Direct-to-consumer must include patients’ personal pharmacist

Washington, DC, politicians are hyper-focused on reducing the cost of medications. It’s for good reason. In the one year from 2022 to 2023, our national drug spend rose by over 45 billion dollars, or 11.4% according to CMS. That rate of increase was more than the increase in spending on hospitals’ and physicians’ office visits. Driven in large measure by increased utilization of advanced biologics and gene therapies for cancer and rare disorders, the picture is complex. Drug prices themselves rose during this time by 1.7%, and the population is continuing to age.

We all know that as we age, prescription drug utilization increases. In the United States, the population reaching the age of 65 years is growing by 4.1 million per year through 2027, when the baby boomer generation will peak in retirement age. (The last of the baby boomers hit 65 in 2029, if you were curious.) By 2030, just over 20% of our population will be over age 65.

The Kaiser Family Foundation reports that over 60% of Americans believe prescription drugs are too expensive, with 30% of consumers reporting they are unable to pay for their medications. This may get worse before it gets better. Axios recently reported that insurance premiums and the employer portion of out-of-pocket costs for employer-sponsored health care are rising at their most significant rate in over 15 years. An increasing number of Americans pay co-insurance for the most expensive prescription drugs instead of a flat copay.

And that leads us to solutions. As I write this, we are nearing the deadline the White House gave America’s pharmaceutical manufacturers to report back on their plans to offer the U.S. most favored nations pricing, and plans for direct-to-consumer (DTC) and direct-to-business distribution. You can read the president’s whole executive order and see the individual letters sent to the manufacturers. However, there’s one glaring “miss” in this approach. No matter if a drug costs a dollar or a thousand dollars, if it isn’t utilized appropriately, it could at best be worthless, and at worst cause the patient harm. In fact, going back to 2017, we know that for every $1 spent on prescription drugs, we spent $1.55 on drug-related problems. That number is likely a serious underestimation of the current spend. Conservatively, it isn’t hard to guess that with more expensive therapeutic agents, an aging population, and decreased access to primary care, drug-related problems could easily exceed $1 trillion. APhA is working with data scientists and other partners to get an accurate picture of the current cost of drug-related problems.

Pharmacists are the drug therapy experts on the health care team. However, the health care system, to date, has not fully valued or utilized pharmacists in identifying and solving drug-related problems. The profession and the system are so hyper focused on the costs of the drugs themselves that we are missing the much bigger opportunity, which is to ensure that patients are on appropriate therapies to begin with, and that those therapies are achieving their intended outcomes.

Imagine for a moment if the Medicare program would simply cover patients having an annual comprehensive medication review, and subsequent medication therapy consultative sessions with a pharmacist at a frequency necessary to meet the patient’s needs? Data show that pharmacists are incredibly effective at getting patients with diabetes to their A1C goal, helping patients reach control of their hypertension and cholesterol, and avoiding acute care visits for their asthma and COPD. We also know from published research that pharmacists' active participation on the health care team—as an equal and compensated member of the team—reduces overall health care costs. We do not need another study or more evidence. The results are clear.

APhA is advocating with pharmaceutical manufacturers and with the government that any DTC program implemented must include coverage for the care services of the patient’s personal pharmacist as a part of the solution. Simply providing inexpensive drugs to patients without the most trusted medication expert involved in ensuring outcomes will be a complete waste of resources and a terrible miss.

And this concept of the patient’s personal pharmacist is critical. No one appreciates it when an insurance company or employer group tells us which physician we must see. So why would we accept a PBM or manufacturer forcing a patient to get their care services from a contracted pharmacy and unknown pharmacist?

Drug distribution aside, systems must include coverage of the pharmacist care services of the patient’s choosing even if the drug is distributed via mail service or home delivery. If the U.S. government would simply take a fraction of the cost of drug-related problems and pay the pharmacist for preventing and solving those problems, we’d still save the U.S. Treasury and American taxpayers hundreds of billions of dollars.

Please help APhA in this advocacy. If you are reading this message, you are likely already an APhA member. If you aren’t, we truly need you to join us. We fight on your behalf every day, and without your support, that fight will be a lot harder to win. And if we don’t fight for you, who will?

For every pharmacist. For all of pharmacy.