Reflection 11/15

When it comes to retail pharmacies, they play a key role in the medicinal care industry. They are the individuals who see the most volume of patients compared to physicians. In a given week in the US nearly 275 million people visit the pharmacy to fill a prescription. This high traffic of patients puts pressure on the pharmacists to perform up to par. The industry is making their best efforts to move their work towards value based rather than volume based and this is based on the three pillars/triple aim; lowering cost of care per capita; improving the overall patient experience, and improving the overall health of the population. Much scrutiny that the retail pharmacists face is in terms of medication adherence and non adherence. When the patient chose to not follow drug regimens, not refill prescriptions, or stretch out there prescriptions, the pharmacists are the people catching most of the blame. They are the ones that are meant to give the patient all the information they need to be able to understand exactly what is expected of them when it comes to taking their medication and completing their treatment. When the chose to disobey there are more adverse events such as emergency rooms that ultimately drive up costs for the patient and the industry. Someone who is adherent to their medication trusts their pharmacists and feel like their is connection between the two more than just professional. This means pharmacists have to step up into the role of making their care much more personal and patient relationship based in order to educate them properly. Hand in hand with this challenge comes more common challenges that show room for improvement. In this time, there is much consolidation occurring in terms of mergers and buy outs. Although this is good for the industry as it finds ways to bring together larger businesses and combine different companies striving for the same goal, it does take a toll on the patients/consumers. When these consolidation occur, there tends to be a disconnect between patient and physician. They may have to find a new physician who does not know them well or they might have to travel even farther to see their primary physician. This makes the patient feel like they are just a number to large corporations rather than prove how important they are to the success of the industry. The industry needs to do a better job at taking these outcomes into account in order to keep patients happy. There tends to be a struggle when it comes to growing costs of medications and regulations. Pharmacies themselves do not have much control over the price of their drugs but they do have control over relaying information to overhead controllers like PBM's to show them that consumers are not happy with what they are paying which will lead to non adherence. Price transparency is very important to the user because they need to be able to put the money aside to pay for their medication rather than be left in the dark about how much it actually costs. This can lead to patients choosing to use a less effective drug or generic rather than the drug they need because they are worried about the price.  When it comes to these healthcare costs, the industry must look to decrease superutilizers which are individuals who are more prone to use more health care than others. They have frequent hospitalization, multiple medication regimens, and many doctors. Being able to decrease this type of patient will drastically decrease expenditures and costs. A struggle at hand is being able to better the patient experience from start to finish. Bettering this journey will help increase profitability, efficiency, and engagement. It is hard to do so because patients today are not only seen as patients but as consumers. They are consumers of the pharmacy, the physician, the hospital, and the insurance company. Being able to see them as both will help all of the players in the game; only seeing them as one or the other will hurt the industry as a whole. All of these complications and challenges are a huge focus for the industry. They all go hand in hand and have a trickle down effect. Fixing one will ultimately help to fix the other.
Another to take into account with all of these challenges is the idea of specialty pharmacies offering specialty drugs and services. This market is based around complex chronic or rare conditions/diseases. Today, with the advanced scientific knowledge, more diseases have been discovered which calls for more drugs to manage or treat. Having these new discoveries that account for many patents, calls for specialty pharmacists and physicians to be educated on these new conditions in terms of treatment and medication regimens. About 60% of the health systems have less than 5% of their patient population needing these services but 25% of them have between 30% and 50% of patients in need. This shows that there is a clear need for this ability out there in terms of allocating facilities and employees that understand this topic thoroughly and would be able to aid the patients as needed. The institutions have many driving factors such as facilitating patient access to drugs, capturing drug revenues, improving monitoring of adherence, improved care of lives at risk, improving net incomes, and using 340b eligibility. As you can notice there are many similarities between the three pillars and triple aim in these factors. With these services being more costly due to the fact that they take much more time and money to produce, then the industry profits. Not only are their revenues increasing, but they are increasing the health of the population which ultimately lowers cost expenditures. Right now the need for them is there and it will be growing so more pharmacies are looking to implement these services. They are hoping that the payoff for cost of employment, education, and production will come in terms of the rise in the demand for them. Through all of this I was able to learn how many struggles pharmacies face on a daily basis. I have never had to go to pharmacy for more than a minor prescription but I do see that if I was in a complex situation I would expect to have a different experience with my pharmacists. I would want them to be extremely knowledgeable on my condition, have contact with my physician, and be able to answer any of my confounding questions in terms of scheduling and regimen. I think that bettering the profession is a huge need since the pharmacists is the most frequently seen profession in the healthcare sector. They go to school for a long time to gain their knowledge so they should get the chance to prove it.