Much has been said and written about the decline of community pharmacies, and rural lawmakers have been quite vocal about their plight. In nearly all of the 25 congressional hearings in 2023 related to the drug supply chain, at least one lawmaker has seen fit to call attention to the plight of community pharmacies. I can attest that members of Congress have also expressed this concern to me in meetings I’ve had with them as well.
However, merely protecting all of the current independent pharmacies from the vicissitudes of market competition will not benefit the patients whose interests are supposedly threatened by their diminution.
The problem at hand is that the current business model of most community pharmacies’ is dying. Consumers have come to expect and demand access to pharmacies conveniently located within retail grocery stores, that are open outside of normal business hours, and that can offer home delivery of drugs. Some independent community pharmacies have adapted to consumer demands, but many more haven’t. As such, pharmacy benefit managers (which create and maintain pharmacy networks), have chosen to prioritize pharmacies that comport with consumers’ demands.
In this new consumer environment we should ask what can be done to revitalize community pharmacies to make them more appealing to consumers. The vast majority will never be able to offer the same conveniences as large, retail pharmacies. Are there other options?
One way to do this would be to pass legislation that would permit highly-trained pharmacists—which accurately describes many of those who work at community pharmacies—to allow them to prescribe drugs for minor acute conditions.
Right now, patients have to visit their doctor to get a prescription, have the prescription sent to a pharmacy, and then go to a separate location to obtain their drugs, which can be a formidable chore for a patient suffering with the flu. Allowing community pharmacies to do evaluation and management services and prescribe basic care would allow them to become a one-stop shop. Such a development would greatly increase their value to consumers and in turn strengthen their negotiating power with PBMs and health plans.
Independent community pharmacists are often located in under-served rural and urban areas and are frequently the most accessible healthcare providers in many communities. Expanding a pharmacy’s scope of practice is a simple way to remove a government barrier to pharmacies becoming more valuable to the communities they serve. Policymakers in New Mexico, Oregon, Idaho, Florida, California, North Carolina, Montana, New York, Iowa, Massachusetts, and Ohio have all taken steps to treat community pharmacies like providers. More states should follow their leads.
Federal legislators can help, too, by passing The Equitable Community Access to Pharmacist Services Act, which would authorize pharmacists to help treat patients suffering from COVID-19, influenza, respiratory syncytial virus, or strep throats, as well as administer several vaccines. The bill would also expand Medicare coverage to allow pharmacists to be reimbursed for these services.
However, the National Community Pharmacist Association (NCPA) has chosen instead to work with PhRMA to blame Pharmacy Benefit Managers for perceived community pharmacist closures. NCPA CEO Doug Hoey has accused “neighborhood pharmacies [of] being mugged in broad daylight.”
NCPA’s advocacy strategy is antithetical to efforts to control healthcare costs, and it is, in effect, attempting to get the government to remove incentives for the private market to negotiate lower prices with pharmacies. It also amounts to a resolute refusal to come up with a workable alternative that makes independent community pharmacies viable in the future other than to have the government protect them, regardless of the costs to consumers and taxpayers.
First, it convinced federal bureaucrats to ban the value-based contract agreements they signed with PBMs. Now, they’re complaining that the federal action banning DIR fees is “backfiring,” because PBMs are “pressuring them” into new contracts with severe cuts to their dispensing fees. We can only assume they’ll be asking policymakers to ban the new type of contract soon. They’ll be playing whack-a-mole with PBM contracts until they get what they really want: no accountability for high healthcare costs whatsoever. They’ll get more money and give consumers nothing in return other than higher healthcare costs across the board.
No one wants to see the demise of independent pharmacists, but their survival cannot be predicated on government protection. Policymakers can expand the scope of practice for pharmacies and allow them to innovate and add value to the economy, or it can ask U.S. citizens to pay more for their drugs in order to protect an antiquated business model.