When I was practicing as a community pharmacist, I saw patients walk away from the counter without their prescription because they couldn’t pay for a drug they needed. I saw patients expecting that their medications were ready for pick up, only to be turned away empty-handed because systems were not in place for a timely exchange of information between the pharmacist and doctor before the patient arrived. And I saw patients come to the pharmacy for prescriptions that could endanger their health by interacting with their other medications. Healthcare providers like me choose our profession to help people receive the care they need. It is heartbreaking when the system does not meet those needs.
Ask a patient who they trust most to respond to their medication questions and the answer is clear: their pharmacist. Historically, community pharmacists enjoyed personal relationships with patients, and the pharmacists were also connected to the providers and care team. These pharmacists had a better understanding of the cultural and linguistic needs of their communities, which made it easier to solve prescription issues. It’s why I started out as a community pharmacist – to be a trusted advisor for my community. Although pharmacists are still highly trusted, the ecosystem has changed. While more people need medication treatment, pharmacy staffing is tight. Community pharmacists are often too busy to act as a personal advisor to their patients.
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Overcoming the barriers
Early in my career, I realized that helping patients achieve their medication treatment goals was harder than I imagined. Administrative and technical tasks took time away from me using my clinical training to help my patients manage their medications safely. The difficulty helping patients was also partly due to the lack of real-time, patient-specific information to address prescription medication costs. Without this, I could only react, rather than be proactive, so my patients didn’t always leave the pharmacy with medications in hand.
The exchange of information between the medical provider and pharmacist is vital. For patients to receive holistic and comprehensive care, pharmacists must be included in the care team. This means communicating and coordinating efficiently with the patient’s medical providers about the medication needs, and serving as a resource for informed, appropriate therapeutic decisions. Restoring the pharmacist’s relationship with patients and providers is paramount for fixing our broken pharmacy care system.
How to focus on the patient
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
In response to the prevailing situation, strategies, programs and technologies are being developed and implemented across the country to put the patient closer to the heart of pharmacy care. Here are some of those promising initiatives.
- Pharmacist providers: As of 2013, California law recognizes licensed pharmacists as healthcare providers who can provide more than just drug dispensing functions, such as holistic medication reviews and consulting with physicians and patients to ensure that patients are taking their medications appropriately. This harnesses their value, enabling them to practice at the top of their license. Health plans and care teams should include pharmacist providers in the care team to better address patient’s medication needs.
- Pharmacy advocate programs: Patients need help navigating their pharmacy benefits and access to medications. These advocacy programs use pharmacy professionals to proactively engage patients and their providers for this purpose. This can especially help patients who may not be taking their medications as prescribed. There are many reasons this can happen, ranging from fear to cost to worry. An IQVIA report showed that 9% of prescriptions are abandoned at retail pharmacies, including 5% when there is no cost to the patient. However, when prescriptions cost more than $500 out-of-pocket, an astounding 60% of patients do not fill them. Pharmacy professionals, including pharmacists and pharmacy technicians, can address this. They can identify lower-cost options or access assistance programs; use the patient’s pharmacy benefits to potentially lower costs; suggest tips to remember to take and refill chronic medications as prescribed; determine ways to get medications delivered if unable to travel; and help address drug side effect concerns.
- Pharmacy access programs: There are pharmacy deserts nationwide, with one mile or more between a neighborhood and pharmacy. This makes it difficult to get to a pharmacy without a vehicle. Pharmacy deserts also exist in low-income neighborhoods containing at least 100 households with transportation barriers (i.e., no vehicle), and at least 0.5 miles between the neighborhood and nearest pharmacy. One-third of all Black and Latino neighborhoods in Los Angeles are pharmacy deserts, per a USC Schaeffer study. Pharmacy access programs provide numerous ways to ensure these communities can access prescription medications, such as through pharmacies with a delivery service, whether courier or mail. Real-time drug cost transparency services and programs: Federal and state regulations now require health plans to provide real-time pharmacy benefits information to prescribers at the time of prescribing and to beneficiaries through web and mobile applications. This gives them instant information about out-of-pocket costs and lower-cost options. It ensures that prescribers have accurate information to discuss with the patient during a visit or phone call, to make a more informed decision about medication choice before sending a prescription to the pharmacy. Patients can also see options to discuss with their physician if needed. Technologies can deliver the same information to the patient’s pharmacist, enabling personalized care.
- Value-based payments: To reduce potentially wasteful spending and ensure that the payment system rewards health outcomes, we must move to a value-based payment model. Medications are typically paid on a per unit basis, no matter how well they work for the patient. More than half of health plans now use at least one outcomes-based contract to pay for prescription drugs. Such contracts tie payments or discounts to actual medication efficacy or outcomes for specific patients. Not only will it make medications more affordable for patients overall, we will also collect better data about which medications are most likely to work well – a move toward personalized medicine.
With innovations like these, we create a winning situation. More pharmacies and pharmacists can focus on drug treatment outcomes for their patients and improve customer loyalty. Patients get more personalized care and utilize trusted pharmacists as part of their care team. Health systems and health plans have greater confidence that their patients and members have the right medications on hand for their individual needs. And pharmacists are working at the top of their license to provide the level of care that inspired them to enter the field. We should strive for a future where patients have easy and affordable access to medications, supported on their journey by trusted pharmacy professionals who are an integral part of their care team.
Photo: Ridofranz, Getty Images
As Blue Shield Vice President, Pharmacy Services, Alison Lum leads the team that is transforming the Blue Shield pharmacy benefit into one that is worthy of our family and friends and sustainably affordable. At Blue Shield, she has taken an active role in employee engagement, management training and leadership development. Prior to joining Blue Shield, Alison was the Director of Clinical Services at a managed Medicaid plan, San Francisco Health Plan, where she was responsible for pharmacy benefits, utilization/case management and provider relations.
Alison also has experience in Medicare Part D, PACE programs and account management. She holds a doctorate of pharmacy degree from the University of California, San Francisco and completed the California Healthcare Foundation Leadership Fellowship. Alison participated on the California Pharmacist Association state-wide task force for SB493 payment models and was a keynote speaker on the topic at the 2015 West Coast Pharmacy Exchange. She was honored with the Blue Shield Team Mission and Values in Action awards for 2016 and 2013 and the inaugural San Francisco Health Plan’s first Here For You award in 2008.
