By Bruce Roberts, RPh, and Ricky Guidry, RPh
In medicine, as in life, sometimes an answer is so obvious it gets overlooked. That’s about how community pharmacists feel about the health care debate.
The pharmacist is the medication expert – highly trained and the most accessible health care provider in any community. Yet the patient-pharmacist relationship has been undermined recently by a variety of factors, even as the cost and complexity of medicine have both increased significantly. Meanwhile, the costs of treating improper medication use continue to soar, estimated at a staggering $290 billion annually by the New England Healthcare Institute.
Two decades ago the profession as a whole began to be pulled away from its roots as a pillar of health care, toward being simply the purveyor of a commodity. External factors, such as declining reimbursement rates and unfair competition, no doubt played a role. But, whatever the cause, some large pharmacies adopted an assembly line mentality, the patient experience was negatively affected and the costs of medication misuse have gone up.
Now there is room for optimism that we can turn the tide and utilize community pharmacists to produce better health outcomes at lower cost.
In Asheville, North Carolina officials tried a new approach to help city employees, dependents and retirees combat chronic problems such as diabetes, asthma, hypertension, and high cholesterol. After an initial education session, patients relied on community pharmacists to keep them on track and adhering to their medication therapy. After one year, the diabetes patients experienced lower costs (from $7,042 per patient to $4,000) and fewer sick days (from 12.6 a year to 6). Treatments for cardiovascular issues and asthma also proved to be less expensive. Even better, patients could spend more time living and less time in costlier doctor’s offices or, worse, emergency rooms.
The experience of Smith Drug Company in Spartanburg, South Carolina tells a similar story. Struggling with soaring diabetes treatment costs, the company shifted its focus to prevention and medication adherence. Patients joining the new program were given free supplies and other incentives. In just one year, treatment costs were slashed from $11,637 to $5,406, while the costs incurred by patients enrolled in the more traditional regimen went up $1,500.
These trends mirror those in other countries. Japan, for example, spends 50% more of its health care dollars on pharmaceuticals than the U.S. does, yet its total health care spending pales in comparison (8.2% of gross domestic product vs. 15.2% in the U.S.).
Pharmacists face an array of challenges in today’s health care system. We need a fairer reimbursement from Medicaid for generic drugs – one that doesn’t pay 64 cents for one dollar’s worth of drugs and expects pharmacies to stay afloat. We need relief from Medicare regulations that would deny seniors a pharmacy choice in getting diabetes testing supplies and other equipment for no good reason. We need transparency from pharmacy benefit managers (billion dollar pharmaceutical middlemen) so patients and health plan sponsors can get a handle on rising drug costs.
But health care reform also offers a prime opportunity to advance the use of these and other medication therapy management programs. Doing so would empower pharmacists to do what we do best, while reining in costs and achieving better patient outcomes.
Mr. Roberts is Executive Vice President and CEO, National Community Pharmacists Association. Mr. Guidry is Founder and Chairman of the Louisiana Independent Pharmacies Association.