The future hospital pharmacist

It's time for a rebrand, hospital pharmacy directors told Becker's

"CEOs and COOs at systems have noticed that the pharmacist can really wear two coats as a leader," Todd Karpinski, PharmD, chief pharmacy officer at Morgantown, W.Va.-based WVU Health System, said. "They can work closely with clinical staff, physicians and nurses with the white coat, but also certainly understand the business operations and the finances and wear the suit coat."

Recent changes for the traditional hospital pharmacist

Not all hospitals or hospital pharmacists are created the same, but in the past few years, the role of healthcare pharmacy directors and their staff has expanded.

Pharmacists have been administering vaccines for decades, but COVID-19 offered a unique chance for the workforce to interact more directly with curbing the pandemic through administering preventive medicines and COVID-19 vaccine shots, according to Sue Mashni, PharmD, chief pharmacy officer at New York City-based Mount Sinai Health System.  

They have also been authorized to prescribe Paxlovid, Pfizer's popular antiviral treatment — a decision that sparked controversy for going beyond their "scope and training." 

Pharmacist roles have grown even beyond pandemic duties. About 10 to 15 years ago, there wasn't a seat at the executive table for most health system pharmacy leaders, and 20 years ago, most of their staff weren't interacting with patients. Now, they're directly assisting in patient care, in regular meetings with CEOs and talking every day with health IT leaders. 

On the horizon

Gene therapies

After achieving a role at patient bedsides, some pharmacists are eyeing the growing promise of genomic medicines, which directors said could change daily roles in the next five years. 

"In psychiatry, for example, instead of picking a drug, seeing how it works for a couple of weeks and then trying another one and then trying another one, we're going to use your genomic sequence and your particular genetic structure to better predict which drugs work for you," Thomas Johnson, PharmD, vice president of hospital pharmacy and laboratory services at Sioux Falls, S.D.-based Avera Health, said. 

For the next additions to the FDA's list of approved gene therapies — which now sits at 26 — Dr. Johnson said pharmacists are "well positioned" for them because the process of delivering gene therapies has similarities to mainstay dosing techniques. 

The most recent gene therapy to be approved by the FDA was one that targets hemophilia B and will cost $3.5 million — making it the most expensive drug on the U.S. market. 

"Yes, [they] are expensive, but we're seeing significant reductions in A1Cs," Dr. Karpinski said of gene therapies that target diabetes. "We're seeing significant reductions in weight of these patients such that maybe we're delaying diabetic retinopathy, neuropathy or kidney disease by 10, 20 years."

Despite gene therapies and biologics hefting a large price tag, Dr. Karpinski and Dr. Johnson said the drugs could decrease patient spending overall because they could remove the need for other costly treatments and procedures. 

Hospital-at-home ventures

As hospitals and health systems move further into hospital-at-home investments, pharmacy directors are working to ensure their teams aren't lost in the shuffle. 

Neil Gilchrist, PharmD, vice president of pharmacy business operations at Cambridge, Mass.-based Beth Israel Lahey Health, said CMS allowances in its Hospitals Without Walls program has offered room for healthcare pharmacists to grow outside the traditional hospital facility. 

Before this workforce can step into an expanded role, there are a few barriers weighing them down. 

Ongoing issues

A pharmacy technician shortage

Many leaders mentioned the nationwide, yearslong shortage of pharmacy technicians as a main problem. 

Pharmacy technicians work to help with tasks such as filling prescriptions under the supervision of a pharmacist, but multiple hospitals have high turnover rates for the position that normally pays about $17 an hour. Bureau of Labor Statistics data shows the average salary for pharmacy technicians is $36,740. 

Some health systems have created training programs to foster career avenues that begin with pharmacy technician roles and can help the hospital absorb workers who go through the program. 

"I think everyone is struggling with the pharmacy technician workforce," Dr. Gilchrist said. "But if you can meet them while they're trying to make that decision about what they should be doing for a career, we can enroll them throughout the year into [our] 16-week program." 

340B compliance and an opaque revenue cycle

With greater struggles with securing prior authorizations and complying with the 340B program, healthcare pharmacy leaders said they're struggling to understand — and explain to their colleagues in the finance department — the revenue cycle. 

"If anybody tells you that they have pharmacy revenue mastered, they probably have been drinking, because it's so complicated," Dr. Karpinski said. 

Steven Allison, PharmD, vice president of pharmacy at Altamonte Springs, Fla.-based AdventHealth, said the industry often loses perspective of what happens "from a patient-by-patient, drug-by-drug reimbursement perspective" because pharmacy benefit managers and insurers are steering patients to their preferred site of care. 

Another persisting financial issue within pharmacy departments is the lack of federal reimbursement since they aren't listed as providers. 

"Literally every other provider can be reimbursed for [some] types of services, but not pharmacists," Dr. Johnson said. "It adds a layer of bureaucracy and challenge that just doesn't make any sense anymore."

One of the first bills aimed at reimbursing pharmacists' work was introduced in 2001, and "22 years later, we're still talking about this," Dr. Johnson said.

Amid hurdles with insurance companies, "It's horrible right now. I mean, we're all in a world of hurt," Dr. Mashni said. "We want to take good care of people. And the margins are just not sustainable."

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