Informed by the newly released NCPA 2019 Digest, members of community pharmacy organizations elaborate on the ongoing discussion of value-based care and reimbursement for community pharmacists.
Released during the National Community Pharmacists Association’s (NCPA) Convention in San Diego, The 2019 NCPA Digest has found that in 2018, independent community pharmacy as an industry represented 35% of all retail pharmacies in the United States and is a $75.8 billion marketplace.
“The digest is our flagship research piece and is the most comprehensive source of information about pharmacy in the country. It is important for policymakers, those who study in the industry, and for our members to see how they stack up [in their pharmacy] and how the industry is changing,” Jack Mozloom, NCPA vice president for Public Affairs, said in an interview with Pharmacy Times.
For more than 80 years, the annual NCPA Digest has served as an important barometer for independent community pharmacy owners to quantifiably measure themselves against their peers and their competitors. The 2019 NCPA Digest demonstrates the need for independent pharmacies that have provided a variety of services over the previous year.
“The 2019 Digest confirms what we’ve been hearing from [our] members: it’s a tough time for independent pharmacies and those who are diversifying their revenue are doing better,” said Mozloom to Pharmacy Times.
However, Joe Moose, PharmD, director of Strategy and Luminary Development for the Community Pharmacy Enhanced Services Network (CPESN) USA disagrees, explaining that the challenge for independent pharmacies isn’t that they are not diversifying, but that they have not expressed their inherent value to payers that are responsible for medical costs.
“Pharmacies—and their patients—remain in a system with a broken payment model that reimburses for a pill, not the ongoing health of the patient. That model is driving many community-based pharmacies out of business and compromising patient care,” Moose said in an email to Pharmacy Times.
Troy Trygstad, PharmD, MBA, PhD, executive director of CPESN USA, said that the inherent value of community pharmacy goes well beyond what is being compensated to community pharmacists.
"Changing the value expression of [c]ommunity-[b]ased pharmacies goes well beyond the generation of another reimbursement stream. Offering and getting paid for enhanced services that pharmacies are uniquely positioned to provide will preserve the privilege of dispensing,” Trygstad explained in an email with Pharmacy Times.
The value to which Trygstad is referring is often found in the extra services that pharmacists provide such as immunizations and long-lasting health services for their local communities.
According to the NCPA report, in 2018, nearly 79% of pharmacies offer medication synchronization services and 77% offer medication therapy management. Ninety-one percent of community pharmacies are offering some type of medication adherence program, aligning the interest of patients, payers, pharmacists, and plans.
“There are (literally) hundreds of thousands of care team members out there working on optimizing medication use, from physicians, to care mangers, to patient navigators and social workers, to call centers stocked with legions of students and re-purposed pharmacy technicians. All of them are competing for the emerging need to hit pay for performance metrics brought to us by a now decade long march toward value-based purchasing. Yet none of them have the access and engagement that community-pharmacies have. You have the most trust […] You are immersed in your community,” said Trygstad in an email to Pharmacy Times.
According to the NCPA report, 76% of pharmacies provide flu immunizations and 69% provide non-flu immunizations, whereas 57% of pharmacies perform blood pressure monitoring and 53% furnish durable medical goods. From a philanthropic standpoint, 65% of all independent community pharmacy owners donated to at least 5 local organizations in 2018.
“Independent community pharmacists have long been lauded for the services patients can access and the quality care they can receive at these locally-owned pharmacies,” said B. Douglas Hoey, RPh, MBA, CEO of NCPA, in a press release. “As economic pressures on pharmacies continue­—and as more medical-side payers find value in community-based pharmacies—it’s increasingly important to change the pharmacy payment model to compensate for value and recognize pharmacists for the services they do and can provide.”
The NCPA report also gave a snapshot of 2018 by the numbers: there are currently 21,767 independent pharmacies, down slightly from 21,909 in 2017. Furthermore, prescription volume was 58,823 (189 per day). Approximately 74% of community pharmacies serve population areas of 50,000 or fewer.
According to Hoey, The NCPA Digest, sponsored by Cardinal Health, is the go-to source for financial, operations, and practice information about community pharmacy to inform these ongoing discussions surrounding the pharmacy industry. The report has more than 30 benchmarks to help pharmacists compare their operations with their peers and guide their decision making, including information on buying or selling a pharmacy, comparing financials with other independent pharmacies, creating a business loan, and employee wage comparisons.
“This year’s digest, in addition to serving as a barometer for independent community pharmacy owners, establishes the steadily growing local networks of CPESN USA as pharmacy’s best bet to transform into a system allowing pharmacists to be recognized for practicing at their full scope,” Hoey said in the press release.
Roughly 2351 pharmacies are participating in the CPESN USA national network of clinically integrated pharmacies, with networks launched and expanding in 44 of 50 states in the US.
Moose noted that the key word in Hoey's comments is “local.”
“Local CPESN networks of community-based pharmacies are providing local care management services that can't be replicated by warehouse pharmacies, robots, and packages in a mailbox," he said in an email to Pharmacy Times.
"As an accountable pharmacy organization, our strategy for a new way of pharmacy payment is to imitate the opportunities physicians are encountering with pay for performance and measurement on clinical outcomes,” Moose continued. “We believe in community-based pharmacies and are excited to share their story.”
Trygstad summarized the feeling of community pharmacists well in his email to Pharmacy Times.
“As the famed runner Steve Prefontaine once said, ‘To give anything less than your best is to sacrifice the gift.’ Our gift is the privilege of dispensing and to give our best is to make sure that we are driving better patient outcomes. By creating a simple plan of care with a goal, we are optimizing medication use […] By keeping patients healthy and out of expensive care [,] we provide value. And if we provide enough value [—] they won't have a choice but to let us keep dispensing.”