Daniel Nam on Post–COVID-19 Implications for Managed Care Pharmacy

In assessing a post–coronavirus disease 2019 (COVID-19) world, several aspects may impact managed care pharmacy practices long-term, including self-administration of therapies and issues in pharmacy reimbursement spotlighted by the pandemic.

In assessing a post–coronavirus disease 2019 (COVID-19) world, several aspects may impact managed care pharmacy practices long-term, including the emergence of telehealth, self-administration of therapies, and issues in pharmacy reimbursement spotlighted by the pandemic, said Daniel J. Nam, RPh, ESq, associate principal of Pharmacy Policy at Avalere Health.


For this year's virtual AMCP Nexus 2020, a panel will discuss post–COVID-19 implications for managed care pharmacy practices. Can you speak on how the pandemic has impacted pharmacy practices at the state level and nationally?

So, I think if you look at both the state and federal level impacts, there are maybe 3 or 4 layers that are important. One are the PREP Act expansions that the federal government have enacted in place over the last few months. The second is the impact on utilization, particularly pharmacy utilization and physician in-office utilization impacts during the COVID-19 period where it peaked off, perhaps a few months ago, and it's bounced back to some extent in some places over the last few months and weeks.

A third area, I think, that there has been an impact on has been the new look at telehealth from a policy, from a provider, from reimbursement perspective, and perhaps having some impact on pharmacy services down the line. Lastly, I guess one thing that it is a little bit of an inverse to your question is an area that hasn't changed really that much is pharmacy reimbursement. That's something that we've seen being done in pretty much the same ways as before the pandemic hit.

In assessing reform to pharmacy practice amid the pandemic, whether temporary or permanent, what have been some welcome adjustments and what challenges need to be further addressed?

One thing that we saw as being very bold and a very dynamic move forward is the PREP Act declarations that pharmacists are able to provide certain types of vaccinations to certain types of groups that previously wasn't allowed in a lot of states. So, that's definitely something that is temporary. Whether it's permanent or not, we will be assessing ways that H1N1 [influenza virus] has impacted the scope of practice in the past and perhaps ways that COVID-19 could do the same to pharmacy practices.

Another aspect here is state dynamics. The PREP Act declarations are on a federal level. State level responses have been generally positive, but given that scope of practice lies squarely within the states, they haven't quite been moving in step with either each other or with the federal government, leading to issues between the federal and state government in the future. So, that's definitely something to look out for, and like I mentioned before, I think reimbursement still remains a challenge to pharmacists during the pandemic and even perhaps after the pandemic, unless some significant policy changes are enacted.

Looking at a post–COVID-19 world, what are the most significant clinical trends in formulary and drug utilization management that pharmacists should expect to influence managed care pharmacy in the next year and beyond?

What we've seen is that in-person care may not necessarily be the only way to receive care, and this applies for telehealth, but also for things like in-office utilization. We think that because of the pandemic, there might be more of a shift in putting more emphasis on self administration rather than in-office home infusion. Even if an infusion needs to take place, perhaps moving forward there might be more emphasis on home infusion rather than in-office infusions. I can see managed care pharmacy shifting and really focusing on areas that they previously were not thinking about as a result.

Concluding thoughts?

So, a concluding thought is that during our talk, we're really going to be talking through the implications of COVID-19 directly to the pharmacy world, but also writ large to other parts of health care. I think it's important to keep in mind the question of whether these temporary changes will translate well or easily to permanent changes, and what that post–COVID-19 world may look like. We'll go into some potential examples, but I think this is an important discussion to have and the right time to have it.

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