Should pharmacists be considered providers?

A pharmacist’s most familiar role is filling and dispensing scripts written by providers, whether the pharmacist works behind a retail pharmacy counter, or within a health facility’s dispensary or as a service point for long-term care facilities. But what about other delivered services, like the administration of vaccines, blood pressure screenings and diabetes management?

Many industry groups argue that the pharmacist’s definitive role should be expanded into some services traditionally delivered by providers, both as an alternative to access and as a way of filling voids in places where provider coverage is scarce. The rubbing point is how pharmacists will be reimbursed by insurers, including Medicare.

For services beyond those governed by Medicare Part D, states have generally made their own rules concerning what services a pharmacist can provide—and be reimbursed for. In 2013, California added an “advanced practice pharmacist” classification to its state pharmacy board. At least seven states have legislated around the issue, by specifying what additional services a pharmacist can be reimbursed for. But until recently, nothing has tackled the national front in earnest.

In March, Congress introduced legislation that would allow certain services provided by pharmacists to be eligible for reimbursement under Medicare Part B, allowing pharmacists to be considered a "provider" for certain services. However, H.R. 4190 would restrict the coverage eligibility to a “health professional shortage area… medically underserved area, or medically underserved population.”

The bill’s supporters say the proposed changes to the Social Security Act are merely keeping up with the changing roles of pharmacists and their relationships with those they serve. “Whether it’s to inquire about medication or potential side effects or discussing other ailments and complications, many patients view their pharmacist as a critical member of their healthcare team,” said Rep. Brett Guthrie (R-Ky.), one of the bill’s sponsors.

The interesting question for long-term care (LTC) is whether the proposed bill’s language would extend to LTC facilities that have sparse physician coverage—Or, if having a physician onsite once a week would constitute a “medically underserved” environment.

In LTC environments, where medication issues are too common yet physician coverage is often limited to one or two visits a week, a consultant pharmacist may be in a position to provide crucial chronic disease management services, a role that would be reimbursed under Medicare Part B if the pharmacist were classified as a provider.

“Patients in these settings often have medically complex needs, have high comorbidity, utilize multiple medications, experience significant medication­‐related problems, and account for the majority of this nation’s healthcare spend,” notes the American Society of Consultant Pharmacists (ASCP) in a position statement about the pending legislation. “ASCP acknowledges the need for pharmacists involved in direct patient care to have appropriate qualifications. While many health care practitioners are involved in medication utilization, pharmacists are uniquely trained and educated as comprehensive medication management experts.”

Watch for our ongoing coverage of the pharmacist's role in long-term care.

Topics: Accountable Care Organizations (ACOs) , Advocacy , Articles , Medicare/Medicaid , Regulatory Compliance