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Tuesday, May 21, 2024

Pharmacies Stepped Up During Covid—and Changed for Good

With 19 locations throughout the Milwaukee area, Hayat Pharmacy focuses on providing quality health care to the underserved. To Hashim Zaibak, pharmacist and owner, quality health care isn’t about dispensing medications; it’s about removing barriers that influence his community’s health. The pharmacists and pharmacy technicians of Hayat, an Arabic word that means “life,” visit patients in their homes, and the team collectively speaks over 20 different languages and dialects. During these visits, which Zaibak calls “Medication Therapy Management,” or MTM, pharmacists educate patients about their medical conditions, provide alternative methods for health management, administer antipsychotic medications, and ensure that patients take medications as prescribed.

It’s a more involved version of care than you might expect from a community pharmacy, a category that encompasses everything from chains like CVS and Walgreens to grocery stores like Kroger to mass merchandisers like Walmart to the independently owned small business down the street. But while the perception of pharmacies as a commodity—and pharmacists as shufflers of pills from the big bottle to the little bottle—has for decades remained largely unchanged, the landscape has changed in recent years, particularly in the wake of Covid-19.


Today’s community pharmacists administer vaccines, manage chronic disease, supply birth control, optimize medication regimens, and in some cases assess genetic markers for personalized medicine, to name just a few services. Unfortunately, the availability of those offerings differs from state to state, and between types of community pharmacies. Professionally, community pharmacies have spent decades advocating for enhanced services, often through legislative initiatives for pharmacists to be identified, legally, as health care providers, as well as for the role of the pharmacy technician to expand.

The Covid-19 pandemic and subsequent federal actions, like the PREP Act, flipped a switch for pharmacy practice legislatively. Practically overnight, pharmacy technicians, under the supervision of a qualified pharmacist and with appropriate training, were authorized to administer vaccines to children and Covid-19 vaccines for any eligible patient over the age of 3 in October 2020. The PREP Act continues to change practice; an August 2021 amendment expanded the authorization for pharmacy technicians to administer the influenza vaccine to any patient regardless of age, similar to Covid-19 vaccines. Legislators saw community pharmacies as a way to fill increasing health care gaps. The pandemic closed many health care practices and opened doors for pharmacies to step in.

Hayat Pharmacy is one among many providers that are using that expanded authorization to better serve their communities. In May 2020, it implemented a new clinical service: testing services—specifically, Covid-19 screenings. Zaibak personally conducted the screenings to demonstrate to staff and patients the importance of this work. During the initial interview for this piece, Zaibak was pulled away to deal with testing patients, now for the Delta variant.

When the vaccine became available, Hayat Pharmacy stepped up. It has an electronic signup system, but the communities Hayat serves have low technology adoption, so most of those early vaccinations went to eligible walk-in patients. Hayat Pharmacy emphasizes care for the elderly, sick, and underserved, and it has administered over 50,000 immunizations to Milwaukee residents. Once adolescent vaccines were authorized, the first dose administered in the pharmacy was by Zaibak to his son.

Just as the community pharmacy’s role has evolved, so too has its financial model. Dispensing drugs is increasingly a loss leader for pharmacies; in some states, the responsibility of dispensing medications has shifted to pharmacy technicians, though still under the direct supervision and oversight of a pharmacist. Community pharmacists are arguably overtrained to only dispense medications; the entry-level degree is a doctorate. Automation and technology help patients get medication, while pharmacists like Zaibak are well positioned to ensure patients know what to do with it.

Optimizing medications—ensuring the appropriate dose is dispensed, monitoring adverse drug reactions to mitigate harm, and recommending specific therapy—are how a pharmacist can improve the quality and care for patients. It can also lead to indirect savings for health care expenditure. Expenses stemming from morbidity and mortality tied to non-optimized medication therapy totaled an estimated $528.4 billion in the US in 2016. The long-term-care admissions, hospitalizations, and other negative outcomes associated with wrong dosing, gaps in care, and so on cost more than prescription medications themselves. Paying for how to use medication, like what Zaibak’s team does during home visits, may be more important than paying for the medication itself, and it creates a different financial model outside of dispensing drugs.

A project in Asheville, North Carolina, demonstrates the potential of pharmacist-led medication optimization. A network of pharmacies partnered with the city to provide medication optimization services to employees. The pharmacists met with the workers to set and monitor treatment goals, provide education, perform physical assessments, and evaluate clinical laboratory data to adjust medication therapy. This intervention resulted in improved health outcomes, decreased employer medical costs by $1,200 to $1,872 per patient per year, and decreased days of sick time in the group of employees that engaged with the pharmacists compared to the baseline. The so-called Asheville Project emphasizes the evolving role of the community pharmacy. That transformation of community practice isn’t the future—the project began in 1997.

Community pharmacies everywhere are past due for an Asheville Project-like transformation. The PREP Act and other legislative steps have helped spur that change in important ways; pharmacies, overnight, were able to screen for Covid-19 infections. Patients of all ages received immunizations at pharmacies. Hayat Pharmacy continues to remove barriers to care in its community and pave the way for a new model of community pharmacy. However, the Covid-19 pandemic showed that Hayat Pharmacy isn’t the exception. It’s the new normal.

The WIRED Resilience Residency is made possible by Microsoft. WIRED content is editorially independent and produced by our journalists. Learn more about this program.

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