Prescribing Rights: Worth it?
Pharmacists are now recognized as providers nearly everywhere—here’s a look at what this could mean for you.
Payment for services
But barriers still remain to pharmacists who are embracing their expanding role of prescriber, Riley continued. The biggest barrier cited by pharmacists is being recognized as providers by payers. “Much of this comes from the reality that pharmacists have, in the past, provided many of these [expanded services] for greatly reduced rates or for free. Recognition of pharmacists as providers is even more important with the shifting from fee-for-service to value-based reimbursement and the expectation of treating patients more holistically,” said Riley.
Currently, pharmacists may bill for medication therapy management services under Medicare Part D, said Jalloh. Additionally, a handful of states allow pharmacists to bill for reimbursement, with the West Coast being the most progressive region, he added. In Oregon, when the bill establishing provider status for the state’s pharmacists was signed into law, it included a provision to “permit health insurers to provide payment or reimbursement for services provided by pharmacists through the practice of clinical pharmacy or pursuant to statewide drug therapy management protocols,” according to a release from APhA. It specifically mentions that “both private and public health insurers in Oregon can reimburse pharmacists for the clinical services they provide under the new law.”
Jeffrey Rochon, PharmD, and CEO of the Washington State Pharmacy Association, said a bill is in place that requires commercial or private health plans regulated by Washington State to enroll pharmacists into their provider networks, and it mandates that these plans pay pharmacists for services provided if they are within a pharmacist’s scope of practice.
But, said WSU’s MacLean, payment for pharmacists has been slow. To date, she said, only a “handful of pharmacists,” have been able to navigate the intricate private insurance networks and actually bill for assessments and other services.
There is some movement at the federal level to reimbursement pharmacist for services. At the 2017 APhA meeting, APhA Senior Vice President of Pharmacy Practice and Government Affairs Stacie Maass, BSPharm, JD, spoke about the Pharmacy and Medically Underserved Enhancement Act (H.R. 592/S. 109), which was reintroduced to Congress in January. She said the bill now has146 cosponsors in the House and 33 in the Senate. APhA Senior Lobbyist Alicia Kerry Mica noted that the bill, which would amend the Social Security Act, recognizes pharmacists as providers under Medicare Part B, and said the “bill addresses the physician shortage in rural areas, and paying pharmacists in underserved areas to engage in certain medical services could work well.”
Still, despite some of the frustrations, “collaborative practice agreements are a valuable tool for pharmacists to operate at the top of their education and assist the other members of the health-care team with their expertise,” said Nicholas Gentile, Director, State Grassroots Advocacy and Political Action, ASHP.
“State requirements ultimately define which disease states and/or medications can be prescribed by pharmacists,” said Gentile. He noted that state laws and regulations also define what pharmacists have to do in order to prescribe. “In some cases, if they have a collaborative practice agreement in place, pharmacists only need to be licensed in the state. In other states, a specific patient care service can only be performed by an advanced credentialed pharmacist,” said Gentile.
APhA’s Jalloh said that on the West Coast, the legislation ranges from states where the pharmacist has full prescriptive authority and may attain the title of Advanced Practice Pharmacist, to other states where that authority is limited to the administration of flu vaccinations. In California, Oregon, and Washington, for example, the pharmacist’s scope-of-practice includes hormonal contraceptives, nicotine replacement therapy, and travel medications.
By practice setting, the role of the prescribing pharmacist is growing most rapidly in the health-system arena, predominantly in clinics that are connected with hospitals, explained Jalloh. The trend is growing among community pharmacists, as well, although workload issues may prove an obstacle, particularly in chain stores. “Independents are more likely than chain pharmacists to be involved in prescribing,” Jalloh said.
Common conditions for which pharmacists may initiate or modify therapy in the health-care arena are diabetes, asthma, COPD, pain, and conditions requiring anticoagulant or cardiac drugs, said Maroyka. He added that behavioral health is a growing area for pharmacist intervention.
Up next: Health systems