The Time Is Now for Congress to Cement Pharmacists’ Roles with Provider Status

April 2014, Vol 2, No 2 - Inside Healthcare
Charles E Collins, Jr, MS, MBA

I recently attended the back-to-back American Pharmacists Association (APhA) and the Academy of Managed Care Pharmacy meetings. I was especially pleased to see the thousands of attendees, and encouraged by the energy and enthusiasm for the pharmacy profession at both meetings.

As with many associations and organizations, both of these professional groups are focusing their attention and efforts on a select set of priorities over the next few years. Although the 2 organizations have different objectives and primary audiences (retail setting and payer environment, respectively), there was a common theme to these priorities—a united front if you will—around the efforts of gaining provider status.

As it turns out, there are multiple pharmacy organizations (22 to be exact) as well as a few pharmacy retailers backing this provider status movement through the recently formed Patient Access to Pharmacists’ Care Coalition (PAPCC) group. This coalition, as well as others, has been the catalyst behind, and the major support for, the recent House of Representatives’ legislation H.R. 4190. This bill, introduced on March 11, 2014, would recognize pharmacists as healthcare providers, and allow patient access to and payment for Medicare Part B services in medically underserved communities.

Here, at Inside Pharmacy, our goal is to have pharmacists “come from behind the counter,” engage the patient, and be the healthcare provider that we know they already are. As our mission statement demonstrates, Inside Pharmacy is well-aligned with the efforts of PAPCC.

Although provider-status discussions and initiatives have been around for years, H.R. 4190 would amend the Social Security Act (SSA) of 1935, and provide pharmacists the opportunity to fully serve their communities. For years, pharmacists have been considered part of the healthcare team, but have not been treated or recognized on par with other healthcare providers such as physicians, physician assistants, and certified nurse practitioners. Because of this “nonprovider” status, there are simply too many pharmacy-capable services that are not being utilized, especially in underserved areas of our country. With a looming physician shortage and ever-changing healthcare delivery models, such as patient-centered medical home (PCMH) and the fast-growing accountable care organizations (ACOs), can we truly afford the status quo for pharmacists?

We are all acutely aware that healthcare delivery in the United States is quite expensive. Pharmacists can play a vital role in providing key services that are more cost-effective than traditional venues. However, according to a recent APhA publication, many health plans, both state and private, often refer to the nonprovider status of pharmacists in Medicare Part B as a reason for not covering services or reimbursement for their respective members. Thus, many individuals are often blocked from receiving valuable services such as medication adherence and appropriate medication use from pharmacists. There is no other healthcare profession that has a more complete comprehensive understanding of these specific areas than the pharmacist.
Due to the Affordable Care Act, we will continue to see new models of healthcare delivery evolve. I have already mentioned PCMH and ACOs. Over the past year, we have seen the government’s public exchange take hold while the private exchanges continue to flourish. These new models will bring new questions and new delivery of services. With high-deductible health plans and consumer-driven healthcare on the rise, the demand for pharmacy services will be at an all-time high.

The time is absolutely now to make this change to the SSA and grant provider status to pharmacists. As this legislation moves forward, other stakeholders will likely follow and recognize pharmacists not only for the valuable services they provide but also as the healthcare providers they are.

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Last modified: May 21, 2015
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