Innovations-Magazine-February-2023 - 9

As trained clinicians, pharmacists have a role to play in explaining
to patients what prescription medications are for, how the prescriber
wants them to be taken, possible side effects, what to do if a dose is
missed, and the importance of the medication for the success of the
patient's long-term care and positive outcomes.
Telehealth services, expanded at the start of the pandemic, have
improved the quality of service and health education to patients by
helping pharmacists process prescriptions, making it easier for patients
to access medications and ensuring that patients take them properly.
Many organizations have provided new ways for patients to discuss
medications with pharmacists via computer or phone, as well as to
autofill and have their medications directly shipped to their homes.
Pharmacies also continue to build and adopt digital systems designed
around medication adherence that can automatically perform tasks,
like tracking specific categories of prescriptions, such as a patient's new
medications, or identifying whether patients are regularly picking up
prescription medications late. Upon flagging problems a patient may be
having, the pharmacist can use the system to easily contact the patient
and log interactions in the system.
As ways to reduce logistical challenges for patients and thus
improve adherence, many insurance plans now allow for 90day
prescriptions and medication synchronization, in which the
pharmacist reviews all of a patient's prescriptions and calibrates their
day's supply as needed so prescriptions can be filled at the same time
going forward.
New and innovative medical device technologies also support
adherence by enabling health care providers and caregivers to
monitor a patient's medication intake in real time.
Other ways pharmacists could help patients may include offering
medicine reconciliation days, which allow patients to take their
prescriptions to their pharmacists to review what they are for,
whether or not they are still needed, and to provide unit dose
packaging to help patients keep to their medication schedule.
Use of technology in this field and its effectiveness in promoting
medication adherence is only likely to increase, even as the effects
of the pandemic decline.
State-Level Considerations
A great deal of progress has been made at the state level in leveraging
the role of pharmacists in addition to telehealth technologies to
improve patient access to high-quality care. Currently, almost every US
state requires pharmacists to counsel or offer counseling to patients,
either in person, in writing, by telephone, or by other means deemed
appropriate by the pharmacist. Many states also require a pharmacist to
counsel a patient when they are receiving a new prescription.
Additionally, more than two-thirds of states now allow the use
of telepharmacies, where pharmacists deliver pharmaceutical care
via telecommunications to patients in remote locations or to rural
hospitals that might not otherwise have direct access to a pharmacist.
However, some states do not allow patients to use telepharmacies if a
physical pharmacy exists nearby.
During the pandemic, some rules were waived by emergency
order in certain states, allowing pharmacists to operate with more
allowance for aspects of the prescription process to be performed off
site, including across state lines by approved personnel in controlled
settings. This sort of interstate digital practice allowed organizations
to conduct " central fill " or " central processing " functions at the offsite
locations, improving patient fulfillment services while effectively
freeing up pharmacists at community pharmacies to perform other
tasks, including patient counseling services.
At some organizations, the goal was to take 40% or more of
prescriptions out of the community pharmacy to improve efficiency and
alleviate pharmacist workload issues. In the face of staffing shortages,
where it is not feasible or possible to hire additional staff, this already
proven central fill model provides a possible alternative to pharmacies
looking to improve work conditions and increase staff bandwidth.
NABP Action
NABP has been proactive in promoting medication adherence on
many levels, including as an advocate for pharmacists and a resource
for the boards of pharmacy.
Following unprecedented challenges over the last three years of
the pandemic, pharmacists continue to face intense workloads and
high levels of burnout, threatening their ability to counsel patients
effectively and stay focused on reducing nonadherence. In 2022,
NABP President Reginald B. " Reggie " Dilliard, DPh, launched an
initiative focused on eliminating barriers and enhancing patient
safety (nabp.pharmacy/presidential-initiative), which emphasizes
improving workplace conditions for pharmacists, especially in
community settings. The initiative includes a focus on identifying
barriers in existing regulations that limit patient access to medication
and care, among other priorities.
NABP also encourages states to review their laws and regulations to
determine if more can be done to address issues that affect medication
adherence, such as pharmacy deserts, where a community's lack of
existing neighborhood pharmacies affects people's ability to access,
learn about, and consistently take prescribed medications. The
Association encourages states that do not yet allow the use of solutions
like telepharmacies to consider updating their regulations to allow
pharmacy practices to innovate more easily in the future.
In support of such efforts, NABP offers its members the Model
State Pharmacy Act and Model Rules of the National Association of
Boards of Pharmacy, or Model Act, which provides boards of pharmacy
with model language that may be used when developing state
laws or board rules, including references to medication adherence
monitoring services.
In addition, NABP supports the Pharmacy and Medically
Underserved Areas Enhancement Act (or the Provider Status
Bill), bipartisan legislation that, if it were to become law, would
introduce significant changes not only to Medicare but also require
private payers to pay for pharmacist clinical services, including
adherence counseling. It would also include pharmacists on the list
of recognized health care providers.
It remains to be seen if technology and the expanded role of
pharmacists - along with legislative support - will be enough to
prevent higher levels of medication nonadherence in the future.
FEBRUARY 2023 | 7
http://nabp.pharmacy/presidential-initiative https://nabp.pharmacy/members/board-resources/
Innovations-Magazine-February-2023

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