Pharmacists traditionally have been one of the most underutilized members of the healthcare team, possibly because they hadn’t been officially recognized as part of that team. That, however, is about to change.
This past October, Gov. Jerry Brown signed California’s pharmacist provider status bill into law, expanding the scope of pharmacists’ practice and recognizing them as healthcare providers. The new law, which takes effect on Jan. 1, 2014, looks to be an important first step in expanding the practice scope of pharmacists, particularly in the community setting.
What is provider status, and why is it important?
Pharmacists were not included in important sections of the Social Security Act that determine eligibility for healthcare programs, including Medicare Part B. Because of this, Medicare beneficiaries have limited access to pharmacists’ services on an outpatient basis. Due to the omission from Medicare, state and private plans also have failed to include pharmacists as providers, or to compensate them for their services.
Numerous studies and demonstration projects have shown the importance of pharmacists in patient care, particularly in managing chronic disease and in controlling inappropriate medication use. Study after study has proven that when pharmacists are included as part of the healthcare team, healthcare costs are reduced, patient outcomes are improved and patient satisfaction is increased. Yet, without provider-status recognition and a compensation model, pharmacists are not being used to fill the increasing gap between the number of patients in the country and the number of healthcare providers.
What does California’s new law do?
While the California bill does not mention compensation or reimbursement for services, it does expand pharmacists’ roles. The bill declares pharmacists to be healthcare providers and authorizes them to administer drugs, including by injection; provide consultation, training and education about medications, disease management and disease prevention; participate in multidisciplinary patient reviews; order and interpret tests to manage and monitor drug therapy; and via state protocol, to independently provide hormonal contraceptives, travel medications and nicotine-replacement products.
The bill also creates Advanced Practice Pharmacist, or APP, recognition. Once a pharmacist is certified as an APP, he or she may perform patient assessments; order and interpret tests; initiate, adjust and discontinue drug therapy pursuant to an order by the patient’s prescriber; and evaluate and manage disease and health conditions in collaboration with other healthcare providers. In other words, activities that are similar to those that pharmacists who work under collaborative practice agreements perform.
Support for provider status for pharmacists has been unanimous among pharmacist groups and associations. Starting in mid-January 2013, a coalition of 14 organizations — including the American Pharmacists Association, or APhA; the Academy of Managed Care Pharmacy, or AMCP; the American Society of Health-System Pharmacists, or ASHP; the National Association of Chain Drug Stores, or NACDS; and the National Community Pharmacists Association, or NCPA — have been working on a set of principles to guide the provider status campaign at the federal level. The coalition gathered important feedback at a national provider status stakeholder meeting last March, and continues to hone “Principles for Improving Patient Health: The Pharmacist’s Role.” The focus is to create provider status principles that are “patient-centered, focus on team-based care and are grounded in the triple-aim of access, quality and cost,” according to APhA’s Pharmacist.com. However, on the federal level, an act of Congress ultimately will be required to recognize pharmacists as healthcare providers.
The timing is optimal. With the country poised on an impending shortage of primary-care providers, adding pharmacists to the healthcare team can improve access to care, expand coverage of care and increase optimal utilization of medications. The author of a recent article in Health Affairs, titled “Primary Care: Proposed Solution to the Physician Shortage without Training More Physicians,” speculated that up to 24% of primary-care physician time “could be saved by sharing the care among a primary-care team. The registered nurse and pharmacist workforces are sufficient to add primary-care capacity.”
The time for pharmacist provider recognition is now.
Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.