Barriers Impede Pharmacies’ Full Potential as Champions of Public Health Care – Drug Topics

Report on the Role of Pharmacy-Based Care in Achieving Sustainable Development Goals

A recent report by the Milken Institute, titled “Advancing Health Through Expanded Access to Pharmacy-Based Care,” outlines significant infrastructure and policy barriers that prevent pharmacies from fully contributing to public health in the United States. This analysis reframes the report’s findings through the lens of the United Nations Sustainable Development Goals (SDGs), highlighting how empowering pharmacies can directly advance global health and equality targets.

Aligning Pharmacy Expansion with SDG 3: Good Health and Well-being

The core of the report focuses on leveraging pharmacies to achieve universal health coverage (Target 3.8) and address critical health challenges, thereby supporting SDG 3.

Addressing Gaps in Universal Health Coverage

Pharmacists are positioned to mitigate the escalating shortage of primary care physicians, which is a major impediment to achieving universal health access. The report notes that with an anticipated shortage of over 87,000 primary care physicians by 2037, pharmacies represent an accessible and effective point of care to serve millions in health professional shortage areas.

Key Service Areas for Health Improvement

The Milken Institute identified 13 core areas where pharmacists can significantly improve patient outcomes and contribute to public health objectives:

• Chronic disease screening
• Adherence and medication therapy management
• Heart health (Target 3.4)
• Diabetes management (Target 3.4)
• Respiratory conditions
• Immunizations (Target 3.8)
• Test-and-treat for routine illnesses
• Health-related social needs
• Reproductive health (Target 3.7)
• Sexual health, including HIV testing (Target 3.3)
• Mental health (Target 3.4)
• Behavioral health

Systemic Barriers to Progress on Health and Equality Goals

Persistent challenges in regulation, payment, and infrastructure prevent the full integration of pharmacies into the healthcare system, undermining progress towards SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Financial and Regulatory Obstacles

The primary challenge is the lack of sustainable payment models. A 2022 survey indicated that while 81% of pharmacists wish to expand their services, nearly 85% receive partial or no payment for them. This disparity in reimbursement compared to other health providers creates an unsustainable economic model and limits the expansion of services that support community health.

Infrastructure Deficiencies

Significant infrastructure barriers impede the efficient delivery of care and contribute to systemic inefficiencies. Key issues identified include:

1. Lack of Standardized Credentialing: The absence of a uniform credentialing process for pharmacists across health plans creates administrative burdens and delays integration into care networks.
2. Billing and Documentation Integration: Current systems are often not equipped to handle billing for clinical services provided by pharmacists, cutting them out of essential healthcare conversations and reimbursement pathways.

A Strategic Roadmap for Sustainable Integration and Partnership

The report provides a clear, actionable roadmap for stakeholders to create a sustainable framework for pharmacy-administered services, directly supporting SDG 17 (Partnerships for the Goals).

Policy Areas of Focus

Researchers identified four distinct policy categories requiring government intervention and multi-stakeholder collaboration:

1. Scope of Practice: State regulations must be updated to reflect the full clinical capabilities of highly trained pharmacists.
2. Payment Pathways: Sustainable payment models must be established to ensure pharmacists are compensated for the clinical services they provide.
3. Operational Efficiencies: Policies should support technological integration and streamlined workflows to free up pharmacists’ time for direct patient care.
4. Pharmacy Team Optimization: Regulations governing the roles and ratios of pharmacy technicians must be modernized to enhance the overall capacity of the pharmacy to deliver health services.

Conclusion: Harnessing Pharmacies for the SDGs

The expansion of pharmacy-based health services requires a coordinated effort to align regulatory frameworks, create sustainable reimbursement mechanisms, and invest in infrastructure. By harnessing pharmacies as trusted and accessible health access points, stakeholders can create a more effective and equitable healthcare system, making significant strides toward achieving SDG 3, SDG 10, and SDG 17.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s central theme is improving public health by expanding the role of pharmacies. It directly discusses providing services for chronic diseases, mental and behavioral health, and reproductive and sexual health, all of which are core components of ensuring healthy lives and promoting well-being. The text emphasizes making healthcare more accessible and affordable to improve community health outcomes.
2. SDG 8: Decent Work and Economic Growth
   • The article addresses the economic sustainability of the pharmacy profession. It highlights the significant challenges pharmacists face in receiving payment for their clinical services, which affects their financial viability and professional growth. The call for sustainable payment models and fair reimbursement is directly linked to ensuring decent work and economic stability for the pharmacy workforce.
3. SDG 10: Reduced Inequalities
   • The article points out that pharmacies can serve as “equitable provider[s]” and are often the “face of neighborhood health care.” By expanding their services, pharmacies can help bridge gaps in healthcare access, particularly in “health professional shortage areas,” thereby reducing health inequalities for nearly 74 million patients in underserved communities.
4. SDG 17: Partnerships for the Goals
   • The article repeatedly stresses the need for collaboration among various stakeholders. The Milken Institute report itself is a product of discussions with “various leaders across health care,” and its recommendations call for “coordinated efforts” and partnerships between lawmakers, health plans, and pharmacy organizations to align regulations, create sustainable reimbursement, and invest in infrastructure.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.4: Reduce premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article identifies pharmacists’ ability to improve patient outcomes in areas like “chronic disease screening,” “heart health, diabetes,” “mental health, and behavioral health.”
   • Target 3.7: Ensure universal access to sexual and reproductive health-care services. The article explicitly lists “reproductive health” and “sexual health,” including “hormonal contraceptives” and “HIV testing,” as core areas where pharmacists can expand services.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services. The entire article is about expanding access to “accessible, affordable, and valuable care” through pharmacies to address the shortage of primary care physicians and serve millions in shortage areas.
   • Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce. The article addresses the need to overcome financial and regulatory barriers to better utilize the highly trained pharmacist workforce, thereby strengthening the overall health system.
2. Under SDG 8: Decent Work and Economic Growth
   • Target 8.5: Achieve full and productive employment and decent work for all… and equal pay for work of equal value. The article highlights a major disparity where “nearly 85% [of pharmacists] said they receive only partial or no payment for additional services,” unlike other providers such as physician associates and nurses. The call for “appropriate reimbursement” directly relates to achieving equal pay for work of equal value.
3. Under SDG 10: Reduced Inequalities
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices. The article calls for changing state regulations (“scope of practice”) and reimbursement policies that are identified as “significant regulatory and reimbursement barriers” preventing pharmacists from providing care, which disproportionately affects underserved communities.
4. Under SDG 17: Partnerships for the Goals
   • Target 17.14: Enhance policy coherence for sustainable development. The article concludes that success requires efforts to “align regulatory frameworks, create sustainable reimbursement mechanisms, and invest in infrastructure,” which is a call for policy coherence.
   • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The article advocates for a collaborative approach, stating that “all necessary partners in the health care sector” must help break down barriers and that “stakeholders can create a more effective health care system” by working together.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For SDG 3 (Good Health and Well-being)
   • Number of health professional shortage areas and affected population: The article explicitly states there are “7488 health professional shortage areas for primary care in the US, accounting for nearly 74 million patients.” A reduction in these numbers would be a direct indicator of improved access to care.
   • Projected shortage of primary care physicians: The article mentions an estimated shortage of “over 87,000 primary care physicians” by 2037. Measuring the mitigation of this gap through expanded pharmacy services would indicate progress.
   • Rate of preventable hospital visits: The article implies that pharmacists can help manage chronic disease and prevent hospital visits. Tracking this rate in communities with expanded pharmacy services would be a relevant indicator.
2. For SDG 8 (Decent Work and Economic Growth)
   • Percentage of pharmacists receiving payment for clinical services: The article cites a survey where “nearly 85% said they receive only partial or no payment for additional services.” An increase in the percentage of pharmacists who are fully reimbursed would be a key indicator of progress toward fair payment.
3. For SDG 10 (Reduced Inequalities)
   • Number of states expanding pharmacists’ scope of practice: The article notes that “many states have expanded pharmacists’ scope of practice,” but barriers persist. Tracking legislative changes that expand this scope would measure progress in removing policy barriers.
4. For SDG 17 (Partnerships for the Goals)
   • Standardization of credentialing and billing processes: The article identifies the lack of “standardization for what the expectation is for pharmacist credentialing” as a major barrier. The establishment of standardized, integrated systems across health plans would serve as an indicator of effective partnership and policy coherence.

4. Summary Table of SDGs, Targets, and Indicators

Source: drugtopics.com