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    Provider status

    Keep the pressure on lawmakers and push for payment


    Provider status for pharmacists is no longer a dream. It is already a reality in 38 states, 76% of the nation. All but two states allow collaborative practice agreements that effectively expand pharmacists’ scope of practice. Between 70 and 80 different pieces of legislation to expand provider status are currently working their way through state legislatures. 

    On the federal side, 282 of 425 Representatives have signed on as co-sponsors of “The Pharmacy and Medically Underserved Areas Enhancement Act,” HR 592. The Senate companion bill, S 314, has 42 co-sponsors. The bill would add pharmacists to the list of healthcare providers designated under Medicare Part B. Most federal programs as well as many state and private payers use the Part B list in designating providers for their own purposes.

    See also: Pharmacist provider status gains traction

    What’s the holdup?

    So why aren’t more pharmacists getting paid for their professional services? Provider status is a necessary step in achieving payment status, but it is only the first step.

     â€œYou can give us provider designation all you want, but until large payers in the marketplace act on it, not much is going to change,” said Mike Schwab, executive vice president of the North Dakota Pharmacists Association.

    “That’s why it is so important to keep building the pressure and the momentum at both the state and federal levels. We are seeing state Medicaid programs, even some private insurers, starting to pay pharmacists as providers. What we need at this point is for one of the big players in the market, whether it is a PBM or an insurer, to recognize the value pharmacists can bring to the patient-care process. Federal provider status will help underline that position, but it doesn’t mean the doors will suddenly fly open. This is something we all have to keep working at, one state, one legislator, one payer at a time.”

    See also: Provider status: Important to pharmacists, critical to patients

    North Dakota is one of several states that has moved the bar on both provider status and payment status in the last year.

    The state pharmacy association worked with physician groups, state regulatory boards, and the state pharmacy school to expand collaborative-practice agreement provisions and point-of-care testing. Pharmacists in North Dakota can now perform about two dozen point-of-care tests and prescribe appropriate drug therapy in a single pharmacy visit.

    The state also requires its Medicaid program to pay for pharmacist management of hepatitis C and asthma patients starting in July 2016. Minnesota, Nebraska, Ohio, Washington, and other states are also rolling out new statutory and regulatory language to designate pharmacists as healthcare providers and to require that they be paid as providers under certain circumstances.


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