As the debate over health-care reform reveals extensive unmet needs for better basic medical services in the United States, an unexpected player with the power to drive significant change may be as close as the corner drugstore. With new incentives and business strategies coming into play to repair and improve the health-care system, local pharmacies are positioned to help meet the top two goals of reform: providing convenient, expanded access to medical care and controlling costs.
Pharmacies — many of them operated by large publicly traded companies such as Walgreens, CVS, and Walmart — have already begun to reach beyond their traditional role as pill dispensers to meet new demand from patients. Consumers, who have become more responsible for their own medical care in recent years, are turning to retail pharmacies for help in managing medical conditions and their out-of-pocket health-care spending. Walmart’s US$4 generic drugs program, for example, which offers a wide range of prescription medication and 1,000 over-the-counter medications at $4 for a 30-day supply, has had a major impact on making medication more affordable — especially because other pharmacies have quickly followed suit.
The innovation does not stop at pricing. Drugstores are experimenting with in-store clinics, wellness programs, health screenings, and disease management services. In one notable program, the city of Asheville, N.C., has been using local pharmacists to provide free counseling and coaching to diabetes patients, generating substantial savings and health improvement. More recently, the U.S. Health Resources and Services Administration launched a similar experiment dubbed the “Patient Safety and Clinical Pharmacy Services Collaborative” in an attempt to integrate evidence-based clinical pharmacy services into the management of high-risk and high-cost patients.
There’s no question that pharmacies could play an even greater role in providing a wide range of basic health-care services in a convenient, cost-effective way. But to reach their full potential to ease the current health-care crisis, pharmacies will have to overcome certain barriers. Some of these constraints, such as regulations limiting the level of service pharmacies can provide, have been imposed by regulators. Others are self-imposed and are designed to accommodate physicians and health insurers. In the current reform climate, these barriers are likely to erode, resulting in new opportunities for the pharmacy to become a critical partner in the restructuring of health care.
Advantages and Constraints
In the current environment, where easy access to cost-effective care is paramount, the pharmacy offers four significant advantages.
1. Trust. Patients already have more contact with pharmacists than other health-care providers and appear to greatly value their pharmacists’ advice. A 2007 Booz & Company survey found that pharmacists ranked first in patient trust when it came to getting information about pharmaceuticals, ahead of consumer organizations such as Consumers Union (publisher of Consumer Reports), doctors, and government officials.
2. Access. The pharmacist is highly accessible. There is a pharmacy within 2.36 miles of any U.S. consumer, on average, according to the National Association of Chain Drug Stores. In addition, in many areas, at least one local pharmacist is available 24 hours a day, with no appointment needed.
3. Skills and services. Pharmacists are highly trained health professionals, knowledgeable about a range of medical conditions and capable of delivering some advisory, diagnostic, and treatment services. An increasing number of pharmacies also have a retail clinic on the premises, staffed by a nurse practitioner licensed to perform a range of primary care services and, in some cases, write prescriptions.
4. Cost. Retail pharmacies operate in a highly competitive business environment, and are already acting to keep the nation’s cost of prescription medications lower by promoting generics. Pharmacy-based retail clinics could often treat patients at a lower cost than physicians’ offices could for the same conditions. Most recently, pharmacies have been playing an important role in providing cost-effective immunizations, whereas 85 percent of physicians find immunization reimbursements inadequate.