by Thomas R. Clark, RPh, MHS, BCGP
Senior Advisor, Government & Regulatory Affairs
Board of Pharmacy Specialties
The SARS-COV-2 pandemic has had a dramatic impact on nearly every dimension of society. The Board of Pharmacy Specialties has been monitoring developments related to the pandemic. Federal and state governments have made changes that directly impact the pharmacy profession. BPS has focused on how these changes might impact pharmacists with BPS Board certification, or create greater opportunities for pharmacists who are Board certified.
One impact of the COVID-19 pandemic has been the accelerated adoption of telemedicine. Medicare policy has been quickly changed to pay for patient visits supported by technology, and private insurance has followed along.
The pandemic created tremendous disruptions in normal patient workloads in certain parts of the United States as the coronavirus circulated. As the number of patients spiked in hard-hit states, governors issued emergency orders to bypass normal procedures for professional license transfer – loosening restrictions so health professionals from other states could quickly move in to assist.
The pandemic has produced some changes that more directly impact pharmacists and the pharmacy profession. The Kansas legislature, for example, just passed House Bill 2016 which includes this language: “a licensed pharmacist may provide care for routine health maintenance, chronic disease states or similar conditions appropriate to such pharmacist’s education, training and experience … without a collaborative practice agreement with a physician.” Some of the specific changes vary from state to state but often include:
- Pharmacists are authorized to conduct testing for COVID-19 virus
- Pharmacists are authorized to refill maintenance prescriptions
- Pharmacists are authorized to substitute another drug in a therapeutic class if the ordered drug is unavailable
- Broader authority for immunization is being provided to pharmacists, including preparation of authority for COVID-19 immunization when available
The overall use of healthcare services has decreased substantially as a result of the COVID-19 pandemic. The Centers for Disease Control and Prevention reports that emergency department visits declined 42% in the United States in April 2020 compared to April 2019. Primary care is being “devastated” by COVID-19 as patients stay away from medical offices to avoid becoming infected with the coronavirus. All these changes have been observed as the pandemic has taken root in the United States in just a few short months.
But when the pandemic is under control, or behind us, which of these changes will persist? How will pharmacists be impacted?
It turns out that many of these changes that have been adopted or hastened out of necessity have been well received. Patients are very satisfied with telemedicine and it is likely to become an entrenched part of health care in the future. There have been no reports yet of dangers to public safety because doctors or other health professionals have been allowed to move from one state to another without jumping through rigorous bureaucratic hoops set up by state agencies. This will make it difficult to go back to requiring all these rules to be put back in place.
The increased flexibility for pharmacists in patient care has also not been accompanied by any reports of problems or concerns. If pharmacists continue to exercise their new flexibility in a responsible manner, it seems likely that this authority will continue and perhaps grow in the future. One big question is whether the volume of health services used by Americans will return to previous levels or will the downturn in the level of health services persist after the pandemic?
President- Blue Thorn, Inc.- Healthcare Consulting
Blowing Rock, NC
Non-Pharmacist Health Professional Member, BPS Board of Directors
Into my 2nd term as the physician representative serving on the Board of Pharmacy Specialties, the progress made by these incredible pharmacist leaders and dedicated staff to advance and maintain high standards for board certification in an expanding number of clinical areas, not only in the US- but globally, has contributed to the transformation and equipping of the profession from primarily product dispensing roles to the rightful medication management experts- proactively prescribing and resolving drug therapy problems in collaborative practice with their other provider colleagues. The recent bureau of labor statistics survey continues to see a migration of the percentages of pharmacist positions into clinical non-dispensing roles as medication therapy ever increases in complexity. From 2013 to 2019, the share of pharmacists employed in settings such as hospitals, physician/outpatient, and home healthcare settings has grown significantly from 27% to 31%. However, this is nowhere near the pace that I believe is necessary to significantly impact the lack of optimized medication regimens- resulting in countless lives lost and the $528 billion in cost I outlined along with two other co-authors in 2018.
With the current new norm- a silver lining exists in the opportunity for clinical pharmacists to move front and center as collaborative team members. In the midst of the COVID-19 pandemic a primary care provider from Illinois included this remark in the week- 5 (April 10-13) Primary Care Collaborative (PCC) survey- “Allow my pharmacists to be included in all of the billing and reimbursement. They are filling the gap in care. Do not discount payment due to telehealth. We are all still spending the same time with patients–it is not cheaper delivery!!!”  The same survey for week 12 of PCPs revealed >80% find video-care is best suited for visits that address stable chronic conditions, mental and behavioral health counseling, and medication reconciliation.
In my discussion with the pharmacy leadership at Desert Oasis in California (a risk- bearing 300 provider group practice in a COVID-19 hotspot), although they already had broad collaborative practice agreements and were well integrated with the physician and other prescribing colleagues, the current pandemic had led to even more use of telehealth visits and further expansion of the clinical pharmacist roles.  Brian Hodgkins, Teresa Hodgkins, and Lindsey Valenzuela described how these virtual visits allowed for the inclusion of multiple care givers (like social workers, physicians, and pharmacists) simultaneously participating on a call with a patient when needed- in real-time. Also, to manage the chronic patients- with the increasingly longer gaps in the PCP interactions, the pharmacists were increasing their number of visits and successfully adjusting/prescribing medications which has resulted in reducing the need for PCP, specialists, and ER visits- while avoiding hospitalizations. When asked if Board Certification was important for these clinical pharmacists- the answer was definitive. All three agreed- more than ever, residency training and Board Certification serves both to assure the competence of the pharmacist practitioners, while serving as reassurance to the clinical colleagues and the broader public- that they are the medication experts- and possess the ability to assume care for the medication needs of patients.
As we are learning through this pandemic- it takes a team. Clinical pharmacist services are vital. We need at least 50% of the pharmacist workforce in direct patient care, where every person has a clinical pharmacist on the team. Let’s learn what this pandemic is teaching us- medication management is not a “nice to have”- but is essential- and clinical pharmacist in collaborative care- should be the key members of the team charged with managing the medications and “filling the gap,” as one PCP so aptly described.
https://gtmr.org/wp-content/uploads/2016/10/GetTheMedicationsRight.v22final-5.20.pdf page 27 and discussion with Brian Hodgkins, PharmD, Teresa Hodgkins, PharmD BCACP, and Lindsey Valenzuela, PharmD, BCACP