The pharmacy profession and the patient care services delivered by the pharmacy team have evolved significantly over the past few years, bringing new opportunities and challenges. The pandemic has spotlighted the value of pharmacies as vital access points to care, leading policymakers and payers to explore new ways to engage pharmacists and the pharmacy team. There is a buzz of optimism that we are at a turning point and that our efforts toward pharmacy sustainability, services, payment, workforce well-being and resilience, and other factors influencing the pharmacy ecosystem, will finally come to fruition in 2023.
A top priority is sustainability of our nation’s community pharmacies—keeping pharmacy doors open with financial stability, predictability, and growth. The current pharmacy reimbursement and payment model is ripe for change and disruption. We are seeing this with the emergence of cash-only pharmacies, which are filling gaps in health care access. Disruption also is needed to break the lopsided, unfair, and deceptive business practices of PBMs who are puppeteering and ravishing the health care industry, particularly pharmacies. In 2022, the Federal Trade Commission (FTC) began a study of PBM practices and announced the agency’s intent to exercise its full statutory authority against companies that use unfair tactics to gain an advantage instead of competing on the merits. All eyes are on the FTC in 2023 to see them use their enforcement powers on PBMs. In addition, more states are expected to pass laws and regulations this year as courts continue to stand by the Supreme Court’s two-year-old Rutledge v PCMA decision allowing state oversight of PBMs. We are also seeing readiness on the federal level to pass legislation that provides fairness, equity, and transparency in pharmacy payment.
Pharmacists have been giving away free patient care services for too long. Enough is enough. We need to push long-standing legislative efforts over the finish line in 2023 and get recognized as providers under Medicare for our nation’s seniors. There is momentum to pass the Equitable Access to Pharmacy Services (ECAPS) Act, which would authorize pharmacists to provide care and receive direct reimbursement for testing, treating, and immunizing services for certain respiratory illnesses. Importantly, this legislation codifies the temporary scope of practice authorities gained during the pandemic and provides a payment mechanism for the covered services. Passage of this legislation would be a critical step in addressing payment challenges for pharmacists in the Medicare program, challenges that often trickle down to Medicaid and commercial health plans that follow Medicare policy. The Future of Pharmacy Care Coalition, which APhA co-leads with other pharmacy champions, and which is supported by a group of over 200 diverse organizations, is working diligently to get this legislation passed in 2023. Any pharmacy company/organization not involved is encouraged to join. Find more information at www.pharmacycare.org.
Change is ahead for pharmacy, along with many opportunities and challenges as we enter 2023. We have positive momentum for the changes and disruption needed for our profession. APhA stands ready, willing, and able for the work ahead, alongside our pharmacy partners, using a solutions-oriented approach to move the pharmacy profession and the sustainability of community pharmacies forward. ■