Integrating Rx with advanced primary care will unlock better health

America's healthcare industry has been squeezed tightly over the past few years with post-pandemic fallout, a declining economy and high consumer expectations. Retail pharmacies are no exception, and it's clear that the traditional pharmacy model is in crisis. With rising costs for medications and supplies and changing consumer retail habits, this doesn't bode well for the brick-and-mortar community pharmacy.

Simply put: the traditional pharmacy model is unsustainable. We will soon see a rash of closing retail pharmacies and consumers scrambling to fill needed prescriptions affordably.

You might be asking yourself why this should matter to you as HR and benefit professionals. I serve as chief human resources officer for a company that works with many large employers concerned about healthcare costs and the decline in population health. What is often overlooked is the role pharmacies play in this problem. Some of this decline can be attributed to reduced access to convenient, affordable pharmacies. When a person can't find or afford their medication, they may decide not to take it or be forced to choose between multiple medications.

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It's time for employers and their advisers to step in to protect employee populations and the bottom line. Here are a few thought on how to accomplish this goal: 

First and foremost, the focus should be on transparency and data. To make pharmacy benefits decisions in the best interest of their employees, employers need to know true medication costs. In the past, carriers have kept hold of employer's claims data, but that is changing. Today, with the Consolidated Appropriations Act now in effect, employers are more easily able to access their data. In fact, the CAA requires it. 

To make informed decisions, employers as you know also need to evaluate their relationships with brokers and consultants and understand their compensation arrangements. Organizations should require them to disclose financial relationships with pharmacy benefit managers (PBMs). This is the only true way to be sure their representatives are acting appropriately for the employee populations they serve. Aside from being the right thing to do, we're seeing through the landmark Johnson & Johnson drug pricing lawsuit that employers will be scrutinized more heavily than ever now that the CAA is fully in effect. 

Second, alternative ways to increase pharmacy access should be considered. The demise of community pharmacies is exasperating an already fragile access problem. Barriers to filling needed medications, such as cost and convenience, can result in an employee simply deciding not to take a drug or taking it incorrectly.  

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Employers can look to virtual, mail order or onsite pharmacies that provide in-person services to employees at or near their workplace to give employers more options. With an onsite pharmacy model, employees have convenient access to receive medications and to form relationships with a pharmacist.

Pharmacists are regarded as one of the few clinical professionals not tucked away behind a closed door, but understaffing at local pharmacies makes that care team inaccessible to most members. Trust between member and pharmacist increases the likelihood that a member will fill and take their medications correctly and adds support for chronic conditions, resulting in healthier, happier members and less time out of work.

Let's compare the impact an onsite or nearsite pharmacy can have on individuals with diabetes. According to the Utilization Review Accreditation Commission, the community benchmark for commercial plans shows about 75% of individuals with diabetes reliant on community pharmacies take their medications as prescribed. We conducted a study of more than 148,000 lives using a Milliman-validated methodology and saw that 87% of our members with diabetes are adherent to their medications.

I believe that an advanced primary care model that includes pharmacy is the foundation to better health.  Employers that integrate onsite pharmacy services on top of a primary care offering save an additional $1,775 per member per year, according to our data, plus what the member personally saves in prescription and over-the-counter medicine costs. You might be asking, "how is this savings generated?" 

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Providing accessible, low-cost pharmacy services alongside primary care fills the gap in traditional care models and puts a whole care team – providers and pharmacists – at the member's fingertips. When those providers and pharmacists work with each other and integrate their care, they provide an extra layer of medication reconciliation. This safeguards against drug interactions that are common when a member visits multiple providers. 

Employers need to acknowledge that traditional care models are at risk and that advanced primary care, including pharmacy, is the road to controlled costs and improved health. 

With a focus on pharmacy and advanced primary care, employers can expect to see a reduction in costly community healthcare and bottom-line spend, and an improvement in chronic conditions that plague their population.

What does this mean for your clients or the employee populations you serve? In a nutshell: improved member experience, better quality of care and lower costs.