The Growing Role of Community Pharmacists in Public Health

At the height of the COVID-19 pandemic, the government responded to the public health emergency by allowing community pharmacists to do more for their patients than ever before. It's time for those emergency privileges to become permanent.

Prior to the pandemic, community pharmacies had been providing point-of-care testing for years as well as vaccinations against not just the flu, but shingles, pneumonia, tetanus, and meningitis.

Then came COVID-19, and suddenly community pharmacies were thrust into a critical public health role as cases skyrocketed and consumer demand for coronavirus tests far exceeded the capacity of primary care providers, local clinics, and regional testing centers. Across the country, local pharmacies—almost overnight—stood up walk-in and drive-through COVID-19 testing services, often booking appointments days in advance for concerned members of their communities.

If the initial response of community pharmacists to the pandemic were a test of their effectiveness as an integral part of our public health ecosystem, they passed with flying colors. But what happens after the public health emergency is declared over?

States such as Arkansas, Mississippi and Oregon have implemented orders to allow pharmacists to independently order and administer REGEN-COV COVID-19 monoclonal antibodies, building on the orders granted by the 9^th Amendment to the Public Readiness and Emergency Preparedness (PREP) Act. This is a welcome trend toward pharmacists someday attaining full provider status.

For pharmacists, this elevated level of involvement in public health strategy represents an unprecedented “test-and-treat” opportunity to help save lives by ordering and administering desperately needed therapeutics. Unfortunately, pharmacists were carved out of the Emergency Use Authorizations (EUA) and blocked from recognition as providers of both Paxlovid^TM and molnupiravir.

Closing Care Gaps

National pharmacy organizations have warned that blocking pharmacists from ordering and administering these critical therapeutics will be detrimental to patients with COVID-19. These organizations include the American Pharmacists Association (APhA), American Society of Consultant Pharmacists (ASCP), American Society of Health-System Pharmacists (ASHP), National Alliance of State Pharmacy Associations (NASPA), and the National Community Pharmacists Association (NCPA).

Both therapeutic products are recommended as soon as possible after diagnosis of COVID-19 and must be initiated within 5 days of symptom onset to achieve optimal results. Given their unique accessibility to most patients nationwide, the local pharmacy is an obvious choice for administering COVID-19 drugs.

According to the NCPA, more than three-quarters (77%) of community pharmacies in the United States are located in areas with populations of less than 50,000, many of which lack easily accessible health care services. Equally important, pharmacists are among the most trusted health care professionals, exceeded only by nurses as the most trusted, according to various patient surveys.

Further, by expanding the clinical services they offer to their communities, pharmacies would be able to develop lucrative new revenue streams. This would enable pharmacies to afford the staff necessary to scale these new clinical services.

Trust and Convenience

As expert opinion suggests, it is not likely that we will fully eradicate COVID-19, but rather the pandemic is expected to become an endemic disease. Americans will still require services that are more conveniently received at their local pharmacist than at a clinical office or hospital that may be farther away. Being recognized as a provider enables community pharmacies to bill medical payers for reimbursement and get paid equitably for services.

For a person struggling with acute illnesses like COVID-19, influenza, or strep throat, there is immense value in being able to conveniently visit their local pharmacy to receive prompt care and treatment. As a result, pharmacies have had success with the cash model for providing these basic but essential clinical services.

In addition to offering accessible care to members of their community, there are at least 2 other ways pharmacies can ease stress on the health care system when resources are spread thin. One is simply by conducting tests and providing treatment that otherwise would have to be handled at physicians’ offices, clinics, and hospitals, thus freeing up resources for emergencies and higher-priority cases.

The second way pharmacies help ease stress on the health care system—and save money—is by playing a key role in keeping community members well. In both cases, regular follow-up with the primary care physician will preserve continuity and prevent care siloing.

The confidence the US Department of Health and Human Services has shown in community pharmacies taking a leading role in test-and-treat programs to combat COVID-19 has been well-earned. For more than a decade, local pharmacists have been testing patients and dispensing antivirals for H1N1, influenza, strep, HIV and hepatitis C, all under strict statewide protocols, guidelines, and collaborative practice. This experience has positioned pharmacies to expand the test-and-treat services they provide to their communities during the pandemic and beyond.

Pharmacies have proven they are up to the challenge and deserve long-term federal recognition as providers and fair reimbursement for services.