makers recognized the opportunity to use pharmacists as a frontline delivery mechanism for vaccines. This changed how the public saw pharmacists; they were no longer the “mystical figures behind the tall counter” but instead were out front delivering care and touching patients. In 2013, California passed Senate Bill 493 authorizing pharmacists to prescribe several different categories of medications, including hormonal contraceptives, nicotine replacement products, and travel medications. Under this legislation, pharmacists can order and interpret tests independently, initiate and administer routine vaccines, and administer prescribed drugs and biologic products. The bill also created the Advanced Pharmacy Practice Model, giving pharmacists collaborative practice authority. California was not the first state to allow pharmacists to prescribe medications, but because of its size, said Weaver, Senate Bill 493 brought a lot of attention to the concept of pharmacists as a prescriber. This was a watershed moment that led to major innovations and extremely rapid adoption of prescriptive authority; for example, authority to prescribe naloxone shifted from a few states to all states within 5 years.

Practice transformation did not come without challenges. First, said Weaver, was pushback from inside the profession; frontline pharmacists felt that “enough is enough already.” Pharmacy Benefit Manager (PBM) practices put stress on the traditional dispensing business model and resulted in added pressures on pharmacists, employers, and independent owners to increase the volume of medications dispensed per hour. On top of this, pharmacists were now expected to provide MTM services and deliver immunizations. Adding prescribing meant that day-to-day operations were “getting to be impossible to execute.” Weaver recalled that in conversations with state pharmacy association members, she shared the “great news” of where the profession was headed but received negative feedback from frontline pharmacists experiencing serious challenges in their day-to-day operations. The second challenge, she said, was drawing more attention from outside of pharmacy, especially from organized medicine. The more successful pharmacy was in the states, the more the American Medical Association increased its focus on opposing the advancement of the scope of practice. Weaver noted that despite the opposition of organized medicine, frontline physicians often are very supportive of pharmacists and other nonphysicians providing services that align with their education and training; in fact, some physician allies have been instrumental in advocating for legislation that expands pharmacist scope of practice.

In 2015, Washington State passed the first payment parity law that required commercial payers to include pharmacists in their network of providers and cover services within the scope of practice if they were covered for any other health care provider. Over the last 10 years, more states have passed similar legislation, transforming pharmacy practice but increasing

the workload. Soon after the payment parity law was passed, the Washington State Pharmacy Association launched an implementation effort and uncovered the extreme complexities that the pharmacy profession would face in the implementation of medical billing models, said Weaver.

The COVID-19 pandemic greatly increased the public’s awareness of pharmacists and their role within patient care delivery. As Trygstad noted, it helped to push forward the logistical solutions to patient care delivery (e.g., scheduling appointments). However, despite these advances over the last 20 years, said Weaver, patients in most areas do not have access to pharmacist patient care services, job satisfaction is low, and the business model is floundering. Pharmacists are struggling with many challenges, including PBM practices, payment models, workforce burnout, pharmacy closures, and pharmacy school enrollment decline.

The profession is at a tipping point, said Weaver, in which community pharmacy can be transformed from a focus on dispensing to patient care delivery, while preventing burnout. To achieve this, two domains would benefit from action: policy and implementation. On the policy side, state pharmacy associations are advocating for solutions on both the national and state levels. Weaver said that despite their small staff, state pharmacy associations carry an outsized level of influence in state governments; legislators see them as representatives of the entire profession and look to them for expertise and feedback on proposed policies. In states with a single, united pharmacy association, their influence and strength are even greater. The profession can help advance reforms by promoting its work as a valued asset to patients and supporting state pharmacy associations, which are “laser focused” on introducing and advancing innovative approaches to challenges, including PBM reform, payment for pharmacist services, and scope of practice. These policy changes can be fiercely opposed; for example, scope of practice changes are very hard fought and often include compromises that get pharmacy only partway to the goal.

One trend in state policy, said Weaver, is adopting a standard-of-care model. She said that “standard of care” is a loaded phrase that carries several meanings. The first relates to discipline. She explained that a court will look at regulations, practice guidelines, and other literature to determine what a reasonably prudent professional would have done under similar circumstances; if a defendant’s conduct falls short of that, they could be found liable for breaching the standard of care. Regulatory boards can also use this model to discipline those who overstep in care delivery. Weaver offered two reasons the profession should adopt this model. First, it is what other health care providers use; if pharmacists want to be treated like those providers, they would need to operate on the same terms. Second, for advocacy efforts, having a model similar to that of other providers weakens the arguments against giving pharmacists full practice authority.

obstacle, said Weaver, is the operational challenge of integrating services into the workflow. To provide care at the point of dispensing, the patient’s individual insurance would have to cover pharmacist services, and that particular pharmacist would have to be enrolled and credentialed in that particular health plan. The logistical challenges multiply when scaling up from this relatively simple scenario, said Weaver:

• How can a pharmacy plan staffing in a way that allows for both dispensing and patient care delivery, if there aren’t yet enough covered patient encounters to support additional staff devoted to patient care services?
• Do the billing systems integrate with the pharmacy workflow in a way that allows pharmacists to easily transition between tasks?
• How can pharmacy technicians be used to support the patient care delivery process, and are the correct laws in place that allow them to do so?
• Do pharmacists have the information technology systems to access and contribute to patient care data and adequately coordinate within the health care team?

Weaver noted that the implementation process also requires state-specific problem solving; the situation will be different in each state with different private plans and different Medicaid plans and managed care organizations. She highlighted that state pharmacy associations could benefit greatly if others joined to support their advocacy work to alleviate these challenges and make the envisioned future attainable. The journey to this point has been long, said Weaver, but if pharmacists work together within the profession, with patients, and with other health professionals, they can get where they need to be.

SCALING AND SUSTAINING WORKFORCE TRANSFORMATION

“Leadership is having a compelling vision, a comprehensive plan, relentless implementation, and talented people working together,” said Brandt, who opened with this quote from Alan Mulally, a renown automotive industry leader (Ford Media Center, 2024). Building on the quote, Brandt added that the talented people at the workshop have the vision and the plan, and “now it is time for ‘relentless implementation.’” Implementation science is the scientific study and application of strategies to promote the systematic uptake of research findings and other evidence-based practices into real-world settings (Kennedy et al., 2006). Brandt pointed out that it combines implementation practice and implementation research. Practice

is focused on the “doing” or “how-to” of implementation, while research focuses on evaluating the most effective approaches. At this workshop, said Brandt, participants talked about transforming pharmacy practice—to expand scope of practice, adopt direct patient care practices, embrace lifelong learning, and train the future workforce for pharmacy. Doing so will require the steps and insights of implementation science. It has been said that it takes 17 years for an innovation to make its way into day-today practice. “We don’t have 17 years,” said Brandt; “we need to make change now.”

A recent National Academies workshop explored the use and application of implementation science in health professions education.¹ Brandt shared a few key takeaways:

• Understanding Implementation Science: Implementation science investigates the factors that influence the successful adoption of evidence-based practices in real-world settings, facilitating the translation of research into practice.
• Building Capacity in Health Professions Education: Introducing and training leaders, faculty, and health workforce researchers in implementation science can enhance the adoption of effective teaching and clinical practices.
• Learning Through Case Studies: The workshop presented case studies demonstrating the application of implementation science concepts in various educational contexts, highlighting practical strategies and challenges.
• Exploring Future Directions: Emphasizing the importance of ongoing research and collaboration, the workshop encouraged integrating implementation science into health professions education to continuously improve educational outcomes and health care delivery.

One approach for expanding the use of implementation science in the profession, said Brandt, is to educate and train residents on its tenets. This bolsters their capacity to learn from unsuccessful interventions by leveraging counterfactual thoughts and understanding contextual influences. These insights can inform better decisions in future implementations. Brandt said that implementation science can also enrich patient care, through standardization across health care settings, error reduction, and innovative services tailored to the needs of the institution. As technology will likely take over some of the dispensing role, implementation science can be used to expand

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¹ https://nap.nationalacademies.org/catalog/26783/exploring-the-use-and-application-of-implementation-science-in-health-professions-education (accessed October 22, 2025).

services to areas including MTM, immunizations, point-of-care testing, transitions of care, and antibiotic stewardship.

Brandt invited Rodriguez de Bittner to share a brief explanation of a program at the University of Maryland School of Pharmacy called “pharmapreneurship.” The innovative program aims to help students develop an entrepreneurial mindset, where they see challenges as opportunities rather than barriers. Students are exposed to the concepts of design thinking; they work on teams with students from other departments, such as engineering, and develop ideas for some of health care’s most pressing challenges. Funding from alumni has allowed the school to help students launch the best ideas.

Brandt shared an example of a program that is implementing change by leveraging pharmacists as champions of age-friendly care. There is a national movement to build Age-Friendly Health Systems, in which care is guided by a set of evidence-based practices and consistent with what matters to the older adult and their family. It started around 2017, said Brandt, with pilot projects in hospital and ambulatory centers, and has grown substantially over the last few years. The Centers for Medicare & Medicaid Services released an Age-Friendly Hospital Measure that took effect in January 2025 requiring participating hospitals to report on elements within five domains: eliciting patient health care goals, responsible medication management, frailty screening and intervention, social vulnerability, and age-friendly care leadership. Brandt noted that these domains cross multiple areas of leadership and that it is critical for pharmacists to be part of the leadership team on a health systems level.

As the population ages, pharmacists are essential in the effort to help patients age in place, said Brandt. She shared details of a program that trains pharmacists to be “age friendly.” Trainees complete modules on different aspects of the Age-Friendly Health Systems program and receive a digital badge upon completion. The program launched in March 2025 and has already trained about 640 pharmacists. Implementation uses a regional approach, with a goal of reaching 2,500 pharmacists across all care settings. Brandt noted that they hope to work with value-based payment models to recognize pharmacies for this work.

In closing, Brandt stated that “amazing and empowered pharmacists are key to resilient health systems.” Transformation is ongoing, and the changes in technology and policy will bolster a future-ready workforce.

ENVISIONING A STRATEGIC ROAD MAP

In this final session, participants dispersed into groups to discuss a “road map” for the future of pharmacy. The objectives, said Bateman, were to consider elements of a road map that 1) integrate transformative strategies for charting the future of pharmacy and 2) identify which

individuals or organization within education, industry, and policy can move the strategy forward. In-person participants were divided into four breakout groups—one for each pillar—and asked to discuss top priorities in each area; virtual participants engaged in an online chat covering all four pillars.

Presentations of the priority areas within each of the four pillars (see Table 6-1) were informed by participants in the breakout groups who talked about narrowing down the long list of priorities and then engaged in a moderated discussion on what each key priority area would look like, why it might be important, and how it might be implemented. Participants reconvened, and a representative from each group briefly summarized the discussions. Table 6-1 is a snapshot of those as presented to the wider audience, which are described later and include comments from Bateman and Bacci, who led the parallel discussions with the virtual audience.

Pharmacy Deserts

Akiyode presented for the group that discussed policies to address pharmacy deserts. Out of the six suggested areas, the group discussed three key priorities: reimbursement and provider status, federal and state incentive programs, and mobile and alternative models. Regarding the first, Akiyode said that the discussion focused on payment parity—payment for services within scope of practice should be no less than for other providers. This would ensure financial sustainability. If pharmacists are compensated fairly, they would be able to expand service offerings and improve patient access to care. Akiyode added that numerous stakeholders can collaborate on this effort, including patient and provider groups, family medicine providers, health care professional organizations, and pharmacy chains. The second priority area included loan repayment programs, relocation support for graduating pharmacists, sign-on bonuses, and financial support for health systems. Groups involved in this area could include chambers of commerce; state pharmacy associations; boards of pharmacies; and nontraditional groups, such as patient access programs with pharmaceutical company sponsorships. Finally, models in the third priority area—including pharmacy delivery, telepharmacy, and remote dispensing—would help increase access to hard-to-reach populations, said Akiyode, and require significant financial investments, which could come from foundations, investors, community partners, or “Shark Tank” style proposals to funders. Bacci shared the discussion from the virtual breakout group; they also elevated “reimbursement and provider status” and “mobile and alternative pharmacy models” as key priorities and added “reforming PBM.”

care. Bateman reported on the virtual group’s discussion, which gravitated toward “legislative and regulatory reforms” and “reimbursement mechanisms,” but added that “provider status recognition” was also considered a priority area.

NextGen Education and Training

Ross gave the report for the breakout group on NextGen education and training. She called out three priority areas: competency-based, flexible curriculum; interprofessional and community-engaged learning; and lifelong learning infrastructure. A competency-based curriculum develops real-life skills and has marker points that require demonstrating competencies before advancing. This, said Ross, builds critical-thinking skills rather than relying solely on memorization. Flexibility could be in terms of time—such as allowing learners to move faster or slower depending on their needs—or delivery format, such as online. Developing and advocating for competency-based, flexible curricula would require multiple stakeholders, Ross said, including the perspectives of students, employers, residency directors, and patients.

New pharmacists will be practicing team-based care in an interprofessional environment, said Ross, so it is critical for them to be educated and trained in such an environment. Students have expressed their desire to be in settings with other health professions, she said, and working together can help build problem-solving skills, bridge the gap between the classroom and real-life practice, and develop a population health mindset. Lifelong learning will also be critical for the next generation of pharmacists, Ross noted, and takes place on a continuum from school through practice, where learners and practitioners benefit from working together in a supportive and innovative environment so new ideas and skills can be learned and shared.

Bacci reported that the virtual group also focused on “interprofessional and community-engaged learning” and “community-based, flexible curriculum.” Another priority area for their group was “technology-enhanced learning.” Bacci noted that several virtual participants emphasized the importance of including practicing pharmacists in the educational process.

FINAL REFLECTIONS

Before closing the workshop, Watanabe moderated an open-mic discussion in which participants were invited to share final thoughts and reflections.

Lauren Bode, University of Vermont Health Network, noted that the workshop featured a discussion of students and early career practitioners. Bode emphasized the importance of including these voices as workshop

participants so they may take conversations back to their workplaces and try to implement some of the ideas discussed. This is a matter of not just inclusion, she said, but ensuring that people with critical perspectives and skills are involved in making decisions. She encouraged participants to be intentional about bringing these voices into any efforts to reform pharmacy for the future.

Vermeulen commented that it can be challenging to move from conversation to action. He noted that pharmacy groups often get together and talk about issues, but without as much progress as there could be.

A participant noted that several speakers addressed the shortage of community pharmacists working directly with patients. He suggested that the effort to make other aspects of pharmacy practice attractive to potential students has resulted in a lack of pharmacists interested in direct patient care. He emphasized that it is “first and foremost a clinical patient care degree.” While some might make different career choices later, it is important to start with this foundational perspective. Meeting society’s demand for safe, effective therapies is pharmacy’s “core purpose as a profession.” Watanabe agreed that clinical care is the foundation of pharmacy practice but emphasized the importance of balancing this aspect with alternative paths.

To move forward on any of the challenges discussed, said McGivney, it will be critical for pharmacy to speak with one unified voice. She recalled an advocacy effort in Pennsylvania many years ago, in which different groups in pharmacy were speaking from their own perspectives. While it was clear to an insider that they were all saying the same thing, legislators did not hear it that way. McGivney stressed that different groups can keep their individual talents and strengths while simultaneously allowing “all that uniqueness to move in the same direction.”

CLOSING REMARKS

Watanabe closed the workshop by offering his thoughts. “Change is coming,” he said. Watanabe noted that schools were not teaching students how to design apps when the iPhone came out in 2007; educators had to bootstrap this new area onto the existing system. Change doesn’t usually “come on your timetable,” so stakeholders may wish to consider being nimble and responsive to rapid changes. A key message from the workshop discussions, said Watanabe, was the increasing cost of health care. The health care system is “off the rails,” and pharmacy can help realign it. Pharmacists can bring their expertise and perspectives to the table when stakeholders are strategizing how to address costs and improve care, he said. Pharmacy can either shape the future of health care or be shaped by it—“we’d much rather try to shape it.”

With that final reflection, Watanabe adjourned the workshop.