September 27, 2023
David D. Pope, PharmD, CDE
Working together, pharmacies and labs can answer the call to align and back legislation that supports pharmacists as providers, help patients gain greater access to affordable care, and reap the benefits of improved health outcomes while growing business revenue.
Provider shortages and health care deserts have led to an increased demand for clinical services at pharmacies, which are increasingly providing clinical services that will need laboratory support.
While the deserts continue to surge, health care expenses have soared and continue to rise exponentially, surging past inflation, which had been flat until recently. In just the last 2 decades, the price of TVs, mobile phones, toys, and computer software have dropped 40% to 80%, while health care costs have risen more than 200%.1
In addition to rising health care costs, the issues of missed clinical visits and first-fill drop offs (when prescriptions are filled but not picked up) have become worse in recent years. The COVID-19 pandemic resulted in countless missed clinical visits. Although there has been a rebound in clinical visits since 2020, there is still a net decline in visits of 10% below pre-COVID-19 levels. Diagnostics have bounced back to a 5% decline below their pre-pandemic levels, but prescription fills have not rebounded, and remain nearly 20% below pre-COVID-19 pharmacy fill levels.2
When health care is not easily accessible and chronic conditions go undetected or are not properly managed, patients often present with more advanced disease stages than they would have otherwise. People with cancer are diagnosed with metastatic cancer. People with diabetes present with end-organ damage.
This highlights the urgent need for collaboration between laboratories and pharmacies to enhance patient care in the evolving health care ecosystem. By joining forces, labs and pharmacies can unlock 3 key benefits that can not only improve patient care and outcomes but also contribute to revenue stream growth.
Partnership between pharmacies and labs helps rural and under-served communities, delivering convenient and timely care where it is most needed to achieve health equity.
Today, while 20% of the US population lives in rural communities, only 11% of physicians practice in such areas. That means that the patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas.3
However, seeking basic care and treatment today is easier than ever, with convenient care options readily available via pharmacies. Right now, 95% of Americans live within 5 miles of a pharmacy and 90% live within 2 miles.3
Pharmacist-provided care is also what patients want. An opinion poll of seniors conducted last year found that 80% “want local pharmacy access to vaccines, testing and treatments for flu, strep or future pandemic infections”; and an even greater number (85%) said that they want Congress to ensure older Americans have access to a broader array of pharmacy services, including testing, vaccination, etc. for infectious diseases like flu, strep and RSV.1
According to a JD Power survey, 51% of Americans visit the pharmacy to get a health and wellness service, such as vaccines or routine screening and COVID-19 testing. Is it any wonder that pharmacies are seeing their patients 10 times more than physicians or other health care providers? 4
In 2023, we are now at the crossroads of pharmacy and diagnostics, as pharmacists are in the process of innovating and looking to expand through “test and treat” and “screen and treat.”
Across the country, pharmacists are testing for cholesterol (Ohio),5 colon cancer (Kentucky),6 pharmacogenomics,7 and even infectious diseases, like HIV,8 nationwide. Genetic testing, while standard for labs, is in great demand for targeted treatments pertaining to all major cancers and new areas like thalassemia and obesity, as well as next-generation sequencing and pharmacogenomics. Beyond providing insight on the compatibility of medicines based on a patient’s DNA and associated metabolism by drug type, a test that says that you have X, Y, or Z can also ensure the right dosage for greater clinical effectiveness based on the patient’s genomic profile.
Prior authorization policies from payors can require routine rapid tests, such as INR liver function and CBC, as well as low acuity type tests, which cannot be provided without the help of labs.
Today, pharmacists across the country, operating at the intersection of diagnostics and treatment, will book office hours. Put another way, pharmacists are a new provider in town. Pharmacists can now order and prescribe in certain states.9 Currently, nearly 40 states allow direct access to testing and recognize pharmacists as providers, thanks to the Public Readiness and Emergency Preparedness Act (PREP Act), which was established in 2005 and reaffirmed in 2020 to allow pharmacists to prescribe oral medication to patients with COVID-19.2
Retail, specialty, and outpatient pharmacies can all benefit from a stronger relationship with labs and in so doing, help each other financially. Helping to drive revenue are specialty oncology and immunotherapy medications, which account for 55% of all pharmacy sales, nearly doubling from 28% in 2011.10Auto-immune medications grew by 459% and oncology was up 346% in that same period. But auto-immune therapies require special considerations because they cost hundreds of thousands of dollars.10
Specialty pharmacies need help to gather lab test results pre- and post-dispensing. Among the specialty drugs requiring lab tests are:
- Hepatitis C, which requires checking the viral loads
- HIV pre-exposure prophylaxis and post-exposure prophylaxis, which can be prescribed after testing
- Clozepine, which cannot be dispensed until verification of white blood cell count
For the relationship to work best, laboratory, specialized diagnostics and pharmacy must understand:
- The real-world impact of diagnostics on patient treatment decisions are critical for advancing personalized medicine initiatives
- The opportunity for greater patient convenience and affordability as some services shift away from the physician’s office to the pharmacy
- Changing regulatory trends enable pharmacists to perform more clinical services to help ensure better treatment utilization, coverage, and patient/provider experience
As payors demand more data for tests for service, the great digital ecosystem is able to funnel more patients into the 4 walls of pharmacy, creating a greater need for lab services.
Pharmacies and labs must align on advocacy, particularly key legislation introduced across the country from the US House and Senate in Washington, DC, to the State Assembly in California.
It is time for policymakers in Washington and in state capitols across the country to formally institutionalize the temporary measures taken during the Public Health Emergency to make essential pharmacist care and services fully accessible and easily affordable, especially for our most vulnerable and underserved communities.
For pharmacists to be recognized as providers, several key challenges must be addressed:
- Federal and State Law: the legal status of pharmacists as care providers must be changed to enable them to practice at the full extent of their training and education. That starts with enacting the Equitable Community Access to Pharmacist Services Act, H.R. 1770, to provide Medicare Part B reimbursement for essential testing, treatment, and vaccination services.
- Reimbursement and Credentialing: Payors, including the federal government, must adapt their policies to ensure pharmacists receive fair compensation for their services.
- Educational and Training Opportunities: To ensure pharmacists remain fully equipped to serve as providers, we must invest in their training to expand clinical knowledge and patient care skills.
Pharmacies and labs have the opportunity to be change agents and contribute to better health care services for patients across America. Working together, pharmacies and labs can answer the call to align and back legislation that supports pharmacists as providers, help patients gain greater access to affordable care, and reap the benefits of improved health outcomes while growing business revenue.
- Perry MJ. Chart of the Day… or Century? American Enterprise Institute. January 11, 2019. Accessed September 27, 2023. https://www.aei.org/carpe-diem/chart-of-the-day-or-century/#:~:text=During%20the%20most%20recent%2021,average%20hourly%20earnings%20(wages).
- Understanding the US Return. IQVIA. June 18, 2021. Accessed September 27, 2023. https://www.iqvia.com/locations/united-states/blogs/2021/06/understanding-the-us-return#:~:text=One%20of%20the%20more%20remarkable,’t%20(Exhibit%202).
- Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. Sci and Pract. 2022;62(6):P1816-1822. doi:10.1016/j.japh.2022.07.003
- Retail Health and Wellness Services Surge in Popularity, Driving Significant Gains in Pharmacy Customer Satisfaction, JD Power Finds. News release. JD Power. July 28, 2021. Accessed September 27, 2023. https://www.jdpower.com/business/press-releases/2021-us-pharmacy-study
- Provider Status. Ohio Pharmacists Association. Accessed September 27, 2023. https://www.ohiopharmacists.org/aws/OPA/pt/sp/provider-status
- KY First State to Authorize Pharmacists to Provide Colorectal Cancer Screening Services. News release. Kentucky Pharmacists Association. November 16, 2022. Accessed September 27, 2023. https://www.kphanet.org/ky_first_state_to_authorize_pharmacists_to_provide_colorectal_cancer_screening_services
- FAQs. RxGenomix. Accessed September 27, 2023. https://rxgenomix.com/faqs/
- Pharmacist Prescribing: HIV PrEP and PEP. National Alliance of State Pharmacy Associations. December 9, 2022. Accessed September 27, 2023. https://naspa.us/blog/resource/pharmacist-prescribing-hiv-prep-and-pep/
- Provider Status: Update with ASHP. Pharmacy Practice News. January 6, 2022. Accessed September 27, 2023. https://www.pharmacypracticenews.com/Multimedia/Article/01-22/Provider-Status-Update/65782
- The Use of Medicines in the US 2022. IQVIA. April 21, 2022. Accessed September 27, 2023. https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-us-2022