Provider status legislation for pharmacists: Momentum accelerates with public support
With health reform and the shift to accountable, evidence-based medicine slowly but surely transforming the nation’s massive but troubled healthcare system, new moves are afoot in both the legislative and executive branches of government that will further elevate the role played by the nation’s 300,000 pharmacists. And, surveys show, those moves have the strong support of most Americans.
It’s no secret that the U.S. health system is in trouble. Unsustainable health delivery costs, a dire shortage of primary-care doctors, the massive swelling of the Medicare rolls as 10,000 baby boomers a day turn 65 — all are stressing an already overtaxed system of care.
In turn, those forces are fueling the growing demand for alternative and more easily accessible sites of care, lower-cost delivery of front-line health services and new models of collaborative care. And retail pharmacists, conveniently located in thousands of communities and armed with years of training and clinical expertise in patient counseling, disease prevention and medication therapy management, are aligned perfectly to meet those demands.
Thrust into the spotlight, the pharmacy profession and the retail pharmacy industry have redoubled their campaign to achieve full health provider status that reflects the reality of today’s clinical, patient-centered pharmacy practice. Over the past several years, they’ve found numerous champions in Congress who recognize the untapped potential pharmacy offers as a solution to many of the nation’s critical healthcare needs. And consumer surveys over the past two years show strong endorsement by the public at large for legislation that would grant pharmacists the same professional recognition enjoyed by other members of the patient-care team, while assuring a fair and standardized reimbursement for medication therapy management and other health services.
In recent years, Congress has considered several proposals to grant pharmacists provider status. The most recent came in late January of this year with introduction of the Pharmacy and Medically Underserved Areas Enhancement Act [H.R. 592], sponsored by Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Todd Young (R-IN) and Ron Kind (D-WI).
A companion bill (S. 314) emerged in the Senate one week later, introduced by Sens. Charles Grassley, R-Iowa; Sherrod Brown, D-Ohio; Mark Kirk, R-Ill.; and Bob Casey, D-Pa.
If passed and enacted, the new legislation would give Medicare patients — particularly those in medically underserved communities — greater access to pharmacists’ expertise and pharmacy services, including immunizations, diabetes screenings and self-management education, cardiovascular screenings and behavioral therapy, in states in which pharmacists are allowed to provide these services. In so doing, it would also grant pharmacists with enhanced status as fully qualified healthcare providers, in effect recognizing the contributions community pharmacists already make in thousands of local settings each day.
“The provider status designation will amplify pharmacists’ ability to do what they do best — serve patients and help them on the road to better health,” noted NACDS president and CEO Steven Anderson. “The recognition by congressional leaders of pharmacists’ increasingly important role in the delivery of healthcare services is growing, and important progress is being made for the ultimate benefit of patients.”
Indeed, identical legislation introduced in the House last year generated a strong show of bipartisan support, with 123 cosponsors. Increasingly, Americans in general also support an elevated health provider role for pharmacists. A survey of informed voters in July 2014, conducted by Public Opinion Strategies and commissioned by NACDS, found that 79% of those polled voiced support for legislation to confer provider status on the pharmacy profession, including 36% who strongly favor it. Support was widespread across the political spectrum, with 85% of democrats and 76% of republicans endorsing a provider status designation for pharmacists.
The public also voiced strong support for legislation that would direct the U.S. Centers for Medicare and Medicaid Services to expand medication therapy management services by pharmacists to Medicare Part D beneficiaries. A survey conducted in 2013 found that 82% of informed and engaged voters were in favor of MTM legislation, including support from 88% of democrats, 74% of republicans and 84% of independent voters.
Mobilized health care: Putting pharmacy services on wheels
Pharmacies and clinics on wheels? That’s the premise behind the growing effort by retail pharmacy and clinic providers to expand their reach via specially equipped buses and other vehicles that provide on-the-spot, temporary access to needed health services in hundreds of communities nationwide.
The literal rollout of mobilized health services is a promising method some retailers are using to improve the quality of care in neighborhoods across the United States. Deploying buses and other vehicles staffed by pharmacists, nurses or other clinicians, pharmacy chains and pharmaceutical wholesalers are bringing mobile prescription delivery, health screening services and health education directly to Americans where they live, work and play.
Ongoing initiatives, such as the Walgreens/AARP/National Urban League Way to Well Tour, McKesson’s Better Health Tour and the Rite Aid Rite Track Diabetes Tour, have all highlighted the accessibility that mobile health vehicles can provide and the incredible number of people who can benefit from these health and screening centers on wheels. The Walgreens Way to Well Tour celebrated a major milestone last July when it was announced that the six-year tour had provided health services and screenings to over one million people in thousands of communities nationwide.
Walgreens spearheads its mobile wellness tour, using custom-equipped buses staffed by trained medical technicians and pharmacists who have administered more than $12 million worth of free health tests since 2006.
Rural areas could see the highest potential benefit, as under-served populations see their health care reinforced by mobile health services. Retail chains and wholesalers are leading the charge in bringing health screening services into rural communities. States like Nevada, North Dakota and Montana are seeing mobile treatment methods boost access to quality care.
Although pharmacy providers paved the way, other organizations and government entities have caught on. One prime example: every V.A. healthcare system in the country has some form of mobile care unit.
Mobile healthcare services are also a proven tactic pharmacy providers have used to deliver care during severe public health emergencies. During the relief efforts following Hurricane Katrina in 2006, CVS Health used two mobile pharmacy units to fill more than 20,000 prescriptions for 7,000 people who took shelter at the Astrodome in Houston.
“CVS/pharmacy utilizes mobile pharmacies for deployment in emergency situations to ensure continuity of pharmacy care when a pharmacy is temporarily shut down due to weather emergencies, natural disasters and similar events,” said CVS spokesperson Mike DeAngelis. “Over the years, they have been deployed to markets impacted by Hurricane Katrina, Superstorm Sandy and most recently to Buffalo following heavy snowstorms in late 2014. They are important tools to help our pharmacy teams ensure that our communities have continued access to prescription medications.”
Shelter from the storm: Reliable first responders, pharmacies provide critical disaster relief
When hurricanes, tornadoes, foods and other disasters strike, where do people turn for help? Retail pharmacies have become a critical community resource in times of great stress, offering food, water, emergency items, medical supplies and healthcare services when most other local businesses are still struggling to reopen or rebuild.
Time after time, those drug store, supermarket and discount-store pharmacies have provided vital relief during times of natural disaster. Setting up in temporary digs like trailers or buses — or bringing supplies and needed pharmaceuticals directly to a local emergency distribution center — community pharmacies have proven themselves as reliable first responders during times of emergency.
Retail pharmacy chains have been diligent not only in providing an immediate response when natural disasters and public health emergencies occur, but also in continued efforts to maintain public welfare in the aftermath of an emergency event. In the wake of Hurricane Sandy, for instance, Rite Aid worked quickly with local community organizations to provide severely impacted areas with water and emergency supplies. And CVS Health partnered with the U.S. Department of Health and Human Services, the New York City Office of the Mayor and the N.Y.C. Department of Health and Hygiene in order to waive co-payment deductibles and other financial burdens associated with prescription medicines for low-income patients in the New York City communities hit heavily by the storm.
When a series of tornados and storms ravaged Oklahoma and Texas in 2013, San Antonio-based supermarket and pharmacy chain H-E-B helped the local fire department set up a command center in the parking lot of its Cleburne location in North Texas to provide crucial aid to storm victims. Walmart sent associates into affected areas of Oklahoma from Arkansas, Texas, Missouri and Kansas to help staff its stores for the relief efforts.
For Walmart, that effort was nothing new. The giant mass merchandiser and pharmacy operator established an Emergency Operations Center (EOC) in the early 2000s, which staffs an in-house meteorologist who monitors weather patterns. The center also includes a team of associates trained to respond to disaster situations. Using this Emergency Operations Center, Walmart is able to assess specific needs and jump into immediate action when an emergency situation occurs.
Point-of-care facilities within retail pharmacies, such as CVS Health’s Minute-Clinics or Walgreens Boots Alliance’s Healthcare Clinics, are staffed by nurse practitioners who can provide critically needed healthcare services during times of crisis, such as administering tetanus shots or dressing wounds. When tornados slammed Moore, Okla., in May 2013, two CVS stores in the town remained open 24 hours a day. Pharmacists and physician’s assistants working at its MinuteClinic lo cation were able to provide much-needed medical care and advice to those impacted by the storm.
Pharmacy chains are also working with local relief agencies in joint efforts that will improve the access to healthcare services during times of public emergency. Rx Response is a charitable disaster response organization created in the wake of Hurricane Katrina in 2006 that helps provide coordinated support from an alliance of local pharmacies, government organizations and supply chain partners.
Rx Response provides crucial information that can benefit those affected by natural disasters and crisis situations. The program also gives emergency responders critical updates on the challenges facing supply chain partners relating to electricity, fuel and transportation issues.
Rx Open is a program designed by Rx Response that helps victims and evacuees find open pharmacies during an emergency situation so they can continue to fill needed prescriptions. The Rx Open tool was utilized during Hurricane Isaac in 2012 and also deployed in 11 states during Superstorm Sandy’s landfall in 2013. Walgreens was the first major retail chain to provide status reports on its pharmacies directly to Rx Response.
Walmart has also begun partnering with Rx Response and participating in its Rx Open program, a company spokesperson confirmed.
By responding rapidly to natural and man-made emergencies, America’s pharmacy providers are filling a critical need, said Tim Belka, director of global security services at Walgreens. “Medications, especially for those with chronic conditions, can be one of the most important healthcare needs that are difficult to meet in the aftermath of a natural disaster,” Belka said. “By giving people a place to go for information and critical pharmacy or healthcare services during a time of crisis, Walgreens and Rx Response can help with disaster relief efforts for impacted communities. As a community health and daily living destination, our stores can also serve as a convenient and centralized aid station during crisis situations.”
Rx Response also allows for patients who may use a different pharmacy to fill out an “Rx On The Run” card, which helps people in severe public health emergencies to refill prescriptions at any available pharmacy. Using this tool, pharmacies can work together to create a continuum-of-care for people trapped in a natural disaster who need specific medicines vital to their well-being.