How pharmacies can thrive amid financial, regulatory and economic uncertainty - MedCity News

Worries about the economy kicked into high gear, melting away notions of a cool, lazy summer for community pharmacies. Amazing lately 68% of CFOs polled by CNBC said they believe a recession will occur in the first half of 2023.

A worried economic outlook is another stressor at the top of an ever-growing list for pharmacies that includes cash flow uncertainty, CMS loopholes final rule around PBM use of DIR fees and the burden of adapting the new Pharmacy Quality Alliance (PQA) pharmacy quality metrics. While PBMs are likely to see increased scrutiny from regulators in light of recent news that a national PBM was charged with the supply of unnecessary prescription drugs to military personnel, they continue to be at odds with the profitability of independent pharmacies.

With the stakes higher for 2023 than in years past, understanding potential industry challenges and leveraging new solutions will be critical for community and independent pharmacies hoping to remain profitable.

2023: What’s Next

The potential for continued DIR reimbursement may be the biggest challenge community pharmacies must prepare for in the coming year, but it’s not the only one.

In a recent report from Columbia University’s Mailman School of Public Health, approx 80% of the surveyed pharmacists expect a more prominent role in preventive care by 2030. Many are already feeling the effects as they are urged by payers and physicians to supplement routine medical care in addition to administering medications.

While the general demand for pharmacies to do more with less is nothing new, younger workers are being called upon to work longer and longer shifts – especially in rural US. Furthermore, although we have learned to live with Covid, the continued prospect of small community pharmacies losing one or two workers infected with the virus (and having to isolate at home for at least five days) puts additional pressure on healthy staff who must to fill in the gaps during their absence. No wonder almost 7 out of 10 pharmacists they say they are burnt.

Meanwhile, payers are under increased pressure to provide an exceptional member experience – and expect their pharmacy partners to help.

In 2020, CMS doubled the weight CAHPS health plan survey metrics related to member experience, which now account for nearly 40% of a health plan’s overall star rating, and increased the weighting of medication adherence metrics in Contract Year 2021 Star rating formula updates. Plans that fall short of 4.5 stars risk losing the incentives they need to stay in business. So, until further notice, pharmacies and health plans have no choice but to work together to optimize member satisfaction and experience.

Planning for the future

There is no one-size-fits-all solution to these concerns, and cost containment strategies can only take a business so far. With that in mind, these three revenue-generating strategies that can help ease financial and operational pressures:

  1. Look for new revenue generating opportunities.

Market preferences are always evolving, and pharmacies that can meet consumers’ needs for convenience, access and service will have more traffic – and their health plans and provider partners will benefit as well. Now is the time to look for new ways to strategically improve the business: for example, offering ancillary services such as telemedicine consultations or clinical care/dietary consultations, or incorporating a medication synchronization program to meet current consumer needs.

  1. Streamline communications under one platform

As demands on pharmacists’ time increase, staying organized and streamlined is key to maintaining sanity. An integrated care management platform can bring together multiple data streams and improve the following areas:

* Supply chain management

* Traceability and transparency of medicines

* Medication administration and management

* Quality improvement reporting

* Performance tracking

* Member engagement and outreach

* Care collaboration with providers and health plans

In addition to streamlining day-to-day activities, using a single platform instead of multiple technology systems can help pharmaceutical professionals reduce manual computer errors and maintain patient safety.

  1. Work more closely with care partners to engage members

Health plans and pharmacies aren’t always on the same page—often because they don’t use the same technology platform—but incentive programs from CMS and others will continue to reward those care partners who can work together to engage and motivate people to increase quality and results. Using an integrated clinical care management platform can help support all care partners in monitoring progress in medication management and CAHPS metrics while streamlining reporting.

Community pharmacies need to scale up now to be ready for 2023 and ensure their operations, technology and partnerships are in top shape should more unexpected economic shocks occur. The more that can be done on the front end now, the better equipped pharmacy leaders will be to handle stressful events and weather financial storms six months from now.

Photo: Ridofranz, Getty Images

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