When people needed critical COVID-19 testing and, later, vaccinations, many visited their local pharmacy to secure those services.
As the healthcare industry continues to grapple with labor shortages and staffing issues, experts argue pharmacists are an underutilized resource that could play a much greater role in patient care. Pharmacists have high levels of trust with patients, who visit their local pharmacy more frequently than they go to other sites of care; pharmacists see patients three or four times more often than primary care doctors.
"Pharmacists, year after year, have been one of the most trusted healthcare providers or professions," Rina Shah, group vice president of the pharmacy of the future and healthcare segments at Walgreens, told Fierce Healthcare.
And patients are actively seeking out this care, Shah said. Walgreens customers, for example, have been asking why they can't receive tests for other common illnesses, such as influenza and strep throat, from their pharmacy in the same way they were tested for COVID-19.
A survey from CVS Health and Morning Consult, released in October, found that 61% of people would like to get a broader range of services at their local pharmacy. It also found that 74% of people trust their local pharmacist and agree they should be able to step in when primary care is not available.
"There is undoubtedly an opportunity to optimize the clinical care provided in our pharmacies," Prem Shah, executive vice president and chief pharmacy officer at CVS Health and co-president of CVS Pharmacy, told Fierce Healthcare. "They have an appetite for this expanded role of the pharmacist.
The COVID-19 effect
CVS Pharmacy has administered more than 78 million vaccines for COVID-19 and provided more than 58 million tests in 2021 alone, according to data from the company. Walgreens has provided nearly 70 million vaccines and administered between 25 million and 30 million tests for COVID-19 from the start of the pandemic through the third quarter of this year.
Those efforts are echoed by other major chains, including Rite Aid, Walmart and grocery store pharmacies across the country. Both for large pharmacy chains and local carriers, these programs were established nearly overnight as the healthcare industry responded to the pandemic in near real time.
Nearly half of Walgreens stores and more than half of CVS pharmacies are in medically underserved communities, enabling them to access critical COVID-19 services at the height of the pandemic, too. Walgreens' Shah said the pandemic broke down many of the barriers in place to enable pharmacists to provide this level of care.
"It helped really provide some proof points for the need for us to be able to play this role," she said. "Every patient should be seeing a family care physician. We just are now playing a much more comprehensive role in that so that we can help those patients get to that level of care."
The expanded flexibilities offered across many parts of the healthcare system extended to pharmacists, and they have pushed for those to remain in place in the long term. In March, for example, the Biden administration launched a national test-to-treat program that allowed pharmacy-based clinics and federally qualified health centers to prescribe antiviral COVID-19 therapies to people who tested positive. That program, however, did not include pharmacists themselves as prescribers.
In July, the Food and Drug Administration granted pharmacists the ability to prescribe Paxlovid, an oral antiviral for COVID-19. Since then, CVS Pharmacy has expanded access to the drug and has enabled pharmacists to prescribe the drug at 9,000 stores as of mid-November.
Prem Shah said the program allows patients to secure the drug faster, rather than facing the potentially lengthy wait at an urgent care center or other location to secure a prescription. And the program has received a positive response from CVS' pharmacists, he added.
Addressing gaps in the healthcare workforce
Shortages across healthcare have been one of the biggest headlines coming out of COVID-19. A recent report from Definitive Healthcare found that more than 300,000 clinicians dropped out of the healthcare workforce in 2021 alone, with many citing burnout and the stressors of the pandemic as causes.
An October survey from Bain and Co. found that 25% of clinicians are considering leaving healthcare due to burnout.
Leaning on clinical professionals like pharmacists can provide a clear strategy to address some of these gaps as the industry grapples with labor issues, CVS Health's Shah said.
"I absolutely think it's a way that we can expand capacity in the healthcare system," he said.
The CVS Health team has worked internally on ways it can free up its pharmacists from the usual day-to-day tasks and enable them to take on more patient care. For example, the pharmacy giant has dug into areas where it can shift responsibilities to pharmacy technicians and others on the team, enabling the pharmacists to practice at the top of their license and interact more directly in the care journey.
That has required investment in technology and work to improve employees' engagement with the company as a whole, Prem Shah said. An example of this at work, he said, was during Hurricane Ian, which swamped parts of Florida in late September. Pharmacists at CVS locations in other parts of the state were able to assist through technology while those impacted directly by the hurricane stayed safe, he said.
This ensured continuity of care even in the middle of a severe and disruptive weather event, he said.
Rina Shah said Walgreens is putting a focus on automation and technology in a similar vein to free up pharmacists to take on more direct care.
Pharmacist burnout is a concern, too
While enabling pharmacists to practice at the top of their license could play a key role in managing ongoing labor issues, doing so also helps keep them happier in their jobs. Walgreens' Shah, herself a pharmacist, said that these clinicians don't dedicate much time in their education to routinely counting pills.
Instead, pharmacy school puts a lot of emphasis on understanding how medications work and how they can interact with each other. Pharmacists are well positioned, for example, to look at the medication regimen for a patient with multiple chronic conditions and assess whether that combination works or could have adverse effects for that person, she said.
"You graduate from pharmacy school trained with all of this different knowledge, a wide array of scope that you can apply, but then when you actually go into practice you're only utilizing a portion of what you’ve been trained for," Rina Shah said.
That's one of the benefits of Walgreens' new Health Corner locations, where patients can meet with pharmacists and nurse practitioners to access multiple services including health advice, appointment scheduling and chronic condition management. The clinicians that staff these stores can also assist in care coordination between different providers.
Shah said the response from both patients and the clinicians working in these Health Corners has been overwhelmingly positive.
Prem Shah said CVS has also put a focus on managing pharmacists' burnout by aiming to tackle key "pockets of pressure" in their daily work, for example making it easier to manage dueling lines at the pharmacy counter and for vaccinations.
Central to the company's strategy around enabling pharmacists to practice at the top of their license is about ensuring that they have the tools and time at their disposal to continue doing work that they enjoy and value. Sharing workflow across stores and allowing multiple locations to operate as one team, as the Florida pharmacies did, is key to this endeavor, he said.
The barriers that remain
While there is a growing chorus calling for pharmacists and other clinicians to grow the role they play in patient care, a number of hurdles still block the course from being an easy one.
Rina Shah said that even with additional flexibilities in place thanks to the pandemic, pharmacies face a patchwork of state and federal regulations on what they can and can't do and what they can and can't bill for. Reimbursement for services beyond prescription fulfillment can land in a gray area and also varies between states, she said.
Bringing down regulatory barriers during the pandemic enabled pharmacies and pharmacists to react nimbly to the evolving virus, Rina Shah said.
"The way we were able to do that is to reduce the number of variants state by state," she said.
CVS' survey found that 69% of patients believe services provided by pharmacists should be billed to insurers in the same way that other clinical services are.
CVS' Prem Shah said that freeing up pharmacists to engage in more direct patient care also requires legacy companies and independent pharmacies alike to be retooling their traditional business model in an industry that's not known for moving quickly to change.
The company is also aiming to make the patient experience smoother at the pharmacy, with the expectation that those changes will also benefit pharmacists. Making more data available to them so they can track their prescriptions frees up pharmacists from spending time on the phone with patients, for example. Then, when they come to their pharmacy to pick up their medication, the pharmacists can instead focus on counseling them about their drug regimen, Prem Shah said.
"Our pharmacists want to continue to play that role of providing more healthcare services," he said. "It requires tweaks in the business model for how we can free up capacity."