Should a Pharmacist Be Allowed to Deliver Primary Care Services?

By Eric Wicklund

Primary care providers are under a lot of stress these days. Pharmacists can help them.

That was the takeaway from an intriguing panel at last week’s HIMSS 2023 conference and exhibition in Chicago. Hosted by Surescripts, the panelists maintained that pharmacists now have the technology and workflows at their disposal to support the PCP and improve the patient’s healthcare journey.

“Pharmacies did step up” during the COVID-19 pandemic, noted Kevin Nicholson, vice president of policy, regulatory, and legal affairs for the National Association of Chain Drug Stores (NACDS), the Virginia-based advocate for traditional, supermarket-based and mass market pharmacies. “The proof is there that pharmacies can do it.”

There were roughly 60,000 retail pharmacies in the US as of 2021, according to the Commonwealth Fund, roughly one-third of which are independent and rest located in retail chains, supermarkets, or mass retailers. Dominated by the likes of Walgreens, Rite-Aid, and CVS, the pharmacy has pushed its way into the spotlight as the neighborhood hub, offering not only prescriptions but health and beauty supplies, groceries, and other retail items.

Frank Harvey, CEO of Surescripts, the healthcare IT company that supports e-prescription and other health information exchange platforms, pointed out that many rural communities in the US have four or less PCPs per 1,500 residents, making primary care access at a distinct challenge. But most, if not all, have a pharmacy nearby.

And they have the technology to connect with care providers and access the patient record.

The idea, the panel said, is to have pharmacists take some of the duties traditionally reserved for PCPs, such as treatment for minor health concerns, thereby giving residents who can’t easily access a doctor or who don’t want to go to the hospital or retail clinic an easy avenue to quick treatment. Most people, they said, would rather go to a pharmacy than a doctor’s office or hospital for basic care services if they had the choice.

“We’re not talking about complicated services,” said Anita Patel, vice president of pharmacy services development for Walgreens. “We’re talking low-acuity, very basic care.”

The challenge? Pharmacists haven’t traditionally been considered healthcare providers, and they’re not recognized as providers in Medicare Part B plans. They weren’t part of the meaningful use movement, and are often on the outside looking in when patient care is discussed.

The pandemic did prove that pharmacies could handle more care duties, and several states have since enacted legislation that allow pharmacists to be classified as providers, but federal officials haven’t made that move.

Nicholson said NACDS has been working with states to redefine the pharmacist as a provider and has been talking to the Center for Medicare & Medicaid Innovation (CMMI) about developing a model program.

Eric Weidmann, chief medical officer for eMDs, a provider of ambulatory EHR and practice management software and revenue cycle management services, was hesitant to accept that change. He said pharmacists might be accepted as care providers in a team setting and for low-acuity health concerns, but there are too many exceptions to the rule that could affect the patient.

“It will be a rocky road,” he said.

Weidmann also pointed out that pharmacies aren’t as interoperable with other segments of the healthcare network as they can be, creating significant gaps in care. The challenges to integrating the pharmacy into the care network, he added, won’t be easy to overcome.

Patel said the pharmacy can be folded into a value-based care model, using infrastructure already in place for diagnostic testing and data-sharing. Nicholson pointed out that pharmacists were among the first to use technology, with e-prescribing platforms that in many cases pre-date the EHR.

Patel also noted that pharmacists don’t need to access the entire medical record to conduct basic care services.

“We don’t need all of that data,” she said. “How complicated are we going to make this? It’s more like how simple can we make it.”

And she emphasized that pharmacists wouldn’t be competing with PCPs, but would help them. They could handle the low-acuity services, then send that data onto the PCP, reducing their workload and allowing them to focus more on care management. That, in turn, would benefit the patient.

“You actually have a care team for you,” she said.

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.