medications to a monthly pick-up date, and 63% report that a pharmacist meets with patients as needed to review medications.1
Like immunizations and medication counseling, pharmacy-based labs with a Clinical Laboratory Improvement Amendments (CLIA) waiver offer crucial services for patients who may have limited access to a physician. CLIA-waived tests can provide results in minutes, giving pharmacists information to determine whether they should provide further counseling or a referral to a higher level of care.1
Of the 52% of pharmacies with a laboratory, the most commonly offered tests are influenza (58%), blood glucose (46%), hemoglobin A1c (40%), and lipids (24%). Another 36% report testing for COVID-19, but the Digest noted that those responses are a mixture of point-of-care tests and specimen collection for off-site laboratory analysis.1
Of course, despite the growing number of services and the value independent pharmacies provide to their communities, challenging economic trends continue. A survey of community pharmacists in February 2024 found that many are struggling to manage losses caused by direct and indirect remuneration (DIR) fees from pharmacy benefit managers (PBMs). More than 50% said they are losing money on at least 30% of the prescriptions they fill, and 85% said the “DIR hangover” threatens the viability of their business. Alarmingly, 32% said they were considering closing their business within the calendar year.1
Furthermore, 97% of respondents reported drug shortages, including 87% who reported a shortage of Adderall or generics and 96% who reported shortages or backorders of GLP-1s. Furthermore, 67% said they are having a difficult time filling open positions and 76% said the most difficult position to fill was pharmacy technicians.1
The Digest noted that tax incentives and revenue during the COVID-19 pandemic were a “critical lifeline” keeping independent pharmacies afloat in recent years. With the decline in demand for COVID-19 services, the effects of below-cost reimbursements is taking a heavy toll.1
Independent pharmacies have proven to be resilient in the face of adversity by adapting to changing industry trends and patient demands. This ability to innovate and provide tailored services will continue to be a valuable asset to their communities in the future, as they continue navigating challenging financial conditions.
