Chaotic reimbursement models put patients at risk

Abstract

The last thing that pharmacists want to do is harm a patient. They go to school to improve the health of society. But misaligned incentives have turned pharmacies into factories. A series of journalistic investigations—starting with the Chicago Tribune in 2016 and most recently a July New York Times story reporting that the Oklahoma State Board of Pharmacy had fined four CVS pharmacies in the state for poor staffing and medication errors—exposed how the profit-over-patients payment model puts the public in danger. Any pharmacist or technician who’s worked in a high-volume pharmacy knew it was only a matter of time before either authorities took notice or we reached an unacceptably high number of injured patients. Thankfully, in Oklahoma, we’re seeing the former. Much of the scrutiny is on chain pharmacies, but blaming chains alone is an oversimplification of the problem. They are businesses, and they exist to make money. The cause of our upside-down priorities is how our health care system pays for prescription drugs and patient care. CVS pharmacists and their peers in other high-volume chains are giving 150%. That’s especially noticeable during the pandemic as pharmacy staff put themselves at risk every day to ensure patients get the care they need. So, what will straighten out this twisted system? Nothing less than a total restructuring of pharmacy payment mechanisms. First, patient care in pharmacies needs to become profitable: Pharmacists’ services must be covered under Medicare Part B through provider status. Next, PBMs must be tamed and held accountable. And finally, vertical mergers must be policed to ensure they actually benefit patients and don’t make care less accessible. You may have heard me on the Pharmacy Podcast Network or on social media saying some things that could be considered controversial, confrontational, or brash. Sure, I came out against the way high-volume chains treat their pharmacists and technicians. But I also tied it to our warped reimbursement system. I believe that if there is an opportunity for our pharmacy chain partners—who employ most pharmacists—to make money providing patient care, they’ll take advantage of it. You can expect more of this candid talk from me. This is a new day for APhA and for pharmacy. As long as I am CEO, APhA will be playing offense, and we will call out bad behavior (and we’ll also call out good behavior, like Walgreens protecting pharmacist, tech, and patient well-being by ensuring pharmacy staff get a half-hour break). Quite simply, we’ve all had enough of PBMs stealing from pharmacies and deprofessionalizing pharmacists. Join us as we take this fight to them.