As the healthcare landscape evolves, community pharmacies have the opportunity to make significant transformations in 2024. Here we’ll take a look at how pharmacies are positioned at the confluence of evolving healthcare needs, technological advancements, and regulatory changes, with an ever-growing opportunity to provide a broader range of services beyond traditional medication dispensing.
OPPORTUNITIES IN PHARMACY SERVICES
One big opportunity in 2024 will be for pharmacies to continue moving beyond dispensing. “As we step into 2024 and confront the evolving changes in the industry, pharmacies must diversify their revenue outside of simple dispensing,” says Larry Stephenson, VP of chain sales at Outcomes. He further encourages pharmacies to embrace a model that offers a comprehensive clinical experience for their patients. “Both are not only achievable, but complementary,” says Stephenson.
“Dispensing activities make up only a small component of what a pharmacist can do,” notes Mark Fulton, director of product regulatory compliance at SoftWriters. “But payers have traditionally only reimbursed pharmacies for the product dispensed. The other services that pharmacists provide — consultation, clinical review, medication problem-solving — are not reimbursed.”
Gold Eneyo, director of clinical pharmacy services at AmerisourceBergen, says “we are seeing pharmacies transforming and expanding their roles into more patient care services.”
Pharmacies have the presence and expertise to offer year-round screening services. “Chronic disease state management will continue to be one of the best ideas for pharmacy in 2024 and beyond,” Eneyo says. Furthermore, she advises pharmacies to integrate personalized medicine through pharmacogenomics, which will allow pharmacists to help tailor medication regimens and recommendations to patients’ genetics and optimize treatment effectiveness. “Pharmacists must prepare now through education, a proper implementation process, and collaboration to become a healthcare destination,” says Eneyo.
COUNTERING RISKS
Meanwhile, pharmacies will continue to face the long-standing downward pressure that prescription benefit manager (PBM) contracts and direct and indirect remuneration (DIR) fees have been putting on reimbursement rates and pharmacies’ profit margins for years now. In fact, DIR fees will be a major wildcard as 2024 starts, notes Advasur Managing Director Randy Hoggle. The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that eliminates retroactive DIR fees beginning in Jan. 2024.
DSCSA ON DECK
Pharmacies are also going to need to devote potentially significant resources to comply with Drug Supply Chain Security Act (DSCSA) requirements in 2024. “This is a huge risk,” notes Advasur’s Hoggle, “as it takes months to set up new DSCSA compliance service providers with supplier onboarding.” He emphasizes that pharmacies cannot afford to turn a blind eye to establishing internal and outsourced DSCSA compliance systems, along with programming and documentation development so that they are ready come Nov. 27, 2024, the new deadline for compliance.
FDA’s stated goal in extending the compliance deadline is to “give trading partners additional time to implement electronic systems for tracing drugs at the package level.” As such, it’s critical for pharmacies to be working hard to implement the internal system necessary to be compliant, as well as deploy and test with external trading partners.
TAKING A STEP BACK
Pharmacies that want to achieve growth in 2024 will need to take a step back from their daily operations and reevaluate the needs of their community, notes Christine Bloome, content marketing manager for BestRx Pharmacy Software. “Doing so will not only enable pharmacies to identify areas of opportunity to better serve their current patients,” she says, “but uncover gaps in care in their area as well.”
Don’t worry that changes need to be big, either. “Offering additional vaccinations or point-of-care testing, as well as providing access to online refill requests and delivery options for OTC [over the counter] items and prescriptions, can make a big impact for patients and pharmacies alike,” says Bloome.
FOCUS ON VACCINES
2024 should see a continued strong focus on the central role pharmacies play in vaccination programs.
“As states look for novel ways to preserve and increase access to healthcare, pharmacies are an obvious solution,” says SoftWriters’ Fulton. “During the COVID-19 pandemic, pharmacies were given increased authority to prescribe and administer vaccines, which helped save countless lives.”
That has led to many people now viewing pharmacies as the vaccination destination for patients, notes Outcomes’ Stephenson. “This not only enhances patient outcomes and fosters patient loyalty,” he says, “but also opens avenues for revenue diversification and expansion, ultimately improving their overall operations.”
The establishment of vaccination programs as a core offering in community pharmacies is backed up by the data. A January 2023 IQVIA report, “Trends in Vaccine Administration in the United States,” found that “Overall, across all vaccines for adults in-scope, a large majority of the administration took place at the pharmacy level compared to a non-pharmacy medical setting.” Of course, a major factor in this finding was the rollout of COVID-19 vaccines, of which 90% were administered in a pharmacy, according to IQVIA’s data. However, pharmacies also administered 60% to 70% of vaccinations during flu season, and 40% of pneumococcal vaccinations, over the last five years.
And there’s more room to grow here, according to Stephenson. “By optimizing vaccination workflow,” he says, “pharmacies can not only streamline the process, but also maximize the number of vaccines administered and the revenue generated.” Stephenson recommends incorporating into workflow patient identification based on both the clinical eligibility and immunization information systems (IIS) registry data, which helps pharmacies ensure no vaccination opportunities are missed.
RAMPING UP PHARMACY SERVICES
There‘s a need to use the demonstration of pharmacy’s efficacy in providing care to keep the momentum going. This will require advocating for changes to state pharmacy laws and a continued push for provider status at the federal level. Ensuring that pharmacists have greater authority to practice at the top of their licenses is critical, according to SoftWriters’ Fulton.
Pharmacies looking to boost service offerings can also look for opportunities to participate in payer and pharma-sponsored clinical opportunities, according to Outcomes’ Stephenson. Examples are medication therapy management, targeted intervention programs, and adherence programs. “Pharmacies can take a proactive role in optimizing medication regimens for their patients,” says Stephenson. “ This not only ensures that patients receive the most effective treatment, but also minimizes the potential adverse effects or interactions, ultimately leading to better health outcomes.”
Engaging in clinical opportunities allows pharmacists to build trust among existing patients and strengthens ties with local healthcare providers, potentially leading to collaborative partnerships and referrals.
Patient attitudes toward pharmacy as a healthcare resource have evolved greatly too. “Patients see pharmacists as a very accessible source of healthcare information,” says AmerisourceBergen’s Eneyo. “And pharmacists can utilize the knowledge gained during their many years of education to help prevent and manage diseases.” For pharmacies to meet patients’ needs and offer the types of services discussed earlier, they must change their current workflow, according to Eneyo. “Pharmacists can create time to focus on care that will improve patient outcomes,” she says, “and utilization of technology will be more important than ever before.”
Eneyo offers two examples of technologies that can play key roles in a new practice model. First, telepharmacy services will allow pharmacists to provide consultations and medication management remotely. Next, artificial intelligence (AI) and automation will help free up time for patient care services.
LTC AT HOME
Long-term care (LTC) services are another evolving area of practice to keep an eye on in 2024. Here pharmacies will want to be up to speed on the opportunities in LTC at home, according to Fulton.
Fulton notes that the opportunity stems in large part from the baby boomer retirement surge. “As demand for assisted living and personal care is on the rise,” says Fulton, “so are the costs for traditional long-term care settings. This fact, combined with an expanding role for pharmacists, is creating a new market of long-term care pharmacy patients who reside at home.”
Fulton points out that unlike typical home delivery patients, LTC-at-home patients, and the pharmacies that serve them, must meet specific criteria outlined by CMS. “Payment for LTC-at-home pharmacy services comes primarily from Medicare Part B,” explains Fulton. “To work through the red tape of initiating and sustaining a successful LTC-at-home pharmacy practice, pharmacies are discovering and sharing pathways for success. Collaborative organizations that provide peer-to-peer networking and assistance are growing in number and look to be a sizable force in the coming year.”
Lindsay Dymowski, who as co-founder and president of the Long Term Care at Home Pharmacy Network heads up one such organization, also sees LTC at home as increasingly vital for community pharmacies.
“Home-based long-term care offers a more patient-centric approach,” Dymowski says, “as it allows individuals to receive care in a familiar and comfortable environment.” She wants to see pharmacists play a crucial role in ensuring that medications are managed effectively and safely in this setting, which is becoming more of a reality with technology that enables remote monitoring, such as telehealth. “With the rising healthcare costs and increasing burden on public and private payers,” says Dymowski, “long-term care at home can alleviate some of these financial pressures.”
TECHNOLOGY PLANNING IN THE PHARMACY
The shift toward LTC at home will have a profound impact on pharmacy operations, according to Dymowski — particularly in terms of workflow, billing, documentation, and patient care.
“Pharmacies implementing LTC at home will likely need to create specialized teams or departments,” says Dymowski. “Billing, especially for combo-shop pharmacies, will require detailed knowledge and strong technology support to prepare and maintain documentation to ensure that their services are adequately reimbursed.”
Pharmacists will need to engage in comprehensive medication reviews, collaborate more closely with providers, and ensure that medications are administered correctly. They will also need to educate caregivers and patients on medication management best practices.
This will be best accomplished by embracing technology as vital for effective pharmacy operations in long-term care at home. Electronic health records, telepharmacy systems, and medication management platforms will need to be integrated into the pharmacy’s workflow.
In fact, day-today operations at many pharmacies have come to rely on such a variety of technology platforms that there’s a real risk of fragmented workflow and patient care protocols, notes Eneyo. “We can have the biggest impact by connecting pharmacies with solutions and workflow updates that meet their changing needs as well as changes in the industry,” says Eneyo. “There are many technology vendors in the market with solutions to help pharmacists add new patient care services and optimize their business operations. But we also recognize that adding solutions has the potential to create complexity in workflow, unless technology works together seamlessly, and teams are ready to adopt new processes.”
PrimeRx CEO Ketan Mehta highlights several areas of technology that he believes will best address pharmacy pain points in 2024. First, he suggests looking for functionality to manage DIR fees, with software-driven analysis down to the plan level, records management that gives management visibility into all cost centers, and robust reporting to monitor the impact DIR fees are having on the pharmacy.
Next, Mehta says to use automation to address the ever-present feeling that there just aren’t enough hours in the day. “Technology is responding with solutions to alleviate many of the tasks that take up an inordinate amount of pharmacists’ time,” says Mehta. “PrimeRx pharmacy software users, for example, benefit from capabilities that include workflow optimization, regulatory compliance automation, and real-time prescription benefit review.”
Then there is what Mehta calls building a brand among patients as a source for over-the-counter and consumer products. Given that prescription revenue accounts for up to 97% of total sales at the typical community pharmacy, according to the National Community Pharmacists Association (NCPA) Digest, the front end can potentially offer beneficial diversification if pharmacies can deploy the right technology to be efficient and meet consumers’ needs.
Datascan President Kevin Minassian reports that his company is focused on updates to user interfaces to bring them into the future with easy-to-navigate screens. He also sees mobile apps as important in 2024, and reports that Datascan is revamping its app offerings. “We’re building a lot more functionality in these mobile applications to make life easier for patients and the pharmacies that serve them,” says Minassian. “Our goal is to simplify our clients’ lives, while making certain our platform runs fast and efficiently.”
Minassian also reports making moves that will provide an upgraded customer service and support experience for Datascan pharmacy users. “We have reworked the way calls are triaged, added staff, and continue to make certain our clients are not waiting on hold to get support on the phone,” he says. “Our new phone system makes it that much easier for us to help our clients through the ability for our staff to use an app on their laptop to help clients from literally anywhere in the world, as if they are sitting at their desk in the office.”
AI LOOMS LARGE
Finally, there’s what may well be one of the most significant technology innovations in recent history to contend with: artificial intelligence (AI). “If you attended any health- and/or technology-themed industry events this year,” says Fulton, “AI is a central component of innovation among startups and legacy firms alike.”
In Fulton’s view, the potential of AI to transform pharmacy technology applications is theoretically limitless, though still not fully understood. “Presently,” he says, “increasingly diverse solutions are coming to market that offer novel applications for AI in patient record matching, clinical decision support, and population health data analytics. At the pharmacy, AI has the potential to prevent errors and improve patient outcomes through metadata analysis and targeted interventions.”
MAKE CONNECTIONS IN 2024
One of the best ideas for pharmacists and owners looking to make the most of the coming year will be to get plugged into everything that’s going on by getting out and making connections with colleagues. “Joining professional organizations, staying informed about pharmacy regulations and laws, and advocating for the profession are avenues pharmacies can use to stay up to date,” says Eneyo.
Pharmacists and owners who are working to promote the cause of pharmacy will be critical for expanding the scope of pharmacy practice, notes Fulton. Their efforts will be what leads to new opportunities for patient care, novel workflows, and additional revenue potential. “To secure and promote these changes,” he says, “pharmacists must continue to advocate their value to legislators and policymakers through professional organizations and civic participation.”
Outcomes’ Stephenson, likewise, encourages community pharmacy to remain at the forefront of healthcare practice in 2024 by actively engaging with state and national pharmacy associations. “These associations serve as an invaluable resource for staying up to date on the latest industry trends and best practices,” says Stephenson.
In fact, what looks new is not really that new at all, notes Fulton. “We are currently witnessing a renaissance of the pharmacy profession,” he says. “The ‘new’ ideas of pharmacist prescribing, pharmacy-based care centers, and long-term care at home are merely a realignment of the practice of pharmacy with the true roots of the profession. Pharmacies have never been more vital, and more central to the health and wellness of our communities. By expanding into service-based activities and leveraging opportunities to practice at the highest degree of licensure, pharmacists can meet the evolving needs of patients and provide a superior standard of care.” CT