David Smith is the president of the National Community Pharmacists Association (NCPA), which represents independently owned pharmacies across the country. Smith graduated from the University of Pittsburgh School of Pharmacy and has had a long career owning pharmacies in Brookville, Pa. and Indiana, Pa. Smith is passionate about improving care through local pharmacies and helped initiate a joint venture between NCPA and Community Care of North Carolina called Community Pharmacy Enhanced Services Networks. The program is meant to make sure pharmacists are essential players in the evolving health care system.
Q: What role do community pharmacies play in the daily lives of people with Medicare?
The National Community Pharmacists Association (NCPA) does an annual survey of the community pharmacy landscape and develops a digest based on the responses received. According to the 2017 NCPA Digest, 36 percent of the prescriptions filled at community pharmacies are for Medicare beneficiaries. Seniors often have the greatest amount of health challenges and the most complex drug regimens. That is why we do everything we can to drive greater medication adherence — because an adherent patient is one that will have the best outcomes.
Community pharmacies contract with many long-term care facilities for their prescription drug services, which can include tools such as blister packages that help organize when seniors should be taking certain medications. Many of our community pharmacies offer the SimplifyMyMeds program, which synchronizes when prescription refills occur so seniors or their caregivers don’t have to make multiple trips to the pharmacy.
We also participate in medication therapy management programs that provide an intense annual review of a senior’s medications to determine what adjustments can and should be made based on many factors, including duplicative medications, side effects and even price concerns.
Another valuable service community pharmacies offer is home delivery, which is a godsend for seniors who are not as mobile, don’t drive or don’t have access to a caregiver. Fundamentally, we’re focused on providing services that patients can use to improve their health outcomes. Most importantly, community pharmacies often have the longest lasting relationship with Medicare beneficiaries, which builds a level of trust and familiarity that is invaluable.
Q: How are you working to ensure that beneficiaries in underserved areas and rural communities have access to pharmacies?
We are committed to ensuring the federal government adopts policies that improve seniors’ access to prescription drug services.
For example, we support The Ensure Seniors Access to Local Pharmacies Act, which allows community pharmacies in medically underserved areas, medically underserved populations or health professional shortage areas to participate in Medicare Part D preferred pharmacy networks as long as they accept contract terms and conditions. We also support The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, which will prohibit Medicare Part D plan sponsors/Pharmacy Benefit Managers from retroactively reducing payment on clean claims submitted by pharmacies under Medicare Part D.
CMS has shown a willingness to embrace the same policy strategy from a regulatory standpoint. They have indicted in their final rule for 2019 Part D plans that they are exploring how to have all price concessions at the point of sale. When President Donald Trump made his recent announcement to tackle the problem of rising prescription drug prices, his proposal included asking the inspector general’s office to investigate price concessions that pharmacy benefit managers retroactively charge pharmacies.
Q: Medication safety, especially when it comes to safe opioid prescribing, is a key issue nationwide. What steps are community pharmacists taking to ensure patients better understand their medications?
From a policy perspective, community pharmacists are offering solutions such as:
- Expanding patient access to naloxone by allowing pharmacists to directly prescribe.
- Establishing standardized limits on maximum days' supply of certain controlled substances, acknowledging that there may be circumstances where prescribers can deviate from the mandate.
- Prohibiting certain controlled substances from being delivered to patients through physician offices or the mail.
- Utilizing electronic prescribing of controlled substances whenever feasible.
- Enhancing prescription drug monitoring programs to track all prescriptions for controlled substances and pushing for national standards.
- Increasing use of and access to medication-assisted treatment, or MAT, and ensuring a robust role for pharmacists.
- Advocating for a more streamlined prior authorization process.
- Advocating for mandatory prescriber education in pain management.
Beyond their suggestions for improving how we tackle the opioid epidemic, community pharmacists work daily to prevent the diversion of opioids through their training and by coordinating with doctors and law enforcement.
Q: How do you think community pharmacists could partner with QIN-QIOs and BFCC-QIOs to deliver more patient-centered care?
Community pharmacies and Quality Innovation Networks-Quality Improvement Organizations (QIN-QIOs) are natural partners to enhance the delivery of patient-centered care. Last year, NCPA collaborated with Health Quality Innovators (HQI), the QIN-QIO representing Virginia and Maryland, to support National Check Your Meds Day.
This event was a natural extension of HQI’s Blue Bag Medication Safety and Reconciliation Program, in which patients are encouraged to bring in their prescription and over-the-counter medicines for review. In addition, drug disposal options are provided for expired, unwanted and unneeded medications.
Q: Anything else you would like QIO News readers to know?
Community pharmacy should continue to seek out opportunities to work with quality organizations, and vice versa, as health care transitions to focusing on value. Independent community pharmacists can leverage the excellent relationships they enjoy with their patients to effect better health outcomes.