Prescribing trends hint at world without PCPs

Primary care physicians (PCPs) have long been the backbone of the American healthcare system, but that’s starting to change as it gets more and more difficult to fill critical roles in first-line care.  

Experts predict shortfalls of up to 48,000 PCPs in the next decade as current physicians retire and fewer medical students choose primary care. Already, only a handful of states can boast any counties that have fully acceptable levels of accessible healthcare: the majority of counties in the country at least partially overlap with recognized healthcare professional shortage areas, according to the Rural Health Information Hub. 

As the Baby Boomer generation gets older and chronic diseases become even more prevalent in people of all ages, patients need somewhere to go for their routine care needs.  According to a new report from Surescripts, they’re turning to pharmacists. 

“As gaps in primary care grow wider, pharmacists have become essential care providers –especially for patients with chronic conditions,” said Frank Harvey, Chief Executive Officer for Surescripts.   

Data from the Surescripts network reveals that the number of e-prescriptions issued by pharmacists increased by 47% between 2019 and 2022. Last year, the top three drug classes prescribed by pharmacists included medications for diabetes, treatments for mental health conditions, and blood thinners used to manage certain cardiovascular conditions. 

Electronic prescriptions for therapies related to diabetes, high cholesterol and hypertension increased 3.6% between 2019 and 2022, the report says. However, e-prescriptions for these conditions issued by primary care physicians decreased 3.5% on average each year, indicating that other types of prescribers, including non-primary care physicians and non-physicians outside of primary care, are taking over. 

Additional findings from the data brief include: 

• The number of primary care prescribers (including physicians, nurse practitioners, and physician assistants) increased by an average of just 0.6% per year between 2018 and 2022. Meanwhile, the number of prescribers outside of primary care increased by an average of 12.1% per year over the same time period. 
• The number of pharmacists prescribing on the Surescripts network grew by 122% between 2019 and 2022. 
• Washington State and California account for approximately 60% of e-prescriptions by pharmacists. Since 2017, Washington has required that health insurance plans include pharmacists in their networks, likely contributing to their active role as prescribers. 
• Independent pharmacies remain important lifelines for counties with primary care physician shortages, making up more than 40% of pharmacies in rural areas that lack PCPs but have an adequate number of pharmacy locations. This indicates an opportunity for independent pharmacies to strengthen their financial sustainability and improve access to care for their communities by taking on more primary care tasks. 

The urgency of the primary care shortage is becoming real in a growing number of communities, with nearly 1 in 3 Americans lacking a source of routine primary care, despite most of these patients being insured. As the crisis grows, states are starting to take action with pharmacists in mind. 

All states now allow for collaborative practice agreements (CPAs) that enable PCPs to delegate authority for prescribing tasks to pharmacists such as initiating, modifying, or discontinuing medications. At least one state is taking this idea even further: in Idaho, pharmacists are allowed to prescribe medications autonomously, as long as they adhere to certain state guidelines. A handful of states allow independent prescribing with additional certification or licensure. 

However, the majority of states are more limited in scope, even though the COVID-19 pandemic has clearly illustrated the important role of pharmacists in coping with massive demand for services like vaccines, COVID tests, and antiviral treatments which would have otherwise fallen fully on the shoulders of PCPs.   

Instead, they are taking incremental steps toward leveraging pharmacists more effectively to take some of the burdens away from PCPs. For example, many states now allow pharmacists to independently prescribe potentially time-sensitive products such as birth control, Naloxone, and pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention. 

While pharmacists cannot fully fill the gap created by the enormous shortage of PCPs, they can play a vital part in ensuring that patients have access to chronic disease medications and other necessary therapies when PCPs aren’t available. The healthcare ecosystem should continue to empower pharmacists through policies, technologies, and care strategies that promote integrated care teams and more robust collaboration, the report concluded. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.