Pharmacists Rise to the Challenge of Expanded Roles

The coronavirus disease 2019 (COVID-19) pandemic continues to put an immense burden on the nation’s health care system and has altered the delivery and practice of health care in many ways.

Health care professionals, including pharmacists, are overcoming those challenges with dedication and ingenuity and continuing to provide quality care to patients. Pharmacists are, for example, addressing concerns from especially anxious, fearful patients amid the cold and influenza season.

The CDC indicates that an estimated 90% of Americans live within 5 miles of a community pharmacy, providing easy access to patients.¹ In a July 2020 report, the CDC indicated that despite the challenge of dealing with the pandemic, pharmacists have maintained the delivery of critical health services to patients, including those patient populations at greater risk for COVID-19—related complications.¹ The CDC report also noted that pharmacists are in a vital position to deliver priority pandemic responses, including COVID-19 testing, point-of-care testing for chronic disease management, and vaccinations.¹

Pharmacists have also been instrumental in providing patients with reliable information about the prevention, detection, treatment, and management of COVID-19.

The American Pharmacists Association (APhA) indicates that the scope of practice for pharmacists has broadened during the pandemic, with more patients seeking care from pharmacists and more pharmacies anticipating increased point-of-care testing and expanded immunization services.²

A recent survey conducted by the National Community Pharmacists Association (NCPA) explored how the pandemic is modifying community pharmacy practice. Respondents said that the pandemic may result in more pharmacies offering point-of-care testing (61.3%) and immunizations (52.1%) and expanding their scope of practice (56.9%).² The majority (61%) also said the pandemic increased consumer demand for online products and availability.² Additionally, the respondents have increased curbside delivery or extended delivery services (82.4%) and increased their online presence or social-media advertising (37.5%) in recent months. Respondents also noted that these changes are expected to continue even after the pandemic, as will pharmacy employees’ use of personal protective equipment, such as gloves and masks.²

Expanding Scope of Practice

In April 2020, the US Department of Health & Human Services (HHS) issued new guidance under the Public Readiness and Emergency Preparedness Act (PREP) allowing licensed pharmacists to order and administer COVID-19 tests that are FDA authorized.^3,4 On September 9, 2020, HHS issued guidance under the PREP Act authorizing state-licensed pharmacists to order and administer—and state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer—COVID-19 vaccinations to individuals 3 years or older, subject to certain requirements.³

Several major pharmacy organizations, including the American Association of Colleges of Pharmacy, the APhA, the American Society for Clinical Pathology, the American Society of Health-System Pharmacists, the College of Psychiatric and Neurologic Pharmacists, the Hematology/Oncology Pharmacy Association, the National Alliance of State Pharmacy Associations, the National Association of Chain Drug Stores, the NCPA, and the National Pharmaceutical Association, have advocated for expanding the role of pharmacists and released a set of policy recommendations to address the challenges associated with combating the virus. The 4 key suggested policy recommendations are: Address continuity and shortage of care; authorize tests, immunize for, and treat, infectious diseases, such as COVID-19; ease operational barriers to address workflow and workforce issues; and reimburse for services and remove barriers.^5,6

Provider Status Benefits

Despite being integral members of the health care team in disease management and patient care, pharmacists are the only providers who do not have full provider status at the federal level.⁷ As of October 2020, just 37 states allow pharmacists to qualify as medical providers under the rules of Medicare Part B, and as a result, pharmacists encounter administrative obstacles when seeking reimbursement for clinical services offered.^3,7

The APhA has indicated it is working to obtain provider status for pharmacists for Medicare coverage and support for fundamental payment reform for pharmacists’ service.⁸

Granting provider status to pharmacists is associated with numerous clinical benefits, including delivery of telepharmacy services, medication management, vaccinations without restrictions, and testing and treating patients.⁹ Granting provider status to pharmacists would eradicate financial, logistical, and regulatory barriers to vaccination and improve vaccination rates and patient outcomes.9 Moreover, provider status would allow pharmacists to improve patient care through disease management services, including counseling, screening, and treatment.⁹

Conclusion

Pharmacists can act as patient identifier, advocate, and educator. Throughout the pandemic, pharmacists have continued to deliver quality care to patients, and their valuable role in patient care continues to evolve. As the gatekeepers of proper drug use, pharmacists provide clinical interventions and patient support that improve outcomes. They are also well trained and positioned to provide a variety of clinical services to patients, such as counseling about the efficacy and safety of vaccines, including the COVID-19 vaccine when it becomes available; disease education and support; medication management and monitoring; patient education; and point-of-care administration and testing.^1,10 Pharmacists can also help dispel misconceptions and myths about vaccinations and provide patients with facts. Their accessibility can augment rates of vaccinations among all patient populations and help patients make informed decisions about their health. The importance of pharmacists in health care delivery is indispensable and should never be taken for granted.

YVETTE C. TERRIE, BSPHARM, RPH, is a consulting pharmacist and a medical writer in Haymarket, Virginia.

REFERENCES

• Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Community pharmacists’ contributions to disease management during the COVID-19 pandemic. Prev Chronic Dis. 2020;17:E69. doi:10.5888/pcd17.200317
• Tanzi MG. Community pharmacies have an even bigger role during COVID-19. American Pharmacists Association. August 18, 2020. Accessed November 10, 2020. https://www.pharmacist.com/article/communitypharmacies- have-even-bigger-role-during-covid-19
• Weitzman D. Provider status for pharmacists: it’s about time. Pharmacy Times^®. October 7, 2020. Accessed November 10, 2020. https:// www.pharmacytimes.com/news/provider-status-for-pharmacists-itsabout- time
• HHS statements on authorizing licensed pharmacists to order and administer COVID-19 tests. News release. US Department of Health & Human Services. April 8, 2020. Accessed November 9, 2020. https:// www.hhs.gov/about/news/2020/04/08/hhs-statements-on-authorizinglicensed- pharmacists-to-order-and-administer-covid-19-tests.html
• Pharmacists as front-line responders for COVID-19 patient care. American Pharmacists Association. Accessed November 15, 2020. https:// www.pharmacist.com/sites/default/files/files/APHA%20Meeting%20 Update/PHARMACISTS_COVID19-Final-3-20-20.pdf
• Pharmacist advocacy groups call for new action to enhance COVID-19 patient care News release. American Pharmacists Association. March 20, 2020. Accessed November 10, 2020. https://www.pharmacist.com/ press-release/pharmacist-advocacy-groups-call-new-action-enhancecovid- 19-patient-care
• Billingsley A. Yes, pharmacists are healthcare providers. GoodRx. June 15, 2020. Accessed November 9, 2020. https://www.goodrx.com/blog/ yes-pharmacists-are-healthcare-providers/
• American Pharmacists Association comments on the presidential election. News release. American Pharmacists Association. November 9, 2020. Accessed November 10, 2020. https://www.pharmacist.com/ press-release/american-pharmacists-association-comments-presidential- election
• Ross SM. 4 ways pharmacists as providers would add value after COVID-19. CureATR. June 30, 2020. Accessed November 10, 2020. https:// blog.cureatr.com/4-ways-pharmacists-as-providers-would-add-valueafter- covid-19
• Tanzi MG. Report highlights pharmacists’ contributions during the pandemic. Pharmacy Today. November 1, 2020. Accessed November 15, 2020. https://www.pharmacytoday.org/article/S1042-0991(20)31057- 4/fulltext