Specialty Pharmacy Continuum
Matthew Gibbs, PharmD
I worked as a pharmacy intern and technician for six years in a large retail chain pharmacy. I admired the relationship the pharmacist I worked under, let’s call her Mary, had with her patients and the unbelievable amount of trust they put in her advice. Mary’s acuity with patients underscored the value that pharmacists—the highest-educated health care professionals on medication topics—bring to the health care team. Indeed, they are uniquely trained to help providers and patients deal with complex issues involving medication management.
I aspired to be a respected resource for my community when I entered pharmacy school, but by the time I graduated in the late 1990s, a major shift in the industry already had taken hold.
I noticed Mary and other pharmacists scrambling on the phone with insurance carriers, calling doctors’ offices to get prescriptions changed to comply with their patients’ formulary. I saw Mary’s relationship with her patients turn from a helpful exchange of medical information to managing copay charges and trying to explain why the price of a medication kept changing each time they went to refill.
Mary is not alone. Pharmacists are reporting higher workloads, more stress and less overall job satisfaction, as a recent survey showed (bit.ly/2ZKgQb8).
Compounding this issue, the largest pharmacy benefit managers (PBMs) now exclude hundreds of products. Brand-name medications are particularly prone to such exclusions: Their removal increased by as much as 63% in 2020, according to CoverMyMeds’ 2020 Medication Access Report (prn.to/3f6nz5P). Moreover, nearly 70% of patients report having made personal or financial sacrifices to afford prescriptions, and 30% say they’ve had to abandon a prescription due to cost, the CoverMyMeds report noted. That abandonment rate is even higher when out-of-pocket costs exceed $100 (Figure). Additionally, formulary exclusions of brand-name medications continue to increase. These barriers to care impede a pharmacist’s ability to play the role they are trained for and limit where they can effect meaningful change.