Q&A: How COVID-19 redefines the role of pharmacy today — and going forward

From managing potential medication shortages to offering COVID-19 testing, pharmacy care services quickly evolved to address the challenges presented by the pandemic. When many providers were closed, pharmacists served as a beacon of care in communities nationwide. What does this mean for employers, employees and their families moving forward?  

In this Q&A, UnitedHealthcare’s Chief Pharmacy Officer, Susan Maddux, discusses:

• The evolving role of pharmacists and pharmacy care services during a pandemic and beyond.
• How pharmacists can play an important role in a care team beyond dispensing and managing medications.
• Ways employers can manage their medication costs, including optimizing their drug coverage options and considering home-infusion for medications that require administration by a health care professional.

Q: What can employers expect in the following months in terms of their employees’ medication needs?

Employers can remind their employees that their pharmacy benefit is helping to provide the access to medication. Adherence shouldn’t be interrupted. Employers may have seen fewer new prescriptions such as those for chronic conditions because employees may have been deferring care, but from our standpoint, we haven’t seen a decrease in utilization of scripts.

Q: What role have pharmacists played in responding to COVID-19?

They’ve been providing care through retail, specialty home delivery and home infusion settings. For example, Optum and other pharmacists were available when many physician offices had to close. They’ve been filling maintenance medications but have also  been addressing questions about drug treatments related to COVID-19.

They’ve addressed spikes in utilization due to the increased attention to hydroxychloroquine. At times, those with chronic conditions were restricted in the amount they could get. Someone with rheumatoid arthritis could only get a 2-week supply when it’s a medication taken chronically. Pharmacists had to assess supply to make sure their patients could to get what they needed.

Q: How is the role of pharmacists expanding, now and moving forward?

Pharmacists were already becoming more involved in care teams before the pandemic. Now, there are opportunities for them to provide more direct patient care and be an integral part of the care team. For example, pharmacists in most states can do COVID-19 testing.

Pharmacists are also integrating with behavioral health more. They’re starting to look at how they can help individuals with medication adherence and screening for depression through pharmacies. For example, Optum Specialty Pharmacy will screen for depression and refer patients with a positive screen based on a validated questionnaire to behavioral health services.

Q: How can pharmacists help patients with adherence and preventing dependency as mental health conditions may worsen?

Pharmacists have a heightened awareness of the risks with medication adherence, especially during times like COVID-19, when access may be a challenge. For example, OptumRx pharmacists were able to identify those who have not gotten medication and do outreach to them. Opioid issues could worsen during times like this pandemic. Monitoring appropriate use of opioids is extremely important and assessing actions to take --- including coordination with physicians and care providers.

Due to this increased potential mental health strain, there has been a rise in prescriptions for sleeping and anxiety medications, which can be addictive. Pharmacists are also looking for various combinations, such as medications to treat opioids and anxiety. These combinations can lead to an increase in adverse events. Pharmacists may recognize potential inappropriate use based on refill patterns for medications as well as duplicate medications. They can educate and refer their patients to resources or services, or suggest referrals through physicians.

Q: How has UnitedHealthcare evaluated access to medications?

We’re continuously evaluating the supply chain and making coverage changes, if necessary. For example, if a prescription drug was excluded, but the alternative covered prescription drug was in short supply, we may provide coverage for the excluded prescription drug. We allowed for early refills of prescriptions to help people shelter in place in early March and we continue to monitor its need. In the beginning of the pandemic, we extended existing prior authorization for medications generally taken on a chronic basis to ease the burden for members and provider networks.

Q: What changes has Optum Home Infusions experienced in response to COVID-19?

We provide a home-infusion option for most medications that require administration by a health care professional. Certain specialty medications may not require an outpatient hospital level of monitoring for their infused or injected medication. During the pandemic, we were able to assist hospitals in moving some of their patients to a home setting, which may have lowered their risk of exposure to COVID-19.

There is opportunity for tremendous savings for employers when employees and their families use home infusions. We feel it’s a better experience, as well. For example, moving the site of care to the home for an employee receiving treatment for an inflammatory condition such as rheumatoid arthritis or Crohn’s disease could mean up to a $21,300 savings opportunity per patient, per year.¹