Pharmacies play a key role in health equity, but reimbursement is needed
Pharmacy hours spoke with Jason Ausili, PharmD, Pharmacy Transformation Leader at EnlivenHealth, during the National Association of Chain Drug Stores (NACDS) 2022 Total Store Expo. Although pharmacies have repeatedly proven their worth and continue to be essential in providing equitable health care, Ausili said commensurate reimbursement is needed moving forward.
Q: Pharmacists and pharmacies have always been frontline healthcare resources for patients, and that has only grown in importance during the pandemic. Can you discuss the importance of access to health care and the role that pharmacies play in this regard?
Jason Ausili, PharmD: Absolutely, and being the most accessible healthcare providers in the country, 90% of the population lives within 8 km of a pharmacy. You go a step further and 74% of community pharmacies have less than 50,000 inhabitants. So thinking about the role that pharmacists have played, I know we’re going to talk a bit about COVID-19, because it’s really shone a light on the value that pharmacists bring to healthcare. But you know, now pharmacists are expanding the services they offer. COVID-19 has really opened the door to vaccines, tests and also therapeutics. But now the world is truly open to more public health services in pharmacies.
Q: Do you think the pandemic has limited or expanded access to healthcare?
Jason Ausili, PharmD: You know, it was difficult, wasn’t it, because all of a sudden the whole population needs more health care than before. But pharmacies were in a unique position, as I mentioned, being the most accessible health care providers. That’s not to say we didn’t have health equity and access issues. But of the more than 263 million vaccines that have been given, COVID-19 vaccines are given in pharmacies, you wonder, well, what if pharmacies weren’t there to rise to the occasion and step up to the plate? niche? Health equity would have been much more affected if pharmacists weren’t there to help the country here.
Q: Over the past two years there has been an increasing focus on equity in health care. What does equity mean in this context?
Jason Ausili, PharmD: Equity really means enabling everyone, every person, to achieve their optimum health. And the cards are stacked differently for different people. Whether you live in a dense urban or rural setting. Not everyone may have the same access to care. So it’s really about understanding what the specific barriers are that prevent each person from reaching their optimal state of health. And then really leverage the pharmacist to create custom solutions to those barriers. Pharmacists are ideally prepared to work with the social determinants of health, as we all know that health is not just medical care, right? Much more depends on where people live, work and play and where pharmacists have the most touchpoints with their patients. Pharmacists see their patients 2 to 9 times more often than their general practitioner. And with the growing shortage of primary care physicians, it makes pharmacists who regularly communicate with their patients even more important. Because they are the most accessible, they are uniquely prepared to address health equity, health equity issues, and really push the bar forward.
Q: How are pharmacists responding to calls for improved equity?
Jason Ausili, PharmD: So I would say we’ve seen it with COVID-19, right? I mean, vaccinations, over 263 million, as I mentioned, that’s an incredible amount of vaccinations that pharmacists have dispensed during the pandemic. But it doesn’t have to stop there, right? There is some really important legislation currently in the works that will further expand the way pharmacists can reach their communities. There is one particular bill in the House that is still in the tabling stage, so we need to move things forward. But it’s the Pharmacy Improvement and Medically Underserved Areas Act, which would give pharmacists privileges under federal provider status and fair reimbursement at 85% of the physician fee schedule. It’s really important that we recognize the pharmacist on this front. Otherwise, the scalability and viability of the services will be at risk if we do not get fair payment. So, there is so much more that pharmacists can do not just for public health services like smoking cessation. We have, you know, I mentioned vaccines and tests and therapeutics, but you also think of disease states like diabetes. Pharmacists are highly skilled and trained to train patients to better manage their disease states, diabetes education, but also diabetes prevention. These are 2 very important areas that impact our country and pharmacists are uniquely prepared to help address these issues.
Q: Health care deserts have also become a significant concern. What role do independent pharmacies play in particular to overcome these deserts?
Jason Ausili, PharmD: Well, as I mentioned, 74% of community pharmacies have populations under 50,000. So when you think of rural and medically underserved areas and medical deserts, the only practical access to care is probably your local pharmacy. And I recently spoke to and interviewed a rural Nebraska pharmacist who lives in a community where the nearest hospital is over 80 miles away. And during COVID-19, he was going to small towns around his community and setting up COVID-19 clinics where he was doing testing and vaccinations, and extremely important services that he was providing to those communities. If not, where would these patients access care? Without him, they wouldn’t have, they probably wouldn’t have access to care. It is therefore extremely important that pharmacies continue. We [must] leverage our community pharmacist in these medical deserts, to really deliver the care that people need.
Q: What do you predict for the future of health equity and the role of pharmacy in it?
Jason Ausili, PharmD: It’s going to expand as the scope of practice for pharmacists expands, isn’t it? So, you think, there are a lot of parallels there. And the privileges that we have obtained during the pandemic, we must ensure that they do not disappear. Some of the privileges offered by HHS and the PREP Act may expire when the public health emergency ends. We need to ensure that pharmacists have expanded vaccination, testing and treatment capabilities not only for COVID-19, but also for influenza, streptococci and other communicable diseases. Thus, in the future, other services that fall within the pharmacist’s scope of practice will also be beneficial given the accessibility offered by pharmacies. The accessibility of pharmacies, all these services will also be more accessible to their patients.
Q: Is there anything you would like to add?
Jason Ausili, PharmD: Yeah, absolutely. So, as I mentioned, I want to reiterate that immediate legislative action is needed in order to solidify the privileges of pharmacists that we have acquired during the pandemic. But that’s not the stopping point. We need to make sure that the legislation that’s currently under consideration—there’s the Fair Community Access to Pharmaceutical Services Act, which is also in the introductory phase, it’s currently under consideration—will also recognize pharmacists as providers at the federal level, therefore under Medicare, and fairly reimburse pharmacies for pandemic-related services. Now is the time to pass this bill. As we learned with COVID-19, will there be another pandemic? Well, I don’t have a magic 8 ball. But at the same time, we have to prepare for another pandemic. Now is the time to do it. It’s not when you’re already in the middle, is it? So, let’s make sure we position pharmacies more for the long haul, to be that key role that can help fight pandemics and also really contribute to health equity and public health services in general. Fair reimbursement is mandatory, right? Because for these services to be scalable and viable for pharmacies, they must be paid fairly for these services. So that’s the other thing that goes with these bills that we need to put in place is fair reimbursement.