A few weeks have passed since the end of 2020, and what a year it was. What occurred last year will forever reshape healthcare, and in turn, medication management. Here are some of the most significant developments from 2020 that affected medication management.
Declaration of the COVID-19 pandemic
On Jan. 21, 2020, the Centers for Disease Control and Prevention (CDC) confirmed the first case of the 2019 novel coronavirus in the United States. Ten days later, the World Health Organization (WHO) declared a public health emergency (PHE) for the sixth time. On February 3, the United States declared a PHE. The following month, WHO declared COVID-19 a pandemic and then, just days later, COVID-19 was declared a national emergency in the United States. By mid-December, the country hit 300,000 deaths from the coronavirus, with deaths and cases soaring through year's end and into 2021.
Not surprisingly, most of the remaining developments highlighted in this list concern COVID-19 in some fashion. And while the pandemic has inflicted tragic suffering and loss, there are opportunities for some good to come out of something so bad. As a New England Journal of Medicine article concludes, "We may now have the opportunity to reform a flawed healthcare system that made the novel coronavirus far more damaging in the United States than it had to be." If we can, then that will be one of the most significant silver linings of 2020.
Development of COVID-19 vaccines
It seems appropriate that the next development discussed concerns what will essentially lead us to the end of the pandemic. As BioSpace reports, the fastest that a vaccine had ever been developed was the mumps vaccine in 1967. It took four years. On Dec. 11, 2020 — about one year after a cluster of pneumonia of unknown origin was identified in Wuhan, China — the U.S. Food and Drug Administration (FDA) issued the first emergency use authorization (EUA) to the Pfizer/BioNTech COVID-19 vaccine. Three days later, Sandra Lindsay, a nurse and director of patient services in the Long Island Jewish Medical Center's intensive care unit, was the first American to receive the coronavirus vaccine outside a clinical trial. Days later, the FDA issued its second EUA to the Moderna COVID-19 vaccine.
Distribution and administration of the vaccine will be one of the most significant, ongoing events through much of 2021. It will also likely serve to further elevate the role of pharmacists in our healthcare delivery system (an important development that will be discussed further below). As a WBUR report referencing comments from Michael Hogue, president of the American Pharmacists Association notes, "Pharmacists will … give the coronavirus vaccine to the general public once it's more widely available, making them a central part of the vaccine rollout."
Greater awareness of racial and ethnic disparities
The pandemic has served to further shine the spotlight on one of the most consequential challenges facing our healthcare system: racial and ethnic health disparities and bias. This extends to medication access and adherence, as numerous reports note. Among the challenges identified:
- "Data from an observational study of outcomes for patients with cancer who were also diagnosed with [COVID‐19] indicate a racial disparity in gaining access to the drug remdesivir as well as increased mortality associated with the steroid dexamethasone." (Cancer)
- "… the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are over-represented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites." (Journal of Managed Care + Specialty Pharmacy)
- "People of color are far more likely to worry about their ability to pay for healthcare if diagnosed with COVID-19 than their White counterparts…" (West Health Institute and Gallup survey)
- "Black Americans were more likely than white people to cite specific negative encounters with the healthcare system, including feeling that providers didn't believe they were telling the truth, being refused a treatment or test they thought was necessary, and being denied pain medication." (National Geographic coverage of poll by The Undefeated and the Kaiser Family Foundation)
Greater awareness of these and other racial and ethnic challenges is prompting industry leaders to push for change. The American College of Physicians recently published a position paper where it proposed a comprehensive policy framework to understand and address disparities and discrimination in healthcare. Utah's four major healthcare systems declared racism a public health crisis. Politico reports that President-elect Joe Biden's decision to select Yale researcher Dr. Marcella Nunez-Smith, an expert on healthcare inequality, to help lead the transition's coronavirus advisory board, "… puts the fight against the virus in devastated Black, Latino, and Native American communities smack in the center of his pandemic response."
Finally, our CEO, Richard Resnick, recently stated that addressing inequality in healthcare is "… the cause of our time." Resnick, who acknowledges that there's bias in the prescription and medication data Cureatr collects, said, "If we don't solve the problem of the lack of equity in healthcare, then we are not doing our jobs."
Rise of telehealth and telepharmacy
More than 3,000%. That's the increase in telehealth claim lines (i.e., individual services or procedures listed on insurance claims) nationally from October 2019 to October 2020. Medical claim lines rose from about 0.2% in October 2019 to more than 5.6% in October 2020, according to the most recent FAIR Health data.
On March 17, CMS announced it was temporarily expanding use of telehealth. Two days later, California was the first state to issue a statewide stay-at-home order. The stay-at-home and shelter-in-place orders forced healthcare providers to quickly turn to the largely untapped concept of telehealth and virtual care to deliver critical and timely health and wellness services that did not require an in-person visit.
The October data show that even when orders were lifted, the ongoing threat presented by the novel coronavirus and risks of exposure to it — which are heightened for large portions of the population — prompted the continued use and reliance upon telehealth. As HHS Secretary Alex Azar stated, "The meteoric rise of telehealth during the pandemic has not only helped us combat the virus, but also prompted a new conversation around the future of patient-centered care."
Telepharmacy, like other telehealth disciplines, has received significantly increased attention. It now appears poised to remain a viable method of delivering services, including medication management, and expanding access to pharmacy operations and services. The concept of telepharmacy dates back about 20 years, and the benefits of the virtual service have been understood for quite some time. But it took a public health crisis to dramatically move the needle.
In December, a number of permanent expansions to the telehealth services Medicare covers were finalized. Hopefully, we will continue to see support grow going forward.
Expanded role of pharmacists
As previously noted, 2020 was a big year for pharmacists — and this extends beyond vaccine distribution. As we previously highlighted, pharmacists' roles have expanded since the beginning of the pandemic in ways that now include the ability to order and administer COVID-19 tests and pediatric vaccines. Pharmacists, we wrote, have also been performing critical tasks during the public health emergency, such as setting up mobile testing sites, providing curbside delivery, continuing to care for patients with chronic diseases, and providing pharmaceutical care to COVID-19 patients.
The greater recognition of the role pharmacists can play in providing direct patient care is prompting the likes of Rite Aid to recently announce it was increasing pharmacist visibility within the center of the pharmacy. NBC News recently reported on states calling on pharmacies and their pharmacists to play a more vital role in initial COVID-19 vaccinations.
Cureatr's Resnick sung the praises of pharmacists in a recent blog when he stated, "I have personally developed an even larger respect for the pharmacy industry and license. Historically, pharmacists know so much and have been asked to do so little. COVID provided an opportunity for pharmacists to become more active members of patient care teams and use their expertise to do so much more for patients."
He specifically acknowledged the essential role of telepharmacists: "… over the course of , the other thing… we saw was this increasing dependence on using pharmacists in the telepharmacy realm to keep patients out of hospitals, which should continue to be a primary objective for as long as we are in this pandemic and should become a more significant after it."
We hope that the attention being paid to pharmacists and the contributions they are making and could make to our healthcare delivery system will ultimately lead to their being granted national provider status.
Worsening drug shortage
Drug shortages were already a public health concern prior to the pandemic. COVID-19 further exacerbated these shortages and revealed the vulnerabilities of the U.S. drug supply chain.
As of this writing, there are more than 200 current drug shortages, according to the American Society of Health-System Pharmacists. An October 2020 report from the Center for Infectious Disease Research and Policy (CIDRAP) noted there were growing shortages for COVID-19-related drugs, with 29 out of the 40 COVID-19 treatment drugs and 67 of the 156 critical acute drugs in shortage status. CIDRAP also noted that drug production was further compromised due to overseas manufacturing shutdowns.
CIDRAP is just one of many organizations calling for the implementation of solutions that can help address the lingering challenge of drug shortages, which often lead to delays in care, cancellations of care, rationing suppliers, or complex workarounds that can increase safety risk. As long as shortages remain, medication management will be more complicated.
Numerous other noteworthy developments
Before we conclude with a final development, it's worth noting that this piece is not meant to be an all-encompassing list. We will undoubtedly spend the next several years working to understand and fully appreciate how the events of 2020 — and the carryover effects of the pandemic into 2021 — affected our healthcare system and, more narrowly, medication management. Just a few of the other noteworthy medication management developments from 2020 include:
- Substantial disruption to prescription drug use caused by stay-at-home orders, reduced visits to practices and pharmacies, increased financial stress due to job and health insurance loss, and other challenges
- Closing of small primary care practices and independent pharmacies, often in rural areas
- Continuing movement toward mail delivery of medications and the impact of delivery delays
- Increasing usage of medications for mental health
Companies stepped up to help
We want to end this roundup about a year with many more negatives than positives with an encouraging development. Many healthcare companies looked at the challenges facing our country during the pandemic and stepped up to try and help through a wide range of initiatives. The list of companies that did so is too long to list. Examples of ways companies help included providing solutions and services for free, hosting complimentary webinars on timely safety and financial issues, and donating supplies to healthcare workers and providers.
At Cureatr, we tried to do our part to make even a small difference. In March, we announced that we were offering free, open-access to Meds 360°, our medication management software, to healthcare providers on the front lines. A bit later in the year, we asked pharmacists to volunteer their time to talk mainly to Medicare and elderly patients about medication adherence and management, using our software to help guide discussions. More than 2,000 pharmacists volunteered.
As our CEO stated, "From the Cureatr and Richard Resnick perspective, being a small part of the effort to help people get through this pandemic is probably the most meaningful professional experience of my life. I know that colleagues here at Cureatr feel the same way."