The ‘perfect storm’ may hit pharmacy

MTM pearls

I have been extremely busy the past couple of months fighting to save my practice. As I have written in past columns, my partners and I have invested heavily in our practice to develop and implement new pharmacy services, including medication therapy management (MTM). As we work toward fair reimbursement for those services and recognition by payers as patient care providers, our dispensing service serves as the foundation of our practice, providing us with the economic support to expand into more innovative patient-centered services. Unfortunately, new reimbursement rates from pharmacy benefit managers are threatening the viability of our practice.

In January, we started noticing that we were paid less than our acquisition cost for an alarming number of prescriptions. Then, our largest insurer reduced our average gross margins by 40% to 50%. This unsustainable reduction is affecting not just our pharmacy, but pharmacies throughout the state. I am concerned that some of these pharmacies are in danger of closing, which will affect access to care for many patients.

As I prepared this column, I came across a commentary published in the Journal of the Twlug by Daniel Brown, PharmD. His writings are consistent with my practice experience and future expectations.1

Key points

  • Pharmacy organizations and experts predicted the need for pharmacists to move from a product to a patient focus, which results in a reduced need for dispensing pharmacists but an increased need for pharmacists providing patient care services, including MTM.
  • Pharmacists providing patient care services may require postgraduate training and/or board certification.
  • The practice model for community pharmacy does not seem to be changing as fast as predicted, but community pharmacists are seen as the face of pharmacy by many patients. Pharmacists can and should integrate patient care services, but their clinical skills and professional services have not been recognized through reimbursement.
  • The professional fee for community pharmacists has been reduced to the point where services and staffing may have to be cut to maintain the economic viability of a practice.
  • Community pharmacists need a new model for reimbursement to recognize the professional services they provide for patients during dispensing, including MTM.

MTM pearls

Colleges of pharmacy recently expanded to meet the predicted increase in pharmacists needed to provide patient care services. Now, we are in a predicament where the number of pharmacists graduating may exceed what the market demands. Our profession is still fighting to gain provider status, but dispensing fees are often insufficient to pay for product, let alone professional services. This situation may lead to what Brown described as the “perfect storm”—an oversupply of pharmacists coinciding with decreased demand. This situation would affect all pharmacists, regardless of practice setting.

When I say there is no tomorrow, there is true urgency in the statement. Change has to happen now, and it needs to be professionwide. As practitioners, we need to work harder to convince patients and payers of our value. Educate them about what you do to ensure that patients achieve their therapeutic goals through medication counseling and management. Discuss your clinical activities, interventions, and collaborations with other providers. Document your patient care activities so that you have proof of what you do. Integrate patient care activities into your daily practice, and follow through with targeted and comprehensive MTM interventions.

Pharmacy organizations need to help create different reimbursement models that pay pharmacists fairly for patient care activities. Reimbursement needs to go beyond our current model, in which pharmacists are paid primarily for select Medicare Part D patients, to include patient care services integrated with dispensing services.

Schools of pharmacy need to prepare students for the changing health care system, in which practitioners will be evaluated based on patient outcomes rather than dispensation. Students must know how to assess patients, implement clinical interventions, and document their activities effectively and efficiently.

Pharmacy has come a long way since the pharmaceutical care movement of the 1990s, but we need to step up our efforts. Our future depends on it.


  1. Brown, D. The paradox of pharmacy: a profession’s house divided. J Am Pharm Assoc. 2012;52:e139–43.