Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
Let’s face it, pharmacists in the community setting have been stretched to their breaking points. Rock bottom reimbursements for drug products have made margins so thin that pharmacies are cutting staffing levels to bare-bones levels just to keep stores open. This means those who remain are overworked, underpaid (in many cases) and left with their heads spinning trying to keep up with the demands of getting the right drug to the right patient and providing necessary vaccines. To ask pharmacists to physically do anything more in today’s environment is just unacceptable. Something has to change.
That “something” is the way pharmacies are paid. Our payment model for pharmacies is terribly broken. We all know that the value of a pharmacist is not in the pills in the bottle—it’s in the care that is provided by the professional. Yet for decades—going back into the 1980s—practically every payment that is made to a pharmacy is tied to some formula for reimbursement of a product. With perhaps the exception of optometrists, we are the only health care provider whose living is dependent upon the sale of a product. PBMs know this and have taken advantage of it in spades. The drug reimbursement system has to change and APhA is committed to advocating for that change because decreased drug reimbursements are causing pharmacies to close at record rates, decreasing access to the care services of pharmacists in local communities. As a pharmacist professional association, not a trade association, we care deeply about patients having access to pharmacists. Anything that jeopardizes that access we will fight. Anything that improves it we will champion.
And this is why we advocate for coverage of pharmacist services under Medicare, Medicaid, and private health insurance. At best, drug reimbursements may break even or slightly better with lots of advocacy. But pharmacists will never truly be fully accessible in their communities unless their employers are paid for the services of the pharmacist. When pharmacists’ services are covered, patients’ lives improve drastically and the model of care in local pharmacies changes. We’ve seen this happen in states where private insurers and Medicaid programs have included pharmacists as providers in their health plans.
But the revenue model for pharmacist services isn’t maturing fast enough, or equally across the country. And without this service-based revenue, the staffing of pharmacies continues to be woeful.
On the other hand, as I visited Walmart pharmacies in Bentonville, AR, last year, I saw pharmacists providing testing and treatment (yes, diagnosis and prescribing) for influenza, strep, and COVID-19. In these stores, there was better staffing, and pharmacists were assigned to dedicated shifts either to oversee dispensing or to appointment-based patient care—but not to both. Walmart has realized that having pharmacists focused on patient care in those places where they can provide the service generates revenue that is substantive and meaningful. Not surprisingly, as a corporation they support the win–win of providing optimal patient care opportunities for pharmacists and driving positive revenue. This is just one example. When the revenue exists to support patient care, I believe pharmacy owners will support staffing that optimizes the revenue opportunity.
APhA is focused on accelerating coverage and payment for the care services of pharmacists. Yes, we are acutely aware of the painful present-day situation of the workplace. But if we do not advocate and work for the future, we’ll never see improvements in those workplace conditions. We must work on both the current problems and create our preferred future—it can’t be either/or.
Above all, we must advocate for coverage of pharmacists’ care services, or our patients will no longer have access to us. The closures of 1,200 Walgreens stores by 2027 and 4,000 store closures across all companies and independents this year illustrates the point clearly. Consumers are losing access. We must fight hard.
Do not grow weary, my friends. Keep the faith and keep fighting. Our patients are worth it. Our colleagues are worth it. We are going to see major breakthroughs in payment as we enter 2025, and it will be in large measure because of your active engagement in APhA and the tireless advocacy partnerships we pursue every day. Thank you for continuing to be a member and fighting with us!
For every pharmacist. For all of pharmacy. ■