Independent pharmacies are in the fight of their lives, and patients are paying the price

It’s the last week of American Pharmacists Month, when we’re urged to feel pride in our profession. But the truth is that a high percentage of pharmacists are in pain.

After years of declining reimbursement, the nation is waking up to the fact that pharmacies, especially independent pharmacies, are closing at alarming rates. The evidence of the trend is in a JAMA Internal Medicine study published earlier this month, which shows that one in eight pharmacies closed between 2009 and 2015.

Even worse, pharmacies that serve large numbers of uninsured, Medicare, or Medicaid patients are closing disproportionately. This is affecting the nation’s most vulnerable patients, who in many cases have the highest drug-spends. They are the patients who need pharmacists the most. Many communities across the country are experiencing “pharmacy deserts,” losing access to services that they had come to rely on.

The study cites exclusion from preferred pharmacy networks and low Medicare and Medicaid reimbursement rates as existential threats to independent pharmacies. It’s not new information for us—addressing the latter threat to pharmacy survival was one of the recommendations that came out of the Enhancing Well-Being and Resilience Among the Pharmacist Workforce national consensus conference convened earlier this year. Thankfully, the message is now reaching a wider audience.

The theme of #APhM2019 is that pharmacists are “Easy to Reach and Ready to Help”—but the closings of pharmacies in underserved communities mean that pharmacists are no longer so easy to reach. As the JAMA Internal Medicine study lead author Dima Mazen Qato, PharmD, PhD, said in a media release, “Efforts to improve access to prescription drugs have focused almost exclusively on reducing drug costs, but affordable medications aren’t easily accessible when a local pharmacy closes. We need policies that specifically address pharmacy closures because such closures negatively impact access and adherence to prescription drugs.” If we continue down this path, communities will be faced with unintended consequences—loss of access, higher medical costs, jobs, and more.

We’ll have more to say in my next blog but work in Illinois to reform working conditions in pharmacies by a state-appointed task force also does a nice job of exposing the single biggest contributor to short staffing—inadequate reimbursement. You can read the report here. Skip to page 21 to read what the task force had to say about the need for reform in how pharmacists and pharmacies are remunerated.

There’s no question that pharmacy, like every health profession, is being radically disrupted. And there are always casualties in disruption. Yet, to provide essential health care services in communities, our pharmacies need to thrive as centers for care where people live, work, play, and pray.

I sound off frequently about our need to stay connected, to learn from each other, and to invent new ways to provide care. I also have recognized that Interprofessional Education (IPE) is a fundamental force for positive change, as our colleagues in medicine, nursing, and public health are being trained to expect their pharmacist to be part of their team, be it side by side or virtual. Diversity in all aspects is essential as well. All pharmacists must remain diverse in our exposure to other ways of thinking and problem solving, and practicing. Community pharmacists have shown amazing resilience in the face of over a decade of declining reimbursement. We may have reached our limit! But we’ve got to fight together for change and stay connected.

It’s easy to predict the future. It's hard to predict when it will come. I can’t predict where or how the training of today’s student pharmacists will be applied, but I can tell you about the opportunities to invent your own jobs to meet these growing needs. We resist technology and change at our peril. The invention of the wheel put out of work many whose job were to carry stuff. Yet it created new, endless opportunities. Disruption is here to stay.

That doesn’t mean we give up the fight against DIR fees and other unfair PBM practices or to gain provider status recognition. Patients across the nation have longstanding relationships with community pharmacies. Many receive enhanced services that are emerging rapidly to the mainstream. We’re all about quality! Remember my 12-word mantra: We promote consumer access and coverage for pharmacists’ quality patient care services

We didn’t get into this profession to meet metrics. We got into this profession to make a difference and to serve our patients and communities with quality care that isn’t measured by “how many.”

Keep telling your story to your elected officials and the media and let them know what pharmacies mean to communities. This recent JAMA article and the Illinois report are great evidence that we have a great story to tell with and for our patients! Patients and the entire health care system lose when pharmacies close!