Traditional primary care models are struggling
Under intense pressure, the care team is evolving. Health systems are wrestling with staffing crises and shrinking budgets, especially in rural areas. We’re facing an alarming shortage of doctors and nurses, and primary care may be hit particularly hard.
For clinicians who remain, all these issues add fuel to an epidemic of burnout. Meanwhile, an aging population with more chronic conditions needs high-touch care more than ever.
As their essential role in COVID-19 response made clear, pharmacists are well positioned to fill some gaps in care—if they can get the tools, information and support they need.
124,000
physicians may be missing from the U.S. workforce by 2034.1
2 in 3
U.S. health systems operated at less than full capacity in 2022 due to staffing shortages.2
9 in 10
Americans live within 5 miles of a pharmacy.3
Where might pharmacists best fill gaps in primary care?
Surescripts examined the location of primary care providers (PCPs) on our network to better understand where primary care shortages are concentrated. We found that nearly half of all counties in the U.S. have just one PCP for every 1,500 people.
For each U.S. county, we calculated the ratio of the number of pharmacies to the population and divided them into low, medium and high terciles. Based on this analysis, 61% of counties with a relative PCP shortage also have a high or medium number of pharmacies by population—creating a strong opportunity for pharmacists to help close primary care gaps.
A separate analysis found that 41.7% of pharmacy locations in these high- and medium-opportunity counties are independent pharmacies, compared to just 28.5% of pharmacy locations in all counties.
Counties with <1 primary care provider per 1,500 people
- Counties with high/medium opportunity for pharmacists to address shortages
- Clinicians seek more collaboration & new technologies to improve care
Surescripts commissioned a survey of 509 U.S. pharmacists and prescribers—including physicians, physician assistants and nurse practitioners with the authority to prescribe—about the collaboration and tools they will need as care delivery evolves.
Nine in 10 prescribers and virtually all pharmacists we surveyed supported a shift toward team-based care. Both groups ranked better patient outcomes as the top benefit of pharmacists taking on more patient care responsibilities. Most prescribers also felt it was important for pharmacists to be able to provide immunizations, smoking cessation support, point-of-care testing, wellness screenings and medication therapy management, among other preventive healthcare services.
We also asked which tools pharmacists and prescribers would find most useful in patient interactions. Three-quarters of prescribers and 71% of pharmacists said electronic access to clinical information would be very useful. Other tools rated very useful by at least half of each group surveyed include benefit eligibility information, electronic prior authorization and secure prescriber/pharmacist messaging.
How important is it for the industry to move toward team-based care?
Pharmacists are playing a larger role in managing chronic conditions
Analyzing e-prescribing activity over the past several years helps us see how primary care responsibilities are shifting. We assessed e-prescriptions for medications used to treat three common chronic conditions: diabetes, high cholesterol and hypertension. E-prescriptions for medications used to treat these conditions increased 3.6% on average each year from 2019 to 2022, but e-prescriptions written by primary care physicians actually decreased 3.5%.
Mirroring trends in e-prescribers joining the Surescripts network, growth came primarily from non-physicians and physicians outside primary care. During this period, e-prescriptions issued by a pharmacist grew 47%, compared to a 31% increase for all prescriptions.
Many of these prescriptions were for chronic conditions. In 2022, the top three drug classes prescribed by pharmacists were medications to treat diabetes, psychoanaleptics used to treat mental health conditions like depression, anxiety and ADHD, and blood thinning medications.
New e-prescriptions for diabetes, high cholesterol & hypertension medications by prescriber type
Where does legislation empower pharmacists to expand their role in patient care?
The pharmacy practice and payment landscape is evolving to align pharmacists’ scope of practice with their education and training. In most states, at least one patient care service provided by pharmacists is covered. But as essential as these policy changes are for empowering pharmacists as care team collaborators, they tend to be implemented slowly and vary from state to state.
Legislation is pending at the federal level that could accelerate access to care by recognizing pharmacists as providers under Medicare Part B. The Equitable Community Access to Pharmacist Services Act (ECAPS) has been introduced in both the House and the Senate to reimburse pharmacists for testing, treatment and vaccination against viruses including COVID-19 and the flu.
At the state level, pharmacists across the country can provide the opioid overdose antidote, naloxone, administer adult immunizations, and are permitted to enter into collaborative practice agreements (CPAs) with other prescribers to take clinical action, such as adjusting dosages or initiating specific therapies.4 These agreements establish dependent prescriptive authority that can be limited to certain patients or applied broadly to patient populations. Pharmacists are increasingly being empowered to independently prescribe certain medications without a CPA to increase access to care, such as vaccination, reproductive health, and HIV prevention.5
Browse the maps to see how pharmacists’ scope of practice and reimbursement changes state by state.
Note: These maps are not intended to be a comprehensive representation of pharmacy legislation. Policies should be referenced for additional details.
Where can pharmacists prescribe scheduled adult vaccines?
Where can pharmacists prescribe tobacco cessation aids?
Where can pharmacists prescribe hormonal contraceptives?
Where can pharmacists provide pre-exposure (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention?
Where can pharmacists get reimbursed for a broad scope of patient care services?
Keep pace with care team evolution
Congress Eyes Policies to Bolster Pharmacists as Care Providers
Virginia Is for Lovers...and Policies that Enhance Patient Care
ICYMI: 5 Things You Need to Know About Evolving Patient Care Teams
Pharmacy views on expanding access to care
- Association of American Medical Colleges, "The Complexities of Physician Supply and Demand: Projections from 2019 to 2034," June 2021, p. viii.
- Kaufman, Hall & Associates, “2022 State of Healthcare Performance Improvement: Mounting Pressures Pose New Challenges,” October 2022, p. 3.
- “9 out of 10 Americans Live Close to Community Pharmacy,” UPMC.com, July 28, 2022.
- Data supplied by the National Alliance of State Pharmacy Associations and Delaware Senate Bill 165, 84:169 (2023).
- Public Readiness and Emergency Preparedness (PREP) Act, U.S. Department of Health & Human Services, May 2023.