As the coronavirus disrupts long-standing structures, new opportunities emerge to position pharmacists as critical contributors to public health.

By Athena Ponushis

Since March, AACP has been working with other national pharmacy organizations, collaborating over weekly calls, to send a unified message to legislators and government officials: Pharmacists are ready to help combat the public health crisis. Expand the authority of pharmacy to take full advantage of the work pharmacists are trained to do.

The greatest success the pharmacy organizations and their government relations teams have seen came in September, when the U.S. Department of Health and Human Services issued guidance authorizing pharmacists to order and administer COVID-19 vaccinations, when made available, to adults and children as young as age three, expanding access to safe and effective vaccines under the Public Readiness and Emergency Preparedness (PREP) Act.

Now those government relations teams are working with Congress to include a provision from the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592) in a coronavirus relief package, granting emergency Medicare provider status to pharmacists to provide COVID-19 and flu testing and get paid for it. “Our main goal is to get this provision in a relief package at least for the duration of the public health crisis so people can see pharmacists on the front lines doing this work, see the positive outcomes and change the narrative of the role of the pharmacist,” said Jasey Cárdenas, AACP associate director of strategic engagement. “My hope is that after the public health crisis, pharmacists get more recognition and are able to be utilized to their fullest extent.”

Pharmacy organizations have also started to talk about what the profession might look life after the pandemic because of the collaboration and progress made during these many months. Testing and vaccinations may bring awareness about the role of pharmacists, but some feel testing and vaccines are too narrow an aim, that a greater opportunity lies within the coronavirus crisis. The opportunity that COVID-19 presents may be found in its disruption of healthcare delivery, allowing pharmacists to rethink the contributions they can make to improving the chronic health of the country.

‘It’s a New World in Healthcare’

COVID-19 has caused a rapid deployment of healthcare professionals to meet an acute public health need. While legislators and government officials have deliberated over how to mobilize the healthcare system to respond to this need, pharmacists have pondered how to prepare for it, participate in it and convince the rest of the healthcare system to see the important contribution pharmacists make, not just to this deployment but to all public health initiatives.

Screenings and vaccinations are critical to a COVID-19 response, and all pharmacy schools train student pharmacists to administer screenings and vaccines. But such services are “point-in-time events,” noted Dr. Todd Sorensen, professor and senior executive associate dean for strategic initiatives and faculty affairs at the University of Minnesota College of Pharmacy. A hypothetical patient goes to a pharmacist and receives the COVID-19 vaccine. The pharmacist reports that the patient received the vaccine, but the exchange does not require the collaboration needed to drive the practice transformation that Sorensen sought as AACP’s immediate past president: that 50 percent of primary care physicians will have a formal relationship with a pharmacist by 2025.

My hope is that pharmacy sees that the opportunity of COVID is not just screenings and vaccines. The opportunity of COVID is the disruption that’s going to occur in chronic care management because of the way we are going to do things differently after COVID. It’s a new world in healthcare.

Dr. Todd Sorensen

While these point-in-time moments may not be enough to transform practice, Sorensen believes there is more opportunity to be found within the crisis to help with that transformation. Because of COVID-19, people are rethinking the structures and barriers that exist in healthcare (e.g., that a patient needs to be at a certain location at a certain time to receive care). Patients expect more flexibility in the system and health plans are starting to pay for telehealth services. Sorensen believes such changes will cause a disruption in healthcare, prompting health professionals to reevaluate how they deliver effective, convenient care. Therein lies an opportunity for pharmacy to create new ways to partner with other providers and emerge from the public health crisis with more influence.

“My hope is that pharmacy sees that the opportunity of COVID is not just screenings and vaccines. The opportunity of COVID is the disruption that’s going to occur in chronic care management because of the way we are going to do things differently after COVID,” Sorensen said. “It’s a new world in healthcare. Some of it, we may wish that it was going to go back to the way it was, but it’s not going to. So we all, collectively, need to be thinking about what does this new world present to us as an opportunity and how do we take advantage of it?”

An Opportune Remake of Practice and Curriculum

Pharmacy schools must think creatively and conjure up auspicious ways for pharmacists to collaborate in this emerging telehealth space. Pharmacy has often been thought of as a community access point, but if it’s easy to connect with a physician over telecommunications, then it might not matter if there’s a pharmacy down the street. Just as the coronavirus has disrupted medical practice, it could disrupt services that have traditionally drawn people into pharmacies. Additionally, while new opportunities are emerging for pharmacists, this is true of other healthcare personnel as well. Certain health-related services that could be extended to pharmacists could also be extended to other personnel who can provide these services at a lower cost of delivery, thus limiting the appeal for pharmacists to serve as a primary provider of these services.

UMN College of Pharmacy has proposed assembling a horizons committee to evaluate the landscape of change in healthcare and provide insights that will help maintain a contemporary curriculum to prepare students for the world that awaits when they graduate. The school is also facilitating a payer-provider partnership called “Slice of PIE (Partners in Excellence)” that is helping community pharmacists transform their practices to participate in a pay-for-performance program offered by a regional health plan, focused on improving chronic health outcomes. Pharmacies participating in this program are a priority for student learning experience placements and are helping pharmacists shift patient care and medication management services over to a telehealth space. Students and pharmacy practice residents in the school’s PGY1 residency program are also helping pharmacists adapt practices in a way that works during the pandemic, such as adjusting to home blood pressure monitoring, as patients are not regularly coming into pharmacies for blood pressure measurements.

We are capitalizing on what we already teach our students, really advocating for pharmacy and doing the work that’s necessary to keep people healthy during this time.

Dr. Anne Lin

Notre Dame of Maryland University School of Pharmacy students have been running numerous flu clinics on campus and visiting senior living communities to vaccinate seniors, in partnership with a health system, as another anticipated wave of coronavirus has prompted a big push for the flu vaccine. Student pharmacists are also educating their community, clearing any misinformation surrounding COVID-19, by holding virtual sessions with various nonprofit organizations.

“Many schools across the country are leading efforts on their campuses and in their communities to protect people with the flu vaccine,” said Dr. Anne Lin, dean and professor at NDMU School of Pharmacy. “We are capitalizing on what we already teach our students, really advocating for pharmacy and doing the work that’s necessary to keep people healthy during this time.”

Sustaining Gains by Staying True to Pharmacy

Hoping to sustain the expanded practices that the pandemic has granted, Lin, current AACP president, has charged the strategic engagement committee with identifying advocacy strategies to leverage the temporary expansion of pharmacy practice capabilities for continuous expansion. Pharmacists received federal authorization in April to administer COVID-19 tests; she would like to see a day when pharmacists have greater authority beyond offering vaccinations and testing and do not have their authority so delineated that their skills are confined to a list. “I am hoping we are going to be able to keep what has changed and make sure we do it in a way that doesn’t lock us into a listing, but rather gives us broad authority to do what our knowledge and skills enable us to do,” Lin said. For all the promising potential of telehealth, Lin wants to remember the barriers, especially in rural areas where connectivity may be an issue and a pharmacist may be the only accessible healthcare professional.

In October 2020, HHS guidance extended the administration of FDA-authorized or FDA-licensed COVID-19 vaccinations by qualified pharmacy technicians and state-authorized pharmacy interns acting under the supervision of a qualified pharmacist. While this authorization will increase access to vaccinations to the public, it also serves as an example of what had been considered a “pharmacist-only” service being provided by others within the profession. Looking ahead, the profession must continue to discern the unique contributions pharmacists make—caring for patients with complex issues, managing their medications and chronic health conditions—and leverage their expertise in the evolving world of healthcare, which is more important than ever as value-based compensation systems grow. Pharmacy may be able to sustain its gains in such a world by staying true to what is inherently pharmacy, which Lin believes COVID-19 brought clearly into view: “If you recall, early on in the pandemic, a lot of physicians’ offices closed. Sure, there was telehealth, but people were not able to access their providers as easily. Pharmacies never closed. There was always a pharmacist there.”

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.