Seeing Through the Fog of ‘Pharmageddon’

Author(s):

Shawn Spencer, PhD, RPh

Pharmacists are uniquely positioned to play a frontline role in advancing health equity. This will require, however, that we build the pipeline of future pharmacists and preserve vital community touchpoints.

The health care industry is experiencing a severe shortage of pharmacists. At the same time, pharmacists — like other health professionals — are grappling with burnout and challenging work conditions.^1,2 This has become increasingly pronounced in community pharmacies, leading to reductions in operating hours,³ pharmacy closures, and high-profile walkouts at a handful of large retail pharmacy chains.⁴

What does this mean for patients, and for the health care system as a whole?

female elderly pharmacist she had problems with depression while working in pharmacy store

Image credit: SHUTTER DIN | stock.adobe.com

The critical role of pharmacies cannot be overstated. For many, pharmacies are the most accessible point of contact with the health care system. The loss of these vital hubs, particularly in rural and underserved communities, is an emerging and existential risk to healthcare access. Fortunately, there are reasons for long-term optimism even amid the so-called ‘Pharmageddon.’

Drawing from my experience as a community and hospital pharmacist, and now in higher education, I believe the challenges impacting pharmacies are emblematic of transformative forces that are reshaping all of health care. This includes not only consolidation and consumerization, but also digitization, automation, and a surge in employee activism. Ultimately, the pharmacy may be a harbinger for where the broader industry is headed.

Pharmacies – and the professionals who run them – are increasingly at the forefront of day-to-day health care delivery. Patients visit pharmacies 12 times more often than their family doctors.⁵ High-risk patients visit their pharmacy an average of 35 times per year, compared to only 4 primary care visits – if that.⁶ About 90% of Americans live within 5 miles of a pharmacy, and 61% expect that primary care services will be increasingly – even primarily – offered through their local pharmacy or pharmacy clinic, according to a recent survey.⁵

The COVID-19 pandemic further underscored the important role of pharmacists within the health care system. Data show that upward of 90% of COVID vaccines were provided through pharmacies (excluding certain temporary public health vaccination sites, for which claims data is not available).⁷ Beyond COVID-19, pharmacies also handle 60% to 70% of flu vaccinations during the annual cold and flu season.⁷ Today, pharmacists are administering routine vaccinations more than physicians.⁸ The integration of digital solutions and automation not only streamlines processes but also opens up opportunities for pharmacists to continue engaging in this type of community-facing and vertically integrated health care.⁹

Perhaps the most important aspect of this changing paradigm is how payers, public officials, and health equity advocates are responding to shifts in pharmacy practice and consumer preference.

Value-based care has surpassed fee for service as the dominant health care payment model in the US, placing ever-greater emphasis on health outcomes.¹⁰ Pharmacists play an important role in value-based care delivery, not only administering prescriptions but also helping to counsel health plan members, manage health care costs, and ensure medication adherence among patients with chronic conditions. No surprise, then, that a sizable share of pharmacist job postings are in managed care, with national payers among the largest employers. For the first time in several years, pharmacist compensation is rising as retail pharmacies compete with payers and hospitals for a limited pool of pharmacy talent.¹¹

Public officials are also taking innovative steps to empower pharmacists and address critical health care needs. “Test and Treat” legislation would allow pharmacists to administer tests and prescribe appropriate treatments right in the pharmacy setting. Patients have widely embraced this flexibility. In fact, pharmacists are as trusted as nurse practitioners and physician assistants when it comes to diagnosing common conditions and issuing prescriptions.¹² States that have embraced test and treat are leading the nation in expanding health care access and improving patient outcomes.

As noted, pharmacist accessibility brings compelling health equity benefits. Studies have already shown that pharmacy closures “disproportionately affect underserved neighborhoods, deepening existing health disparities,” said Omolola Adepoju, PhD, MPH, in a press release,¹³ who led an important study on pharmacies and their relationship to medically underserved areas.¹⁴ So-called “pharmacy deserts” have profound consequences, as patients in these areas struggle to manage chronic conditions and maintain reliable access to medications.

About the Author

Shawn Spencer, PhD, RPh, is Dean and Chief Academic Officer of the School of Pharmacy at Philadelphia College of Osteopathic Medicine – Georgia (PCOM Georgia). He is a former hospital staff pharmacist and retail pharmacy manager.

With advanced clinical knowledge and an accessible on-the-ground presence, pharmacists are uniquely positioned to play a frontline role in advancing health equity. This will require, however, that we build the pipeline of future pharmacists and preserve vital community touchpoints where pharmacists can nurture long-term patient relationships.

Despite the shifting health care landscape and near-term challenges for pharmacies, certain fundamentals remain largely unchanged and ultimately optimistic: 97% of Americans want a pharmacist to educate them about their medication,¹² and overwhelming majorities look to pharmacists as trusted members of their health care team.

For now, we may need to show extra patience at the pharmacy counter. But there is light beyond the fog of ‘Pharmageddon.’

References

1. Doctors not the only ones feeling burned out. The Harvard Gazette. March 31, 2023. Accessed February 12, 2024. https://news.harvard.edu/gazette/story/2023/03/covid-burnout-hitting-all-levels-of-health-care-workforce/

2. Antrim A. Pharmacists Report High Levels of Burnout, Resulting in Understaffing and Alternative Career Paths. Pharmacy Times. April 26, 2023. Accessed February 12, 2024. https://www.pharmacytimes.com/view/pharmacists-report-high-levels-of-burnout-resulting-in-understaffing-and-alternative-career-paths

3. Cerullo M. Drugstore closures create “pharmacy deserts” in underserved communities. CBS News. Updated October 25, 2023. Accessed February 12, 2024. https://www.cbsnews.com/news/drugstore-closures-cvs-rite-aid-pharmacy-deserts/

4. Yang J, Young K, Corkery A. Why pharmacy workers are going on strike amid widespread store closures. PBM News. October 29, 2023. Accessed February 12, 2024. https://www.pbs.org/newshour/show/why-pharmacy-workers-are-going-on-strike-amid-widespread-store-closures

5. McCoy S. Safety, access, and affordability: How the pharmacist role is shifting. Wolters Kluwer. February 16, 2023. Accessed February 12, 2024. https://www.wolterskluwer.com/en/expert-insights/safety-access-and-affordability-how-the-pharmacist-role-is-shifting

6. Harvey F. Pharmacists Are Essential to Rural Access to Healthcare. MedCity News. March 21, 2023. Accessed February 12, 2024. https://medcitynews.com/2023/03/pharmacists-are-essential-to-rural-access-to-healthcare/

7. IQVIA. Trends in Vaccine Administration in the United States. January 13, 2023. Accessed February 12, 2024. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/trends-in-vaccine-administration-in-the-united-states

8. Rosenthal M. New Report: Pharmacists Providing Vaccinations More Often Than Physicians. Pharmacy Practice News. February 13, 2023. Accessed February 12, 2024. https://www.pharmacypracticenews.com/Covid-19/Article/02-23/New-Report-Pharmacists-Providing-Vaccinations-More-Often-Than-Physicians/69473

9. Landi H. CVS Health rebrands healthcare services business as it plots long-term growth strategy. Fierce Healthcare. December 4, 2023. Accessed February 12, 2024. https://www.fiercehealthcare.com/providers/cvs-health-rebrands-healthcare-services-business-it-plots-long-term-growth-strategy

10. LaPointe J. Value-Based Payment, Fee-for-Service Levels Hold Steady. TechTarget. November 9, 2022. Accessed February 12, 2024. https://revcycleintelligence.com/features/value-based-payment-fee-for-service-levels-hold-steady

11. Fein AJ. Pharmacist Salaries and Employment in 2022: The Good Times Roll for Retail Pharmacists. Drug Channels. June 6, 2023. Accessed February 12, 2024. https://www.drugchannels.net/2023/06/pharmacist-salaries-and-employment-in.html

12. US survey signals big shifts in primary care to pharmacy and clinic settings as consumers seek lower medication and healthcare costs. Wolters Kluwer. December 7, 2022. Accessed February 12, 2024. https://www.wolterskluwer.com/en/news/us-survey-signals-big-shifts-in-primary-care-to-pharmacy-and-clinic-settings

13. Luhn B. Pharmacy Closures Impacting Medically Underserved Communities. University of Houston. August 28, 2023. Accessed February 12, 2024. https://www.uh.edu/news-events/stories/2023/august-2023/08282023-pharmacy-desert-study.php

14. Adepoju OE, Kiaghadi A, Niaki DS, Karunwi A, Chen H, Woodard L. Rethinking access to care: A spatial-economic analysis of the potential impact of pharmacy closures in the United States. PLoS One. 2023;18(7):e0289284. doi:10.1371/journal.pone.0289284