There are areas of the country where hospitals, doctors, specialists and other health care providers are not easily accessible. This creates a shortage of care in both rural and urban areas due to geographical and economic limitations. For many, getting access to a primary care doctor when they need a prescription just isn’t easy, with the average wait time for a physician appointment being 26 days1. When members cannot easily access care, not only does it impact their health, but it also increases the potential for future costly medical claims. When some less complex care is shifted to pharmacists, however, physicians have additional time for patients with more complex needs.
Pharmacists may be the medication experts, but plan sponsors don’t call on them as much as they should. With more than 65,000 pharmacies across the country, pharmacist care has untapped potential.
Most individuals visit pharmacists for the purpose of obtaining their over-the-counter medications and their annual flu shot, but pharmacists are capable of much more. America’s pharmacists are expanding their roles beyond prescription dispensing, increasing health care affordability and convenience for plans and their members. By operating to the full potential of their education and skill set, pharmacists are able to broaden their services from medication dispensing to chronic disease state management, prescribing of certain medications, medication therapy management, medication administration services, vaccination programs, testing and more. In a 2022 survey, when pharmacists were asked if they had the interest and confidence to meet the needs of physicians and patients in the future of pharmacy, more than 75% agree or strongly agree with the ability to be a resource for drug interactions, medication management, and pharmaceutical therapy.
COVID-19 changed health care. Pharmacists were on the frontlines of the pandemic, administering tests and vaccinations and filing PaxlovidTM prescriptions. Currently, multiple states grant pharmacists prescribing authority, meaning they can evaluate symptoms and treat COVID-19 and flu with medications like PaxlovidTM and Tamiflu®. These states also allow pharmacists to prescribe oral contraceptives and medication to aid smokers in their journey to quit. Expanding access to pharmacist-prescribed medications lowers health care costs for plans and members who can avoid a hefty physician office visit claim and copay. In 2022, plan sponsors paid an average of $120 per physician office visit.2
Pharmacies can offer more than just COVID-19 and flu shots. 50,000 adults die from vaccine-preventable diseases in the U.S. every year. Pharmacists are trained to administer vaccinations such as hepatitis, HPV, measles, pneumonia, yellow fever and more.
Medication therapy management sessions offered by pharmacists improves medication use, reduces risk of adverse events, increases medication adherence and decreases wasteful health care spending. In 2021, our MTM program triggered over 412,000 measurable drug therapy problems, resulting in a 37% acceptance rate and over $44 million in overall health care savings. For elderly patients who take multiple medications and those with comorbidities, this service is invaluable.
For working Americans, doctors’ appointment availability is not always realistic. Pharmacies, however, are open in the evenings and on weekends, which can make maintaining chronic diseases such as asthma, diabetes, depression or rheumatoid arthritis more manageable. With regularly scheduled touchpoints, pharmacists can help patients better understand their condition and stay on top of therapies and medications.
The future of pharmacy services
Issues of care access are widespread in the United States, but they don’t have to be. For people in rural areas and even in urban communities, pharmacists may be the most, if not only, accessible health care provider. As America faces a very real physician shortage, the future of pharmacy is bright as pharmacists are excited to provide more services and physicians are confident in their abilities. “Pharmacists are an integral part of our team. I fully trust them,” said an internal medicine physician from The Prescription of Trust report. By relying on pharmacists and taking the burden off of physicians and urgent care clinics, we can open new doors to accessible care.
Plan sponsors can take steps now to shift care to pharmacists. By working directly with pharmacies in their network or through partnership with their Pharmacy Benefit Manager, plan sponsors can implement contracts for a variety of services. Then, through targeted member communication, they can inform members of alternative sites of care and how to access that care.
1 Healthleaders survey, September 2022
2 Estimated based on BOB claims of large health plan in 2022