Many folks who have a minor ailment, a question about medicines, or a health concern in general often stop by their local pharmacy to ask the pharmacist for advice. I grew up in a rural area of Southern Illinois that did not have a full-time physician. The health department clinic was only open on select mornings each week to administer vaccines. The pharmacist was the only healthcare professional that my family could easily see within 30 miles.
Regardless of where we live, we’ve likely taken for granted that there is a pharmacy nearby. Today those pharmacies are often owned by CVS or Walgreens or are situated in a grocery store or big box retailer like Wal-Mart, Costco or Target. Health systems like Loma Linda University Health also own community pharmacies. There are still nearly 22,000 privately owned pharmacies in the U.S.1
Prescription Medication as a Consumer Product
However, all of this is rapidly changing. Many consumers who need medicines are looking at how they can get the cheapest drugs in the fastest way. Drugs are often viewed as a commodity, much like groceries, which we seek to purchase at the cheapest price. We also like front door delivery, such as with Amazon.com. However, there is one problem. Prescription drugs can harm us. Sometimes unexpected and unwanted reactions happen when we take drugs. National data shows that nearly 200,000 adults and 75,000 children visit the emergency room each year due to adverse drug events.2 Drugs are in many ways quite different from groceries given their risks. Yet we treat them like any other consumer product.
While I am a pharmacist, I’m also a consumer. I, too, want to buy the cheapest medicines in the most convenient way possible. However, I also want to have the assurance that a pharmacist is reviewing my medications and medical history regularly. I need to know that he or she is checking to make sure my dose is right and is available whenever I have a question about my medicines or my condition. At least half of all Americans take at least one medicine regularly, with that number rising rapidly as we age.3 But when I’m picking up my medicines from the pharmacy, I may not think about anything other than the pills in the bottle.
Lack of Payment for Pharmacist Services
Medicare, our national health insurance program for seniors, does not pay pharmacists for managing medicines, preventing illness, or providing any other healthcare service.4 Medicare only pays the pharmacy for the drugs but not for the care a pharmacist provides except in very limited circumstances. National pharmacist professional associations, hospitals, and others are trying to get Congress to change this, but passing a law takes time.
A Shift in the Way Drugs are Paid for by Insurance Companies
Additionally, Medicare, Medicaid, and private insurers hire specialized companies called Pharmacy Benefit Managers (PBMs) to process payments to pharmacies for drugs. This is separate from the way the rest of health care is paid. Just four major companies now control payments for eight out of ten prescriptions.5 These PBMs generate billions of dollars for their shareholders by dictating how much pharmacies will be paid, with most pharmacies as of 2019 unable to cover their costs of dispensing drugs.1 This means they can’t hire the pharmacists they need to take care of patients.
The Continuing Trend of Community Pharmacy Closures and Why We Need to Take Action
All of this is leading to the most rapid closure of community pharmacies in America’s history. Over 8,000 pharmacies have closed nationwide since 2018. Even Walgreens and CVS are closing pharmacies. I recently attended a conference where DrugChannels.com CEO and futurist, Adam Fein, projected that another 10,000 to 15,000 pharmacies will close in the next five years. A recent survey of privately-owned pharmacies backs up Dr. Fein’s projection, finding that as many as 50 percent (around 10,000) pharmacies are contemplating closure within two years if drug product reimbursements are not corrected and/or pharmacist services are not paid for by insurers.6
Industries change and pharmacy is no different. This change, however, is going to cause a major problem for many of us who have no option for health care other than our local pharmacy. It will impact public health because our pharmacists won’t be available to give flu shots or help during outbreaks. Dozens of well-run studies have demonstrated that when pharmacists provide good care in local communities in collaboration with doctors, people are less likely to wind up in the hospital. For many communities, the closure of the pharmacy and loss of the pharmacist means that healthcare services, not just drugs, are harder to reach. As consumers and healthcare providers, we all need to partner together to advocate for pharmacist inclusion in the U.S. Social Security Act as providers. We need to let our employers and payers know that we expect to continue to have access to and coverage for the critical services of a pharmacist and we need to insist that the companies that pay for drugs are doing so in a way that ensures pharmacies can stay open. Our health depends on it.
Michael Hogue, Pharm.D., FAPhA, FNAP
Dr. Hogue is the Dean and Professor of Loma Linda University School of Pharmacy. He is also the president-elect of the American Pharmacists Association (APhA) and will become the 165th president of the organization in March of 2020. His research interests include the attitudes and consumer behaviors in community-based care, vaccines and immunizations, and health policy.
- 2019 NCPA Digest. Alexandria, VA. National Community Pharmacists Association. 2019. http://www.ncpa.co/pdf/digest/2019/2019-digest.pdf
- CDC Medication Safety webpage. Centers for Disease Control and Prevention. https://www.cdc.gov/medicationsafety/program_focus_activities.html. Accessed Jan. 9, 2020.
- Therapeutic Drug Use webpage. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm. Accessed Jan. 9, 2020.
- Pharmacists Provide Care webpage. American Pharmacists Association. https://pharmacistsprovidecare.com/. Accessed January 9, 2020.
- The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. Drug Channels Institute. https://drugchannelsinstitute.com/files/2019-PharmacyPBM-DCI-Overview.pdf.
- National Community Pharmacists Association. www.ncpanet.org