The economic impact of pharmacist intervention during pandemics

KEYWORDS:

• Health outcomes
• economic benefits
• community pharmacists
• pandemics

1. Introduction

The Coronavirus disease 2019 (COVID-19) pandemic has finally subsided, but not without leaving devastating repercussions for health systems, patients, and economies on a global scale. Not only has this pandemic claimed lives, but its disruption has also wreaked widespread havoc across numerous sectors, with the healthcare industry being one of the most severely impacted [1].

The impact of SARS-CoV-2 on health systems has been profound. Hospitals and healthcare facilities have been overwhelmed by patient influxes, leading to overcrowding and shortages of essential medical supplies and personnel. Regrettably, prioritizing COVID-19 cases has sometimes resulted in the delayed or deferred care of non-communicable diseases or chronic illnesses, further straining healthcare resources [2].

In response to the pandemic’s demands, governments and healthcare providers have endured significant financial strains due to testing, contact tracing, and the establishment of special COVID-19 treatment centers. Additionally, the procurement of Personal Protective Equipment (PPE) such as ventilators has further burdened budgets, compounding the already complex economic challenges posed by the pandemic. Within the US alone, Congress allocated over $178 billion toward response efforts including testing, treatment, and vaccine distribution efforts [3].

Under these trying circumstances, healthcare professionals, particularly pharmacists, have proven indispensable in maintaining individual and community well-being. Pharmacists play an integral role in public health efforts during a pandemic, including administering SARS-CoV-2 testing, immunizations, and providing clinical and preventative services. Beyond traditional medication dispensing, pharmacists extend their expertise by providing self-care recommendations for minor ailments, triage services for conditions requiring further medical attention, and medication-management services for chronic medical conditions [4–6].

The aim of this editorial was to investigate the economic implications of pharmacists’ services during pandemics, contextualizing existing literature in terms of economic benefits.

2. Expert opinion

In this editorial, we aimed to shed light on the economic value that pharmacists add to public health efforts and their ability to bolster healthcare systems during pandemics. Acknowledging their economic benefits should lead to informed policy decisions that harness their full potential during times of crisis. By understanding pharmacists’ contributions, we can better appreciate the role they play in maintaining both individual well-being and resilience against challenges like SARS-CoV-2 and other pandemics.

Pharmacists played an invaluable role in managing the COVID-19 pandemic and maintaining the continuity of healthcare services during this crisis. A key contribution they provided was administering vaccinations against COVID-19, which was crucial for combating the spread of the virus. Additionally, they spearheaded educational campaigns aimed at informing the public about the disease, vaccinations, and preventive measures. Pharmacists also managed minor ailments within communities, thereby alleviating the burden on hospitals during this critical period. They shared crucial knowledge regarding repurposed drugs with other healthcare professionals, thus expanding treatment options and creating more avenues for patient care. Monitoring self-medication among community members and reporting any side effects from either self-medication or vaccination were key roles they fulfilled. They ensured compliance with pandemic-related preventive measures among the general population, thereby helping limit the spread of the virus. Pharmacists were instrumental in developing protocols to manage and contain infection outbreaks, contributing to efforts to control their spread. Their efforts complemented other vital roles they undertook, such as disease prevention, infection control, ensuring an adequate drug supply for patient care needs, and supporting other healthcare professional [7–12].

2.1. Medication management

Value-based healthcare interventions aim to improve outcomes while managing expenses. Pharmacists, with their proficiency in medication management, can facilitate significant drug cost savings, thereby contributing substantially to the reduction of overall healthcare expenditures. Their role in these interventions is twofold. First, they employ their expertise in medication management to realize substantial cost-saving measures for the medications prescribed to their clients. Equipped with the necessary knowledge and tools, pharmacists can select cost-effective medications without compromising patient outcomes. They are capable of identifying less expensive generic drugs that offer equivalent therapeutic effects to their more expensive counterparts. Second, pharmacists optimize economic outcomes by prescribing medicines based on the most current disease management guidelines. These often include cost-effectiveness analyses that recommend treatments that provide superior health outcomes at reduced costs. A study conducted in the United Arab Emirates (UAE) demonstrated that pharmacist interventions on the medication regimen of COVID-19 patients resulted in cost savings. However, the study did not quantify these savings [13].

2.2. Reducing adverse drug events (ADEs)

During the pandemic, patients attempted to manage symptoms at home, and an increase in OTC medication use occurred as patients sought home treatment options. Moreover, new treatments were developed and introduced in addition to increased off-label uses of existing drugs, and therefore, the risks for medication errors and ADRs increased significantly. Community pharmacists provided advice and guidance on the safe and effective use of OTC medications in order to avoid misuse, additional healthcare utilization, and associated costs; one review study concluded that these pharmacies provided ideal settings for safeguarding over-the-counter medication [14]. Furthermore, pharmacists play an essential role in managing complex medication regimens to ensure safe use while monitoring for potential ADRs. For instance, hydroxychloroquine was originally thought to be an effective COVID-19 treatment but posed serious side effects and interactions that necessitated its careful monitoring to avoid harming patients or incurring additional healthcare costs. A US study showcased the financial benefits of pharmacist interventions on ADEs, resulting in a total cost avoidance of $307,210. This was broken down as: $128,283 from drug interactions; $20,727 from unnecessary drug use; $157,993 from ADE management; and $207 from drug allergy management [15].

Pandemics also brought dramatic changes to healthcare delivery, with telehealth and remote consultations becoming the standard mode. However, telehealth presented challenges to medication adherence due to reduced face-to-face interactions and patient support; in response, pharmacists adapted by using virtual platforms for education, counseling, and follow-ups during this difficult period [16]. This was crucial, considering non-adherence costs $100 billion annually in the US alone [17,18].

2.3. Supply chain management

Pharmacists’ roles in supply chain management during crises such as the COVID-19 pandemic can bring significant economic advantages. Earlier research demonstrated that medication shortages cost the U.S. healthcare system around $2.3 billion in 2011 [19]. Prevention of medication shortages via management of medication stock levels and enhancement of medication accessibility and affordability would prevent potential price spikes due to demand peaks. Furthermore, pharmacists work alongside suppliers and manufacturers to maintain adequate stock for effective functioning of the healthcare system. During the pandemic outbreak, they were instrumental in keeping critical supplies like personal protective equipment readily available, thus helping avert disruptions of services with accompanying economic ramifications.

Between January and March 2020, at least 59% of reported drug shortages in Canada were due to manufacturing disruptions from suppliers in China and India. Notably, hydroxychloroquine and salbutamol inhalers had become critical shortages by late March. The situation was exacerbated by increased demand and hoarding, with some individuals pursuing these drugs as potential COVID-19 treatments despite limited scientific evidence. These shortages occasionally resulted in a domino effect, where the unavailability of one drug led to a shortage of its alternative. Amid these challenges, pharmacists played an essential role in managing drug allocations, advising patients, and sourcing alternative treatments [20].

2.4. Vaccine administration and distribution

Community pharmacies are an invaluable asset in expanding health services and increasing patient access to care, such as COVID-19 vaccinations. Pharmacies serve as an alternate entryway into a complex healthcare system and are especially beneficial for people living in hard-to-reach areas, thus reducing healthcare disparities. Additionally, they tend to offer safer immunization options than facilities like hospitals, which may expose individuals to secondary infections more readily.

Participants in the Federal Retail Pharmacy Program in the United States had administered and reported over 304.7 million doses of the COVID-19 vaccine by 7 July 2023 [21]. Improved access to vaccines through community pharmacies has resulted in higher vaccination rates among underserved populations and adults. Pharmacies also possess the necessary personnel for administering vaccines as well as responding directly to basic medical queries, which relieves the physician’s workload.

In the US, distributing influenza vaccines via pharmacies resulted in savings of up to $2.8 billion for third-party payers and $99.8 billion for the broader society [22,23].

2.5. Deprescribing during the pandemic

Inappropriate medication therapy not only imposes a financial burden on patients but also significantly impacts the healthcare system. For example, in Ontario, a retrospective cohort analyses, utilizing administrative clinical databases revealed that about 0.75% of annual emergency department (ED) visits for adults aged 66 and above in Canada were due to adverse drug reactions (ADRs), incurring an estimated annual cost of $35.7 million [24]. Furthermore, 37% of elderly individuals in six Canadian provinces were prescribed potentially inappropriate medications. Notably, women aged 85 and above were the most vulnerable. The primary culprits were benzodiazepines and hypnotics, leading to an expenditure of approximately $419 million in 2013 on such medications outside of hospital settings [25–28].

During a pandemic, the role of pharmacists in deprescribing becomes increasingly critical. While tapering off or discontinuing drugs to manage polypharmacy and enhance patient outcomes is always beneficial, it is particularly crucial during health crises. Pandemics strain healthcare resources and can restrict patients’ access to vital medical care. By refining medication regimens through deprescribing, pharmacists can mitigate risks related to drug interactions, side effects, and hospital readmissions, thus alleviating pressure on healthcare systems and supply chains.

In the future, pharmacists will play key roles in managing future pandemics or outbreaks. Being accessible healthcare providers, they can offer timely updates regarding transmission prevention measures, vaccination strategies, and appropriate treatments during such crises. The pandemic has demonstrated that community pharmacists can assume many new roles, from managing drug supply chains and delivering telepharmacy services to providing ambulatory pharmacy services and participating in research and clinical trials, as well as playing an instrumental role in research/clinical trial collaboration. As healthcare shifts toward proactive prevention and wellness, pharmacists can assume an integral role. Home or community care may increasingly enlist their services. Pharmacists can play a critical role in antimicrobial stewardship by treating patients, advocating for health policies, and monitoring antibiotic use during pandemics. Furthermore, pharmacists have shown great interest in expanding their role in vaccine administration, as seen with their expanded responsibilities during the COVID-19 pandemic vaccination efforts.

3. Conclusion

Despite the limited real-world data on the economic benefits of pharmacist interventions during the pandemic, pharmacists have played an indispensable and pivotal role, offering extended services and taking on broader roles. Their unique position within the healthcare ecosystem allows them to make invaluable contributions to community well-being and social welfare. For instance, many adopted virtual platforms for patient education, counseling, and medication follow-ups, ensuring continuity of care. By expanding their roles to include such patient-centric responsibilities and adopting innovative solutions, pharmacists can maximize their impact during these challenging times.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed receiving a stipend from the American Society of Health System Pharmacists to create an online course on medication history taking. They have also received funding from Synapse Medicine to conduct an investigator-initiated study of the impact of their medication decision support software on inpatient pharmacist recommendations. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.