Like doctors, nurses and other healthcare providers across the country, pharmacists play a pivotal role in patient care. Unlike those providers, pharmacists are not allowed to charge for their services beyond filling prescriptions. However, that could change if Congress passes a law that would grant provider status to pharmacists.
Pharmacy and Medically Underserved Areas Enhancement Act
In January 2015, the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314) was introduced into both chambers of Congress. It was quickly moved to several House and Senate committees for consideration and has been received with overwhelming bipartisan support. So far, more than 280 lawmakers have signed on as co-sponsors. That is more than half of the members of Congress. The legislation would give patients access to Medicare Part B services rendered by state-licensed pharmacists in medically-underserved communities. The benefit for pharmacists is the law would allow pharmacies to bill for those services through Medicare coverage.
Millions of Americans do not have access to adequate healthcare due in part to a shortage of primary care physicians. The Congressional Budget Office (CBO) projects as many as 36 million people could gain health coverage under the Affordable Care Act, making the physician shortage harder on communities.1 Add to that a projection from the Association of American Medical Colleges that by 2020 there will be 91,000 fewer doctors to meet the challenge, and the push to grant provider status to pharmacists is understood.2 Provider status for pharmacists will expand basic healthcare coverage to people living in rural areas of the country.
“Pharmacists can help,” said Stacie Maass, senior vice president, Pharmacy Practice and Government Affairs for the American Pharmacists Association (APhA). “Pharmacists offer convenient access to diverse services that can improve patient care, patient health and outcomes.”
Provider Status at the State Level
Prompted by the first national piece of provider status legislation introduced into Congress in 2014, many states decided to take the initiative and pass their own bills. Oregon is the latest state to grant provider status to pharmacists. The initiative allows pharmacists to be paid for clinical services like medication therapy management (MTM). Leah Bishop, a registered pharmacist and the owner of Drug Mart in La Pine, OR, is excited about the possibilities of being able to bill for her services.
“One of the exciting elements of this bill is pharmacists can prescribe birth control to patients,” Bishop said. “It will work the same way that we administer immunizations.”
For states that have already passed such legislation, provider status is the only common denominator. The provisions for each vary between states. It’s those differences that determine which services can be reimbursed and, more importantly, at what level. Bishop added that while pharmacists are already a critical link in the healthcare chain, the federal designation will help make billing uniform. Bishop said a national law granting provider status to pharmacists will help streamline the effort and put everyone on the same page when it comes to billing and interpretation. As with any government regulation, however, pharmacies need to be ready to deal with the bureaucracy that will surely accompany any pay schedule for pharmacists. For example, in some states, pharmacists can bill for their services at a rate of 85 percent of what a nurse practitioner could charge.
“Sometimes change can be overwhelming,” Bishop said. “But we need to embrace it. It’s hard to go outside your comfort zone, but we are going to have to step outside and take some risks.”
“While state-level changes will help increase the contribution that pharmacists can provide to patients, the lack of Medicare Part B recognition is a significant barrier,” Maass said.
Pharmacists Provide Care Campaign
The APhA launched a program called Pharmacists Provide Care to lobby Congress to pass the Pharmacy and Medically Underserved Areas Enhancement Act. So far, more than 20,000 people have joined the campaign. The group has produced videos of pharmacists talking about the benefits of gaining provider status and garnered enough support to generate more than 30,000 letters being sent to members of Congress.3
“Enabling pharmacists to practice at the top of their education and training, and be better integrated into the patient’s healthcare team, will improve healthcare and outcomes and greatly benefit specific populations, especially those with chronic conditions, such as diabetes and cardiovascular disease,” Maass added.
The APhA pointed out that pharmacists already provide a broad range of patient services, including health and wellness screenings, counseling to manage chronic diseases, administering immunizations and working with doctors to help reduce hospital readmissions.
It’s common for pharmacists to spend more one-on-one time with patients than primary healthcare providers. Pharmacists take pride in knowing the impact and difference they make in the lives of patients. While the designation of provider status will open new revenue opportunities for pharmacists, Bishop warned those in the profession should not lose focus of what drives a pharmacy. “At least 90 percent of what we do is filling prescriptions, so we can’t throw the baby out with the bathwater,” she said.
Bishop also suggested pharmacists look at areas in which they have a passion to find ways to capitalize on provider status. “For example, if a pharmacist likes drawing blood, then he should consider going that route and working on labs for patients,” she said.
However, the APhA argues federal law is grossly outdated by omitting pharmacists’ services in the list covered by Medicare. Even though, the second attempt at passing such legislation to change that is still in committee, the APhA is hopeful strong bipartisan support and the efforts to lobby Congress will make this goal of provider status a reality for pharmacists and the patients they serve.
Sources: 1 Congressional Budget Office. n.d. Web. 19 Nov. 2015. https://www.cbo.gov/.
2 “Pharmacists and Unmet Need.” American Pharmacists Association. Web. 19 Nov. 2015. http://www.pharmacist.com/sites/default/files/files/PAPCC_Unmet_Need.pdf
3,4 Spira, Michael. “Your efforts can lead the profession over the provider status finish line.” American Pharmacists Association. Nov. 2015. Web. 19 Nov. 2015. http://www.pharmacist.com/your-efforts-can-lead-profession-over-provider-status-finish-line
5 Abraham, Joseph. “Pharmacy Care.” Independent. June 2015. Web. 19 Nov. 2015. http://www.independent.com/news/2015/jun/20/pharmacy-care/
6 H.R.592 - Pharmacy and Medically Underserved Areas Enhancement Act. Congress. Web. 19 Nov. 2015. https://www.congress.gov/bill/114th-congress/house-bill/592/cosponsors