Concerns about the economy have kicked into high gear, melting away notions of a cool, lazy summer for community pharmacies. Recently, an astounding 68% of CFOs polled by CNBC said they believe a recession will occur during the first half of 2023.
The concerning economic outlook is yet another stressor atop an ever-growing list for pharmacies—which includes uncertainty around cashflow, loopholes in CMS’ final rule around PBMs’ use of DIR fees, and the burden of adapting Pharmacy Quality Alliance’s (PQA) new pharmacy quality metrics. While PBMs will likely see increased scrutiny by regulators in light of recent news that a national PBM was charged with delivering unnecessary prescription drugs to military personnel, they continue to be at odds with the profitability of independent pharmacies.
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Alex Miguel Alex Miguel, PharmD, is SVP, GM Enhanced Medication Services at Transaction Data Systems, the leader in pharmacy software solutions, which proudly supports one of the largest installed bases of pharmacies in the industry with systems in all 50 states and the Virgin Islands. For more than 40 years, TDS has been dedicated to […]
Because the stakes are higher for 2023 than in years past, understanding potential industry challenges and tapping into new solutions will be crucial to community and independent pharmacies that hope to stay profitable.
2023: What’s ahead
The potential for continued DIR clawbacks may be the biggest challenge community pharmacies need to brace themselves for in the coming year—but it isn’t the only one.
In a recent report from the Columbia University Mailman School of Public Health, nearly 80% of pharmacists surveyed expect a more prominent role in preventive care by 2030. Many are feeling the effects already, as they are called upon by payers and physicians to supplement routine medical care in addition to administering medications.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
While the general demand for pharmacies to do more with less is nothing new, younger workers are being called upon to clock in for longer and longer shifts—especially in rural areas of the U.S. Also, while we’ve learned to live with Covid, the ongoing prospect of small community pharmacies losing one or two workers who contract the virus (and need to isolate at home for at least five days) puts additional pressures on healthy staff who must fill in the gaps during their absence. It’s no wonder that nearly 7 in 10 pharmacists say they’re burned out.
Meanwhile, payers are feeling increased pressure to provide an exceptional member experience—and expecting their pharmacy partners to help.
In 2020, CMS doubled the weight CAHPS health plan survey metrics pertaining to member experience, which now account for nearly 40% of a health plan’s overall Star Rating, and increased the weight of medication adherence metrics in its Contract Year 2021 Star Ratings formula updates. Plans that fall short of 4.5 stars are at risk of losing the incentives they need to stay in business. So, until further notice, pharmacies and health plans have no choice but to work together to optimize member satisfaction and experience.
Planning for the future
There’s no single solution that will address these concerns, and cost-containment strategies can only take a business so far. With that in mind, these three revenue-generating strategies that can help to ease financial and operational pressures:
- Seek out new opportunities for generating revenues.
Market preferences are always evolving, and pharmacies that can meet consumers’ needs for convenience, access, and service will see more foot traffic—and their health plans and provider partners will benefit, as well. Now is the time to seek out new ways to strategically enhance business: For example, offering ancillary services such as telemedicine consultations or clinical care/dietary counseling, or incorporating a medication synchronization program to address the current needs of consumers.
- Streamline communications under one platform
With demands on pharmacists’ time going up, staying organized and streamlined is the key to staying sane. An integrated care management platform can bring together multiple data streams and improve the following areas:
* Supply chain management
* Drug traceability and transparency
* Medication administration and management
* Quality improvement reporting
* Performance tracking
* Member engagement and outreach
* Care collaboration with providers and health plans
In addition to easing day-to-day activities, using a singular platform in lieu of multiple technology systems can help pharmacy professionals reduce manual computing errors and maintain patient safety.
- Work more closely with care partners to engage members
Health plans and pharmacies aren’t always on the same page—often because they aren’t using the same technology platform—but incentive programs from CMS and others will continue rewarding those care partners who can work together to engage and motivate individuals to raise quality and outcomes. Using an integrated clinical care management platform can help to support all care partners when monitoring progress on medication management and CAHPS metrics, while streamlining reporting.
Community pharmacies need to ramp up now to be ready for 2023 and ensure their operations, technology and partnerships are in tip-top shape should more unexpected economic turbulence arrive. The more that can be done on the front end now, the better equipped pharmacy leaders will be to handle stressful events and weather financial storms six months from now.
Photo: Ridofranz, Getty Images
Alex Miguel, PharmD, is SVP, GM Enhanced Medication Services at Transaction Data Systems, the leader in pharmacy software solutions, which proudly supports one of the largest installed bases of pharmacies in the industry with systems in all 50 states and the Virgin Islands. For more than 40 years, TDS has been dedicated to the success of the pharmacy market and pharmacy supply chain. With its portfolio of products and services including Rx30, Computer-Rx, KloudScript, Pharm Assess and Enhanced Medication Services, TDS provides innovative technology solutions and pharmacy management systems to the pharmacy industry. Miguel has a successful history developing, implementing and executing clinical programs for the provision of medication therapy management services on behalf of various national Medicare sponsors.
