The Reinvention, Not the Death, of Community Pharmacy –
September marked Pharmacists Month nationally and is a relevant time to reflect on the evolution of the pharmacy profession, and the advancements of healthcare practices, technologies, standards, and innovations.
Does the acquisition of PillPack by Amazon mean the end of community pharmacy in the same way that Netflix displaced Blockbuster? The answer lies in what disruptive innovation is, and what it is not. Disruptive innovation describes how a new idea or product that upsets an existing industry, usually forcing a once stable or sluggish sector to adjust rapidly and creatively to avoid obsolescence. Some have looked at organizations like Amazon, Uber, Netflix and Airbnb as disruptive innovators because each has transformed the way people interact with their respective industries in drastic fashion.
In pharmacy, Amazon’s interest in pharmacy distribution and the acquisition of the innovative drug packaging service, PillPack, have prompted some to categorize this as a disruptive innovation of pharmacy. Consequently, some have questioned the viability of community pharmacy:
- What will happen to community pharmacies once people can have their medications delivered through Amazon?
- How will community pharmacists adapt?
- What distinctive value will community pharmacy bring?
However, since disruptive innovation is predicated on the creation of new value and new markets, this thinking is foundationally flawed. To equate innovations in the distribution and dispensing of medicines as replacing services provided by community pharmacists is to fundamentally misunderstand pharmacist patient care services and their contributions to improving health and managing costs.
Pharmacists are medication experts, located conveniently in virtually every community in the U.S. Pharmacists are a community-based sentinel for medication-related issues: regularly providing advice directly to patients; checking for adverse events; navigating coverage issues; and coordinating with patients’ physicians on issues that arise. These services are vitally important considering that prescription medications are the primary tools used to treat both chronic and acute conditions to improve health. In fact, 75 percent of physician visits, 72 percent of outpatient hospital visits, and 80 percent of ER visits involve drug therapy.
Despite our reliance on medications, we do little to assure that key standards are met:
- the medication regimen aligns with both patient and clinical goals,
- the regimen is understood and achievable by the patient, and
- the regimen is revisited with the patient regularly and as problems are encountered.
This is a void that pharmacists can and will continue to fill through direct patient care services.
Truly optimizing medication therapy requires much more than facilitating medication adherence through convenience medication packaging. We define medication optimization as a personalized, patient-centered, collaborative approach to managing medications that is applied consistently across care settings. Comprehensive Medication Management (CMM) performed by pharmacists is a key component. Medication optimization results in maximizing the benefits of medications to meet quality and cost goals, which is crucial given recent cost estimates, which put the annual cost of failing to optimize prescription drug therapy at $495.3 billion to $672.7 billion. Pharmacist interventions, namely CMM, are central to reducing those costs and resolving quality issues that result in avoidable spending like treatment failures, new medical problems, or both.
Realizing that cost-saving potential, however, requires a different perspective on drug spending and a greater understanding of the role pharmacists can and do play to optimize medication therapy. As described in a commentary co-authored by Jon Easter and health economist, Ken Thorpe, PhD, earlier this year, the laser-like focus on drug pricing misses a bigger opportunity to both lower costs and improve quality; an opportunity for which pharmacists are ideally suited to lead. As discussed, the larger opportunity involves expanding the focus to look at drug-sensitive spending, which includes the costs of medicines and the medical costs of failing to optimize their use.
The lack of system-wide incentives and sustainable payment models that support clinical services in the community pharmacy setting are major barriers to building these connections, but interest is growing. For example, a large survey of Accountable Care Organizations (ACOs) showed a growing trend of ACOs engaging in medication optimization to enhance outcomes, improve patient experience, and lower costs. Respondents, however, identified both pharmacists operating at less than full scope of practice and a lack of reimbursement for pharmacist services as significant barriers to adoption of medication optimization.
Disruptive innovation is actually a welcome force in pharmacy. Given the opportunities medication optimization offers to value-driven health care, community pharmacists will be essential to the future of health care.