Step 2: Promote Widespread, Affordable Access to Prescription Drugs through Support for Pharmacists and Pharmacies

Pharmacists are embedded in communities across the country and have frequent face-to-face interactions with patients—“roughly twice as frequently as [patients] visit primary care physicians,” and even more often for those that live in rural areas. Close to 90% of Americans live within five miles of a pharmacy,” making them among the most accessible of health care professionals. Pharmacists are highly trained clinicians. Before serving patients, they must now complete a 4-year doctorate program, attain over a thousand hours of clinical training, and pass rigorous clinical and state board exams. Unfortunately, community pharmacists are often overlooked as an essential part of care teams.
There is no question that pharmacists provided safe, rapid, and cost-effective care during the COVID-19 public health emergency, administering “more than 303.5 million COVID-19 vaccinations.” As a result, they are “credited with preventing more than one million deaths, eight million hospitalizations, and saving our country more than $450 billion in health care costs.”
PBMs worked with pharmacies during the COVID-19 public health emergency (PHE) to adopt and advocate for flexibilities like adjusting home delivery policies; postponing routine fraud, waste, and abuse audits; temporarily waiving proof-of-receipt signature requirements; and preserving supplies of drugs for patients who were stable on the drug or had a proven need to start the drug.
To preserve the benefits of a robust high-quality pharmacy market, PCMA recommends policymakers take the below actions:
- Expand the number of states that authorize pharmacists to prescribe and dispense naloxone, hormonal contraceptives, emergency contraception, smoking cessation therapies, and pre- and post-exposure prophylaxis for HIV prevention (PrEP).
- Encourage all states to build on policies that allow pharmacists to administer vaccines by expanding the types of vaccines they can administer to include COVID-19, influenza, pneumococcal disease, and international travel vaccines, and, as appropriate, removing mandates requiring prescriber involvement.
- Expand the number of states that allow pharmacy technicians to administer vaccines as delegated by the pharmacist.
- Ensure all pharmacists are authorized to order and administer “test and treat” components for common acute conditions such as strep throat, urinary tract infections, and respiratory viruses (e.g., RSV, influenzas, COVID-19, tuberculosis), and allow the ordering of rapid diagnostic tests and associated treatments for common conditions.
- Expand the list of drugs pharmacists can prescribe independent of physicians to include select categories of drugs.
- Pharmacists should have the ability in each state to prescribe the following:
- Hormonal and emergency contraceptives
- HIV prevention drugs (PrEP and PEP)
- Naloxone or other opioid antagonist and any drug delivery paraphernalia necessary to administer the opioid antagonist in accordance with G.S. 90-12.7
- Tobacco cessation medications
- Epinephrine or other anaphylaxis management medication, including self-administered formulations for the management of severe allergic reaction
- Glucagon or other self-administered formulations for the management of hypoglycemia
- Short-acting bronchodilators, for patients with asthma
- Prenatal vitamins
- Dietary fluoride supplements, in accordance with recommendations of the American Dental Association for prescribing of such supplements for people whose drinking water has a fluoride content below the concentration recommended by the U.S. Department of Health and Human Services
- Prescription medications, not requiring a diagnosis, that are recommended by the Centers for Disease Control and Prevention for individuals traveling outside the United States
- Antibiotics and antivirals in response to pharmacist-diagnosed illnesses.
- Seventy-five percent (75%) of pharmacy prior authorizations (PA) are fully electronic and use the National Council for Prescription Drug Programs (NCPDP) SCRIPT electronic standard for PA. PA is a critical tool for helping patients access safer and lower-cost drugs and reflects the most recent clinical standards.
- Public policies should focus on establishing and adopting technical standards and resources for everyone to facilitate adoption and uptake of electronic tools that improve speed, accuracy, quality, adherence, and overall system satisfaction.
Grant pharmacists Medicare “provider” status during a public health emergency (PHE) so that, once a federal PHE is declared, there is no delay in pharmacists’ ability to (1) test patients for COVID-19, influenza, respiratory syncytial virus (RSV), and strep throat; (2) treat individuals with select medications for COVID-19, influenza, strep throat; and (3) administer COVID-19 and influenza vaccines
Redesign the Medicare medication therapy management (MTM) program so that it targets and engages appropriate patients, is scalable, is funded appropriately, has clear evidence-based metrics, involves stakeholder input, is promoted to beneficiaries, and evaluated by CMS
Support pharmacists’ ability to substitute a biosimilar without a prescriber’s approval
Remove legal and regulatory barriers that prevent innovative payment, program, and reimbursement models for enhanced pharmacy services
Sources
Congress Must Act to Protect Vital Pharmacist Services. Health Affairs. Nov. 2023. https://www.healthaffairs.org/content/forefront/congress-must-act-protect-vital-pharmacist-services
National Association of Boards of Pharmacies. https://nabp.pharmacy/initiatives/pharmacy-practice-safety/
Congress Must Act to Protect Vital Pharmacist Services. Health Affairs. Nov. 2023. https://www.healthaffairs.org/content/forefront/congress-must-act-protect-vital-pharmacist-services
Congress Must Act to Protect Vital Pharmacist Services. Health Affairs. Nov. 2023. https://www.healthaffairs.org/content/forefront/congress-must-act-protect-vital-pharmacist-services