To Really Cut Health Spending, Put Pharmacists on the Front Line

The bill to lower drug prices introduced by House Speaker Nancy Pelosi (D-Calif.) has a big number attached to it. By allowing Medicare to negotiate prices on select brands and insulin, the federal government will save $350 billion over seven years, according to the Congressional Budget Office. 

But Congress is overlooking a bigger number. The estimated cost to health systems from medication-related problems, such as patients not taking their drugs as prescribed, was $528 billion in 2016. That is 16 percent of total U.S. health care expenditures that year.  

Put plainly, that means poor management of medications is driving avoidable hospital admissions and early deaths. More than half of all Americans have one or more chronic diseases, and for 90 percent of them, medications are the first line of treatment. 

Another way of looking at the contrasting numbers is that the most expensive drugs may be the ones not taken, or not taken as recommended by physicians and pharmacists. 

The Pelosi bill — or any legislation aimed at reducing health costs — would be seriously enhanced if it included provisions that enabled pharmacists to get onto the front lines and begin providing high-impact clinical services such as comprehensive medication management.  

With expanded authority, pharmacists could review test results, adjust the dosage of prescribed drugs, monitor compliance with medication, diet and exercise, and take on other oversight duties.    

Evidence keeps piling up that better use of pharmacists could cut deeply into that half-trillion-dollar expense. To cite just a few of many studies:

— In Colorado, coronary artery disease patients who received care from a collaboration of pharmacists and nurses soon after hospital discharge were 89 percent less likely to die compared to patients not enrolled in the program.

— In Hawaii, medication management services provided by specially trained hospital and community pharmacists were associated with a 36 percent reduction in medication-related hospitalization rates. 

— In Los Angeles County, pharmacist visits to black barbershops made a big difference in controlling hypertension.  Almost 90 percent of barbershop customers managed by a pharmacist achieved control at six months compared to one-third of those managed by physicians through regular appointments. 

So what has kept these pilot projects from maturing into expanded use of pharmacists, who are the nation’s third-largest group of medical professionals behind physicians and nurses? 

Tradition is part of the reason.  When physicians and nurses were organizing their professions decades ago, pharmacists for the most part saw themselves in a different light, as individual druggists and community businesses. They missed out when Medicare and Medicaid began creating reimbursement codes for providing medical services beyond filling prescriptions.  

Competition is another impediment.  Physicians have looked skeptically at the prospect of pharmacists expanding their scope of practice, especially in the arena of patient care. 

But today, pharmacists graduate with the Doctor of Pharmacy degree, equivalent in terms of years of study to physicians and dentists. They are experts in mastering complex medications, including more than 10,000 prescription drugs. Meanwhile, the United States is forecast to have a shortage of up to 121,900 physicians by 2032.   

Some health care systems have recognized the financial gain from more effective use of pharmacists. The value generated by a brittle diabetes patient who has his or her medication therapy managed by a pharmacist and prevents hospitalization goes directly to the bottom line of these systems, which realize profits when their enrollees stay healthy rather than by collecting fees for each service. Mergers and acquisitions involving pharmacies and health plans are putting financial priority on delivering better-quality health care, which greatly improves when pharmacists work closely with other professionals as a team. 

Pharmacy schools keep demonstrating that pharmacists can improve community health if they just get the chance. For example, the USC School of Pharmacy was awarded a federal innovation grant that demonstrated the value of embedding pharmacists on health care teams. Building on this work, the Centers for Disease Control and Prevention just awarded a grant to the school to work with the Los Angeles County Department of Public Health in preparing hundreds of pharmacists to provide medication management to patients in clinics and community pharmacies.

Now Congress needs to do its part. It should revive legislation from last year to approve pharmacists as providers of more essential services under Medicare. The result would be expanded consumer access to pharmacist-guided patient care, better management of chronic diseases and reduced health care spending. There is money to be saved, and most importantly, lives to be spared. 


Vassilios Papadopoulos, D.Pharm, Ph.D, is dean of the School of Pharmacy at the University of Southern California. 

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