Data from a recent survey reflect a resounding shift toward the role of pharmacies becoming sites for primary care.
Trying to predict the future of pharmacy practice is a challenging endeavor. What our profession looks like in the coming months and years will likely be determined by an interplay of a multitude of factors, only some of which are within our control or even on our radar. Regardless, determining where we're headed and which factors may be shaping the road ahead is valuable to adequately prepare for that future, as well as assess whether there may be anything in our control worth changing.
To that end, insights such as those gleaned from the Pharmacy Next: Health Consumer Medication Trends survey commissioned by Wolters Kluwer can offer a valuable direction for what we can expect in the near future based on consumer needs and the evolving pharmacy landscape. The data reflect a resounding shift toward the role of pharmacies as becoming sites for primary care, as well as provide clarity on some of the tradeoffs consumers are willing to make for more affordable and personalized care.
Expanding Pharmacy and Pharmacist Services
Not surprisingly, 97% of Americans say that a pharmacist should have responsibility for informing them about the safety and/or efficacy of their medications. What might be a little more surprising is that, according to the survey, 61% of Americans believe that 5 years from now, most primary care services will be provided at pharmacies, retail clinics, and/or pharmacy clinics rather than a primary care provider’s office. Similarly, 72% of Americans said they would be open to having medications prescribed by a specially-trained pharmacist instead of a physician.
Movement in this direction across the profession is already taking place, and has been for many years. There are already more than 3000 retail health clinics in North America, and business acquisitions by some of the larger retail pharmacy chains in 2022 suggest this number and the services provided at these sites will continue to expand. Additionally, pharmacists are critical providers of vaccines in all 50 states, and in more than 20 states, pharmacists either have direct authority to prescribe or authority under a collaborative practice agreement to prescribe in response to the results of a rapid diagnostic test for diseases such as COVID-19, influenza, and strep. Many states also authorize pharmacists to prescribe hormonal contraceptives or to initiate pre-exposure prophylaxis treatment to prevent HIV. Using consumer attitudes as a guide, these pharmacy service offerings will likely continue to expand.
However, although many Americans say they are not concerned about the safety of receiving medication guidance by someone other than their physician (such as a pharmacist and/or nurse practitioner/care staff) at a clinic, issues like pharmacy staffing and medication safety still cause some consumers to pause. Specifically, 51% of survey respondents said they were worried about potential problems with their prescriptions stemming from pharmacies being understaffed.
To expand pharmacist responsibilities and pharmacy services without leading to immense burnout, adequate training and support of pharmacists is critical to the success of these efforts. Respondents additionally noted concerns regarding more traditional pharmacy services if additional services are added, with half of consumers worried about getting the wrong dosage, the wrong medication, or the wrong instructions. While some of these concerns may be addressed by improving understaffing issues in pharmacies, these concerns highlight challenges that may also be overcome, at least partially, by technology and workflow improvements.
Tradeoffs to Reduce Health Care Costs
Another important concern of respondents is medication cost. According to the survey, more than 2 in 5 Americans (44%) have chosen not to fill a prescription because of the cost over the past few years. Further, tthe number of patients who are skipping medications due to cost is even higher (56%) among those without health insurance. Medication non-adherence is a complex problem that needs to be addressed by many stakeholders, including providers, pharmacists, pharmaceutical companies, payers, and patients. The data highlight the potentially outsized role that cost may be playing in these adverse health behaviors.
Indeed, between July 2021 and July 2022, more than 1200 medications had a price increase that exceeded the rate of inflation (8.5%), with the average increase for these products a substantial 31.6%. The Inflation Reduction Act of 2022 aims to help limit medication prices and tame price increases, but some of these measures do not begin for several years and more is likely needed for meaningful price control. Some pharmacies, such as Mark Cuban's CostPlus online pharmacy, are even looking at a cash-only system that bypasses insurers and pharmacy benefit managers.
Not surprisingly, consumers seem interested in exploring many different ways to save on health care costs. More than half (56%) of respondents often ask their prescriber about less costly alternatives, and 43% ask their pharmacist about less costly options. Meeting this demand for information will require additional training for pharmacists, and access to tools that can help make safe recommendations that also address patients’ concerns around cost.
Other considerations raised to reduce costs included an increased interest in receiving prescriptions by mail if it means lower costs, seeing alternative providers, or making more prescription drugs available over the counter. While some of these shifts are already in place—namely the rise in mail-order pharmacies over the last decade—others may come with important safety trade-offs to consider.
Meeting the Rise of Personalized Medicine
Some of these safety considerations stem from a lack of visibility into patient health data in decentralized care settings. With the rise of personalized medicine and tailored prescribing, interoperable health records represent a significant hurdle to overcome. However, thanks in part to the rise of mainstream genomic testing like Ancestry.com or 23andMe, patients are increasingly expressing interest in using these insights to inform their medications.
Despite the availability of specific published guidance for more than 160 drug-gene combinations, the use of genomics to inform prescribing, also known as pharmacogenomics, is still limited. When provided with an overview of pharmacogenomics, more than 70% of Americans would provide a blood sample for genomic analysis if it meant that they’d receive more personalized medical care. Similarly, over 4 in 5 Americans would provide a sample for genomic testing if it meant that their prescriptions would be safer or more effective, and 88% see an incentive for health insurance plans to cover genomic testing costs if it helps to avoid wasted spending on ineffective or unnecessary medications.
It is important to note that pharmacogenomics represents just one aspect of the effort to personalize a patient's drug therapy. Avoiding hazards like dangerous drug interactions, duplicative therapy, drug-disease interactions, or allergies may be of even more value than using genomics to guide prescribing. To that end, over 4 in 5 (85%) respondents said they would make their medication history more accessible to an extended care team if it would improve the safety and/or relevance of the drugs prescribed to them. It’s also clear more education is needed for patients so they can inform other providers about personal health conditions that may impact their care—for example, almost two-thirds (65%) of respondents did not know that things such as their kidney health might actually change the dose of medications they are prescribed.
Pharmacist responsibilities are certain to continue changing in 2023 and beyond. While some of this will likely be driven by a continued shift in pharmacies and retail clinics offering more and expanded services, consumer concerns about medication cost and safety are also important drivers. These changes represent significant opportunities for pharmacists to offer services for which many patients have been clamoring to receive for decades.
As medication experts and one of the most respected and accessible health care professionals, pharmacists are well-positioned for expanded care responsibilities that consumers are increasingly looking for. At the same time, it is essential that these decentralized clinical sites provide adequate staffing, training, and other support to fully realize the benefits that these efforts offer to individual patients as well as to the broader health care system.
About the Author
Daniel S Streetman, PharmD, MS, is the manager of referential drug interactions and pharmacogenomics, clinical effectiveness at Wolters Kluwer.
Rebelo A. Pharmacy Next: Health Consumer Medication Trends. Wolters Kluwer. December 7, 2022. Accessed January 24, 2023. https://www.wolterskluwer.com/en/news/us-survey-signals-big-shifts-in-primary-care-to-pharmacy-and-clinic-settings