2020 Pharmacy Industry Update from ScriptPro - The ScriptPro Blog

  • 2020 Pharmacy Industry Update from ScriptPro

  • By ScriptPro
    February 25, 2020

    The regulatory landscape for pharmacy is constantly changing. To maintain visibility and help our customers navigate the changes, ScriptPro’s Strategic Industry Affairs (SIA) group monitors the industry. Want to know what’s ahead in 2020? Here are a few notable advancing trends in pharmacy.

    Pharmacists as Providers

    The landscape of the patient experience is evolving with a shift towards receiving healthcare in nontraditional settings. Healthcare received outside of a physician’s office, from differing practitioners, offers patients more of what has been wanted/needed: immediate access to care and an increased personal experience.

    Pharmacists offer the unique ability to merge proximity and a high level of trust from patients, making them an ideal healthcare partner. [1],[2] However, pharmacists still are not federally recognized under Medicare Part B as health care providers and state definitions often limit their scope-of-practice.

    Provider status helps to enable patient access to a provider’s clinical services and reimbursement to the provider for provision of those services. While pharmacists are considered providers in most states, they are constrained in their ability to provide a full suite of clinical services due to the parameters of their scope-of-practice.

    Full provider recognition, which would allow pharmacists to practice at the top of their licenses and increase reimbursement, is gaining momentum. The Pharmacy and Medically Underserved Areas Enhancement Act has been introduced into Congress and would allow pharmacists to be reimbursed for clinical services. Similar efforts are also being explored within state legislatures.

    Specialty Pharmacy and Accreditation

    The specialty drug market has seen exponential growth, now comprising nearly one-third of the pharmacy industry’s revenue with expected additional growth to upwards of 50% within 2020. [3]Due to the complex conditions these drugs treat as well as their cost, specialty drug manufacturers and payers look to partner with pharmacies that can ensure a patient’s continuity of care with measurable results. The industry standard has become specialty pharmacy accreditation from one or more of three agencies: ACHC, CPPA, and URAC.

    Accreditation demonstrates an elevated degree of competency, focusing on medication adherence and patient outcomes, while also verifying compliance within strict guidelines. While accreditation itself isn’t a regulatory requirement, it may be a contractual requirement for some third-party payers and manufacturers. And along the same line, both accreditation and regulation are focused on compliance.

    With the anticipated growth in the specialty pharmacy sector and its many branches (drug approval and availability, licensure, accreditation, PBMs, etc.), regulations are evolving to meet the demands of the changing landscape.

    Legislative policy changes for provider status and specialty pharmacies are gaining traction, however, the environment remains both complex and nuanced. ScriptPro’s SIA group is adept at recognizing trends that present both challenges and opportunities, and is well positioned to stay ahead of industry and regulatory changes.

    Technology Partner You Can Count On

    ScriptPro understands this changing landscape of health and pharmacy care, and proactively develops solutions that help you stay on top of managing clinical care for your patients and gain healthier outcomes. Our Advanced Pharmacy Clinical Services (APCS) platform uses patient profile and dispensing data to drive workflow, tasks, and treatment documentation for patient case management. Learn more here.

    [1] https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx

    [2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183172

    [3] https://www.specialtypharmacycontinuum.com/Operations-and-Management/Article/06-18/Accreditation-Explosion-Among-Top-SPTrends/48759?sub=B19DFEE12FBA691FE7D24B42CC345FBFC7911C2DBFCD97F452A17216EB59A&enl=true