Cast in a new light

Pharmacy presses lawmakers for provider status

As the pharmacy profession marks American Pharmacists Month in October, its drive to achieve full recognition and status for pharmacists as health providers continues to gain momentum.

The campaign for provider status and full integration in a collaborative healthcare system enlists the lobbying efforts of virtually all the nation’s top pharmacy organizations and dozens of state-based pharmacy groups. It also goes to the heart of pharmacy’s future, defining the industry’s struggle to evolve beyond the confines of the old prescription-dispensing model and to secure a full stake in the integrated healthcare model now taking shape across the United States.

Specifically, the effort aims to “pursue legislative and regulatory changes to the Medicare program and relevant sections of the Social Security Act … to recognize the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program, regardless of the settings in which they practice,” noted the American College of Clinical Pharmacy. The target is “more patient-centered, team-based and quality-focused care” that provides recognition and a fair reimbursement for pharmacists engaged in that care model, ACCP reported.

The effort is critical to pharmacy’s future. Noting that “a dichotomy exists between what many pharmacists do and what they’ve been trained to do,” the American Pharmacists Association casts the issue as a “paradox in pharmacy between the vision of patient care and the reality of community pharmacy practice.” The gap between that vision and reality for community pharmacy continues to stymie efforts by pharmacists to gain elevated stature as fully engaged members of the health provider network in America — or to gain the recognition and reimbursement that pharmacists need to fully develop the kinds of collaborative practice models needed to transform the fractured, overly expensive U.S. health system.

This, despite the fact that “when pharmacists get involved, overall healthcare costs go down and quality and patient safety improve,” APhA asserted. The group has joined with other pharmacy organizations — including the National Association of Chain Drug Stores; the National Community Pharmacists Association; the American Society of Health-System Pharmacists, or ASHP; the Academy of Managed Care Pharmacy, or AMCP; the American Association of Colleges of Pharmacy; the ACCP; and a number of pharmacy retailers — in a major push to generate support among congressional lawmakers and federal health officials for a change in federal health regulations that would designate pharmacists as recognized healthcare providers.
The focus of that effort is convincing lawmakers to insert new language in the Social Security Act that would define pharmacists as patient care providers who qualify as such for payments under Medicare. “We need the recognition as providers so the healthcare system supports us financially,” noted ASHP CEO Paul Abramowitz at the group’s summer meeting in June.

Also backing “the recognition of pharmacists as non-physician providers under the Social Security Act” is the Academy of Managed Care Pharmacy. Provider status, AMCP stated, would “allow pharmacists to be reimbursed directly from Medicare Part B for providing cognitive services to patients covered under the program.”

“Although current Medicare Part D law reimburses pharmacies for pharmacists providing some cognitive services, including medication therapy management to a select subset of patients, the program is restrictive and encompasses only a small set of the services pharmacists are capable of undertaking,” the group asserted in a position statement. “Most states permit pharmacists to enter into collaborative practice agreements with prescribers, which grant pharmacists authority to manage a patient’s drug therapy.”

“A large body of published literature provides significant evidence of the benefits gained by allowing pharmacists to more fully utilize their expertise within clinical settings as part of the healthcare team,” added the statement. “AMCP strongly believes the inclusion of pharmacists as healthcare providers will enhance their ability to work as part of healthcare teams to address primary healthcare needs and increase the potential of pharmacists to provide these services with fewer barriers.”

NCPA calls the change “long overdue,” and noted, “with this federally recognized designation, pharmacists could finally be recognized for the valuable work they do and for their dedication to their patients.”

APhA agreed. “Provider listing in the Social Security Act is an important component in the ultimate goal of providing consumers and other healthcare providers with access to our services,” noted the pharmacy organization. “For patients to achieve the full benefit of their medications, pharmacists must be part of the team.”

To drive progress on the move to boost pharmacists’ provider status, APhA allocated $1.5 million to “a multifaceted initiative by the profession to gain recognition for pharmacists as healthcare providers.” The effort, said the group, seeks to ensure that:

  • Payers and policy-makers give patients access to pharmacists’ clinical services and recognize pharmacists as healthcare providers who improve access, quality and value to health care;
  • Patients have access to pharmacists’ clinical services through Medicare/Medicaid, other federal and state health benefit programs, integrated care delivery models and/or private payers by listing pharmacists as providers and/or properly valuing these services in payment models; and
  • Every patient’s health benefit plan package includes pharmacists’ clinical services as a core component.

The drive for provider status isn’t limited to big organizations and retail pharmacy chains. Individual pharmacists, including Sandra Leal, a PharmD and certified diabetic educator, and even student pharmacist Steve Soman have launched petition drives to convince President Barack Obama, the U.S. Congress and health policy-makers to support provider status and adequate clinical care compensation for pharmacists.

Meanwhile, pressure is building at the state level for legislation granting pharmacists professional provider status. In California, for instance, the California Medical Association in August agreed to drop its opposition to a bill in the state legislature that would expand the role of pharmacists after negotiations with the California Pharmacists Association, or CPhA. If enacted, the bill would boost pharmacists’ authority to order and interpret some tests of patients’ drug therapies and initiate routine vaccinations, among other duties.

“This exciting development reflects the recognition in the provider community of pharmacists’ high level of training and expertise, and of the contributions that pharmacists can make to patient care,” CPhA stated.

Pharmacy gained a powerful ally in the drive for provider status when the U.S. Public Health Service, or USPHS, and U.S. Surgeon General Dr. Regina Benjamin went on record urging policy-makers and health regulators “to support and implement existing, evidence-based and cost-effective pharmacist-delivered patient care models as the demands within our healthcare system escalate.”

Importantly, USPHS also noted that adequate reimbursement for this higher level of pharmacy practice was essential to making it work. “For pharmacists to continue to improve patient and healthcare system outcomes, as well as sustain various roles in the delivery of care, recognition as healthcare providers and compensation models reflective of the range of care provided are needed,” noted the agency, which is part of the Department of Health and Human Services.

In June, Rear Admiral Scott Giberson, chief professional officer for USPHS pharmacists, reiterated that support for provider status for pharmacists in a speech to the ASHP in Minneapolis. “Pharmacists are the second-most highly trained health professional … based on years of formal education,” Giberson noted, and are “a primary key to cost containment,” with a demonstrated “average return on investment of $4-to-$1 over the last two decades.”
Giberson added: “Pharmacists are likely the most underutilized healthcare provider in the nation. We may be missing an opportunity to address health system burdens with one of the nation’s most capable providers.”


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