Pharmacists Taking on More Responsibility to Fill Care Gaps

Alicia Ault

April 09, 2015

The push for better coordinated and cost-effective healthcare is putting pharmacists at the center of a debate that about responsibility and reimbursement.

In the United States, medication problems, including nonadherence, cost $300 billion annually. Almost half of patients prescribed medications for chronic disease do not take those medications correctly.

Pharmacists "are already trained to provide the services we are advocating for," Stacie Maass, BSPharm, JD, senior vice president of pharmacy practice and government affairs at the American Pharmacists Association (APhA), said at the group's 2015 annual meeting in San Diego. "They just haven't had the opportunity."

Last year, 25 organizations created the Pharmacists' Care Coalition to advocate for improved patient access to pharmacists to help with medication oversight, disease management, and other services.

A proposal to grant pharmacists provider status under Medicare was introduced in the House in January by Rep Brett Guthrie (R-Kentucky). The Pharmacy and Medically Underserved Areas Enhancement Act (HR 592) has 83 cosponsors, almost equally split between Republicans and Democrats. It has been referred to the House committees with jurisdiction over Medicare, and a Senate companion bill (S 314) has 10 cosponsors.

The legislation would not vastly expand reimbursement to pharmacists, Maass explained. It would allow state-licensed pharmacists to bill under Medicare Part B for patient services such as medication or disease management, but only for medically underserved patients and those in areas with a shortage of healthcare professionals.

In addition to lobbying for the passage of bills such as this one, "we continue to highlight pharmacist value in any avenue that we can with federal agencies," she told Medscape Medical News.

The APhA is also working with the National Alliance of State Pharmacy Associations to support state laws that grant pharmacists provider status under Medicaid and provide state employee health plans. Both organizations are also targeting accountable-care organizations, health systems, and private employers.

New Laws

State legislators are very active this year, said Krystalyn Weaver, PharmD, RPh, director of policy and state relations at the national alliance. In 2014, 26 bills related to state-level pharmacist provider status were introduced by mid-March; so far this year, 75 such bills have been introduced.

Provider status legislation generally falls into three categories: designating pharmacists as providers; expanding the scope of practice; and paying for services.

Already in 38 states, pharmacists are designated as providers, but the definition of provider is not always codified in the same area of the law from state to state, Dr Weaver told Medscape Medical News. It can fall under profession and occupation laws, insurance laws, public health laws, medical liability laws, or in several of these areas.

According to the national alliance, 11 state Medicaid programs pay pharmacists for medication management: Colorado, Iowa, Kansas, Minnesota, Mississippi, Missouri, New Mexico, Oregon, Texas, Washington, and Wisconsin. In Ohio, a private Medicaid managed-care contractor pays for medication management.

Many pharmacists still don't completely understand how quickly changes are happening in the states, Dr Weaver explained, but "they need to be ready to provide these services once we have the infrastructure in place."

Ms Maass is an employee of the American Pharmacists Association. Dr Weaver is an employee of the National Association of State Pharmacy Associations. They have disclosed no relevant financial relationships.

American Pharmacists Association (APhA) 2015 Annual Meeting. Presented March 27, 2015.


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