June 2021 – Bula Digest
Evolving compliance from obligation to opportunity
Pharmacists are the Most Accessible Healthcare Professionals
Pharmacists have been quietly meeting the needs of their patients during the pandemic. They have once again proven that they are the most accessible healthcare professional. They satisfy the needs of their patients without appointments and continue to provide exceptional healthcare.
This season has highlighted that a pharmacist’s role is critical to ensuring that Americans have the best possible healthcare. Not only have they tested a significant portion of the American population for COVID-19, but they are at the forefront of administering COVID-19 vaccinations.
Pharmacists as Healthcare Providers
Pharmacists are skilled healthcare professionals. Their training prepares them to provide many clinical services, including:
- Patient medication management, particularly for chronic conditions;
- Preventative services like screening and immunization;
- Medication administration, particularly injections;
- Medication reconciliation during the transition of care;
- Patient counseling, education, and lifestyle changes; and
- Prescribing through collaborative practice agreements or standing orders.
This means that Medicare does not pay for the healthcare services provided by pharmacists. Private health insurance companies are also reluctant to reimburse pharmacists for the services they provide.
With that said, different states are increasingly adding pharmacists to the list of health care providers under their Medicaid programs. Even so, if states do not mandate payment for pharmacist services, insurers do not need to pay.
Pharmacists are responsible for providing pharmacy services for free. Refusal to perform or provide pharmacy services could be considered patient negligence and result in disciplinary action and lawsuits. Mistakes made by a pharmacist when providing these services can similarly lead to disciplinary actions and lawsuits.
Benefits of Reimbursing Pharmacist Services
More than 88,000 pharmacies across the United States offer various pharmacist services.
Recent Legislative Changes Establishing Pharmacists as Healthcare Providers
As previously mentioned, different states continue to allow pharmacists to bill for services as healthcare providers. So far in 2021, more than 40 bills and rules have been introduced in over 25 states that affect pharmacist service reimbursement. At least 9 have passed, and 25 are still in the proposed stage.
The following three states made the most significant changes, allowing pharmacists to receive payment for the services they provide.
On May 7th, 2021
Oklahoma passed SB 392, requiring health insurance companies to provide direct payment or reimbursement to pharmacists for healthcare services they provide to patients. This law will take effect on January 1st, 2022.
On January 10th, 2021
Alaska adopted regulation 7-120.110 requiring the department to pay pharmacists for administering vaccines according to regulation 7 AAC 110.750.
On January 7th, 2021
Ohio also adopted regulation 5160-8-52, allowing pharmacists to enroll in Medicaid as healthcare providers. If the service provided by the pharmacist is within their scope and medically necessary, pharmacists receive payment for managing medication therapy and administering immunizations.
Bills to Add to the Watchlist
On April 22nd and April 26th, the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759 and S. 1362) was introduced to the Federal House of Representatives and the Senate. If passed, this bill will grant community pharmacists “provider status,” establishing them to provide care to underserved Medicare beneficiaries. Part B of Medicare will compensate pharmacists for the patient care services they provide.
It is reasonable to expect that the passing of H.R. 2759 / S 1362 may initiate a cascade of laws and regulations requiring Medicaid and other private health insurance companies to reimburse pharmacist services. We recommend that you add them to your watch list.
Many states are increasingly establishing pharmacists as healthcare providers. Let’s hope that this trajectory continues. If the federal government passes bills HR 2759/ 51362, this trend may increase at an even greater rate.
American Pharmacy Association, (2021). Pharmacy’s Top Priority: Medicare Provider Status Recognition. Available at: Medicare Provider Status Recognition (pharmacist.com) (Accessed:12 May 2021).