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In mid-February, the federal government undertook a new tactic in its quest to inoculate the country against COVID-19: sending the vaccine directly to grocery store and retail pharmacists and relying on them to deliver millions of doses to eager Americans.
Suddenly, all eyes turned to a category of often-overlooked health care providers: the neighborhood pharmacist.
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“The pandemic has been a tale of two realities for us,” says Emily Zadvorny, a clinical pharmacist and the executive director of the Colorado Pharmacists Society. (She also teaches at the University of Colorado Skaggs School of Pharmacy.) Although pharmacists were busy during the early days of the pandemic—especially since they were often the only health care provider open—Zadvorny says the industry has experienced its own “surge” over the past three to four months during the vaccination rollout.
“Across the country, pharmacists have delivered millions of vaccines on top of what pharmacists and techs do every day,” Zadvorny says. While that has engendered a lot of pride across the professional community, pharmacy workers in many settings are also experiencing severe burnout.
Since the start of the year, retail pharmacists’ hours have been longer and their workloads more significant than at any time in recent memory. They’ve been hosting early-morning inoculation clinics and dealing with the mounds of administrative work that come with filing claims to Medicare, Medicaid, and private insurance for reimbursement. Pharmacies that are Federal Retail Pharmacy partners—which received vaccine doses directly from the U.S. government—have to report immunization data to both the state registry and the Centers for Disease Control and Prevention. Pharmacists say their phones have been ringing almost nonstop with questions that range from how to get appointments to which vaccine is “better” to whether a particular reaction is considered normal.
Jacob Hansmeier, the director of pharmacy at Jefferson Center for Mental Health—a network of private, nonprofit mental health centers in Jefferson, Gilpin, and Clear Creek counties—says he recognizes exhaustion in his colleagues. “In terms of busyness, we’re not as busy as the hospital staff who dealt with the front end of the pandemic or the retail pharmacists [at such places as Walmart and Safeway] who are dealing with really heavy schedules now,” he says. “And even so, at my clinic, we’re tired.”
Hansmeier’s team expanded their patient population, serving both the Jefferson Center’s patients and opening up walk-in vaccines for the general public, but he acknowledges that he’s got it easier than his colleagues who work at national chains, because the center is closed on weekends and his clinic has adequate staff. “My friends who work in retail,” Hansmeier says, “they’re really wiped out.”
Zadvorny agrees: “The burnout issue is real, and I believe it’s highest in chains.”
And the problem in chains goes beyond COVID-19 shots. The real problem is economics. Retail and grocery pharmacies, including independents, are hesitant to hire more workers because margins on prescriptions are tiny. And pharmacists are rarely reimbursed for the care they provide—such as counseling patients on potential adverse drug reactions or helping patients manage chronic conditions—despite the fact that they are well trained health professionals.
“We go to school [for a length of time] second only to physicians,” she says. “We have true expertise in optimal use of medications.” With the country facing a shortage of primary-care providers, pharmacists could be a big part of the solution to deliver care—as they’ve proven with the vaccine rollout.
Now, governments are exploring the possibility of doing exactly that: In April, a new bill was introduced to Congress that would allow pharmacists to bill Medicare Part B for care delivered to medically underserved patient populations, which can mean rural residents, the underinsured, and people who, for ethnic, religious, or racial reasons, have little access or don’t trust mainstream health care. Currently, each state defines pharmacists’ scope of practice, which might include administering vaccines, helping patients manage chronic disease, conducting cholesterol and other point-of-care tests, and more. If the bill passes, pharmacists will be able to bill Medicare for those services and get reimbursed at 85 percent of the physician fee schedule.
Two similar bills are making their way through the Colorado General Assembly this legislative session: House Bill 1275 would provide Health One Colorado (Medicaid) reimbursement to pharmacists for point-of-care services, and Senate Bill 094 would modernize pharmacists’ scope of practice to include prescribing medications for self-limiting conditions (those that don’t pose long-term harm for most of the population, such as the flu or stomach bug); ordering and analyzing lab tests; and performing minor physical evaluations. For example, if you suspect you have a urinary tract infection, instead of trying to get an appointment at the doctor’s office, you could pop into the pharmacy, get tested, and walk out with antibiotics.
“If [the government] recognizes that more services are provided,” Zadorny says, “and those services are paid for, pharmacies can hire more staff. It shifts the model and relieves some burden on pharmacists. Nobody denies that technology can count pills. Let’s let technology do what it does best and [let pharmacists] provide valuable human services instead.”
Zadvorny hopes the bills will gain momentum from pharmacists’ new place in the spotlight. “The pandemic has really shined that light on our contributions,” she says. “In a lot of ways, the country is primed for this legislation and the conversation it involves.”