The State of Play: What Prescribing Trends Say About the Future of Primary Care

Care for Chronic Conditions Is Shifting Beyond Primary Care Physicians

We dug into the prescribing data to learn that pharmacists are caring for patients with chronic conditions more regularly, filling gaps that exist as primary care provider (PCP) shortages worsen, with just one PCP for every 1,500 people in nearly half of the 3,233 U.S. counties, according to our research. 

Since 2019, pharmacists are e-prescribing medications used to treat chronic conditions more than other drug classes. And in 2022, the top three drug classes prescribed by pharmacists included:  

1. Diabetes mellitus agents or medications to treat diabetes 
2. Psychoanaleptics used to treat mental health conditions like depression, anxiety and ADHD 
3. Antithrombotic agents or blood thinning medications 

Overall, e-prescriptions for these conditions increased 3.6% between 2019 and 2022, but e-prescriptions written by primary care physicians actually decreased 3.5% on average each year during this time period. Growth came primarily from non-physicians and physicians outside primary care.   

Pharmacists are indeed stepping up to take on more primary care responsibilities. 

Independent Pharmacies Save the Day 

It’s also important to note that in counties with relative PCP shortages that have a medium or high pharmacy opportunity, the majority, 41.7%, are independent pharmacies compared with 35.4% being chain pharmacies.  

This is a somewhat stark contrast when looking at pharmacies across all counties where 45.9% are chains and 28.5% are independent.  

This is a unique opportunity for independent pharmacies as it suggests they are poised with a greater opportunity to fill gaps in primary care, according to our analysis.  

Practice Outpacing Policy on the National Scale

There’s mounting evidence that clinicians, including 89% of prescribers and 97% of pharmacists, believe it’s important for the healthcare industry to move to a team-based care model. Combined with PCP shortages, the need for pharmacists to be able to practice at the full extent of their education and training far outpaces the incremental and varied policy shifts to date.  

While all 50 states and Washington D.C. have now enabled collaborative practice agreements and six more states now allow pharmacists to prescribe contraceptives, bringing the total to 24 states plus D.C., the specifics of pharmacist prescribing authority can vary wildly by medication type and by state and other challenges persist related to pharmacists being appropriately reimbursed for the care they are providing. According to National Alliance of State Pharmacy Associations (NASPA), 178 bills related to pharmacist scope of practice and payment were introduced in 38 states in 2022.  

“These recent policy updates empower pharmacists to help make routine care more accessible to patients across the country,” said Elise M. Barry, MS, CFRE, President of NASPA. “Pharmacists are equipped with the education and training to provide essential care for patients, and we continue to advocate for policies that reinforce pharmacists’ as patient care team collaborators.” 

These policy changes are essential, yet they tend to trickle in, state-by-state. To truly realize the benefit pharmacists can bring to patient care, as fully empowered care team collaborators, requires a comprehensive policy shift on a national scale.  

Clinicians Look to Technology to Support Care Teams 

• Nearly three-quarters of prescribers and pharmacists agree electronic access to clinical information would be very useful 
• More than two thirds of clinicians agree benefit eligibility information and electronic prior authorization would be very useful 
• Half of prescribers and more than 80% of pharmacists would also find direct, secure messaging between pharmacists and prescribers to be very useful