The Evolving Role and Importance of Pharmacists in the Health Care System

To celebrate American Pharmacists Month, Pharmacy Times® interviewed Amelia Arnold, PharmD, VP of Operations for 4 Community Pharmacies locations in Maine, who was instrumental in getting provider status legislation in Maine passed and serves as a tireless advocate to educate lawmakers about the value pharmacies provide. Arnold discusses her career journey and the changes she has witnessed in the pharmacy profession. She highlights the increased recognition of pharmacists as clinical providers, especially during the COVID-19 pandemic, but also expresses concerns about unsustainable reimbursement models. Arnold emphasizes the rewarding aspect of working in small communities where pharmacists are highly respected, and she recounts the decade-long advocacy efforts to achieve provider status for pharmacists in Maine. Throughout, Amelia underscores the importance of pharmacists as accessible, trusted healthcare providers who offer a range of services beyond just dispensing prescriptions.

My name is Amelia Arnold. I'm a pharmacist in Maine, and I work for Community Pharmacies, which is an 8-pharmacy chain here in the state.

I wanted to be a pharmacist when I was in high school. Back when I graduated, there were no options in Maine to go to pharmacy school. Now there are 2, but I had to pick another school in New England. So, I went to the University of Connecticut. I loved my time there, and I always knew that I wanted to be a community pharmacist.

It's changed a lot, and some for the better, some not for the better. I think we're being taken much more seriously as clinical providers, as pharmacists, and that's especially true after COVID. I see that our value in the community is recognized, which just makes me so happy. But unfortunately, just with the current reimbursement models for PBM claims, it's just heading in a very unsustainable direction, so that's definitely taken a turn, not in the right direction. But again, I'm really encouraged by seeing, even here in Maine and my work in the legislature that we're now recognized for how important we are. We're not just tied to that product; we're dispensing with a lot more to offer.

I think the most rewarding part of pharmacy for me is that I come from a small town in Maine, and our company focuses on having pharmacies in small towns. I see the impact that they make in their community. I see how respected our pharmacists, our staff members, our technicians, and our cashiers, how everyone is so valued and recognized for the service they're provided in those small towns. That's definitely where I feel that it makes me feel the most rewarded for our job. I do a lot of work more on a state level for advocacy, and seeing that transition since 2020, and really before having to fight and argue our worth, and that we were worth so much more than just that product we're selling. Seeing, now that that's recognized across the state, and that we have legislators thanking us for what we're doing, is also really rewarding.

What is the value of the pharmacists to you personally and to the overall health care system?

The value to me is really that impact we make every day on our patients, right? So that we are accessible, that people can come right in and talk to us, that we're respected. As I mentioned, I am from Maine, and Maine is a very rural state. I'm from a small town in a rural part of the state, and it's hard to maintain the level of interaction that you need with your health care team. So, talking about your prescribers, your nurse practitioners, your pH, your doctors, they come and go from the area. There's a lot of turnovers, there's a lot of change, and there's a lot of provider shortages, but pharmacies are always there. We're always there, we're opening our doors, we have those communities that we've had the same pharmacist for quite some time. That's really what I enjoy about Maine.

Key Takeaways

Pharmacists are increasingly recognized as valuable clinical providers, but face challenges with unsustainable reimbursement models.
Pharmacists play a vital role as accessible, trusted healthcare providers in local communities, especially in rural areas with provider shortages.
Pharmacists' scope of services extends well beyond just dispensing prescriptions, including vaccination, counseling, durable medical equipment, and more.

With the role of the pharmacists growing, what is the importance of pharmacist for patients and the community?

The importance is being that steady presence and being that person who is there, that we're accessible, that we're reachable, that come in, that you can see us, that we build those relationships that were the medication experts, but also, we're the ones that you can get through to even if you can't reach another health care practitioner. We're open, we're there, we're accessible, we're respected. That's the role, it's so important to continue to build. We are so much more than just a prescription. That's an important part, and you can never take that away from pharmacy, that we're dispensing those prescriptions to our patients, but that it comes with so much more. It comes to being a vaccine destination, that it comes to providing durable medical equipment for your health care, that it comes with the counseling on the prescriptions you're receiving, but even just the over the counter products that you're receiving or getting the advice on when you may need to go and seek an additional level of care — that's everything we have to offer. And in a place like Maine that's just irreplaceable.

I think I'm just trying to tell everyone to take a lot of pride in what we're doing. It's our busy time of year. This is the time of year that we're giving our vaccines, we're showing our worth for our company. It's getting out there and not just providing vaccines to our patients in the store, but going out to employers, going out to long term care facilities, going out to community settings, and showing them that this is what we do. We are able to give their vaccines, but also, we're able to connect with them on so many more levels, and really show our worth, taking a lot of pride in what we do.

In Maine, it was going back over a decade, we were able to obtain provider status in 2021. But going back a decade before that was something we had been really working hard on a state level to get provider status. We had submitted a few bills to the legislature, and this had all come about. There was a pot of money that was available for nicotine replacement counseling and smoking cessation counseling. So, pharmacists went to the state Medicaid system and said, we think we can provide these— we already provide these services when we're dispensing our prescriptions and over the counter, can we take part in this? And we were told, unfortunately, you're not recognized as a provider in statute, so we can't give you any of this money. So, that started a saga, I guess I would call it that was a decade long. Every couple year we went from the legislature, and we tried to say, well, we're providers, we need you to recognize that in statue. At first, we were met with a lot of resistance and questioning our motive — this is just a money grab, you're going to start charging people for a recommendation over the counter and really just not a favorable response. Then during COVID, I had been working the legislature doing advocacy work for a few years, we're able to say this is where we stand up, you see the value in what we're providing. We're giving you these vaccines, but not just that. You're talking about allowing pharmacists to prescribe birth control. You're talking about pharmacists prescribing Narcan, prescribing PrEP and PEP for HIV. At what part are you going to recognize that if you keep asking us to do all these things, you can't expect that level of us being willing, if you're not willing, to show that we're a provider. And they agreed. They said we worked really hard with that committee to show them that our motives were pure. It was a decade in the making, but it was one of the most exciting moments of my career when that was able to happen.