Federal Provider Status

We all know that when pharmacists are on the team:

  • Patients benefit —enhanced satisfaction, care, and outcomes
  • Communities benefit —healthier population, increased access to immunizations
  • The health care system benefits —quality, access, and costs are improved

To ensure that pharmacists are included on every patients’ healthcare team, pharmacists need to be included on the “list” of providers defined in Medicare Part B. To achieve this, the profession of pharmacy has come together to advocate for what we call “provider status.” Bills are currently active in both the House of Representatives and the Senate. The profession of pharmacy has come together to work on this with a unified voice. And it’s not just pharmacists who know that ensuring patient access to pharmacists services is a priority.

Summary of HR592 & S314

  • Pharmacists – State-licensed pharmacists with a B.S. Pharm. or Pharm. D. degree who may have additional training and certificates depending on state laws
  • Services – Services authorized under state pharmacy scope of practice laws
  • Patients – Services provided in/ for Medically Underserved Areas (MUA), Medically Underserved Populations (MUP), or Health Professional Shortage Areas (HPSA)
  • Reimbursement – Consistent with Medicare reimbursement for other non-physician practitioners, pharmacist services would typically be reimbursed at 85% of the physician fee schedule

Provider status for pharmacists will result in a team-based patient-centered health care system providing improved care and value.

House and Senate Cosponsors of the federal provider status bills:

The federal provider status bills pertain to Health Professional Shortage Areas (HPSAs). Use this tool to lookup which counties in Colorado are HPSAs.

Download the Colorado State Fact Sheet for more state-specific information on provider status.

 

The Profession of Pharmacy, Working Together

papcc_logo

The Patient Access to Pharmacists’ Care Coalition (PAPCC) is a multi-stakeholder and interdisciplinary initiative. Membership is comprised of organizations representing patients, pharmacists, and pharmacies, as well as other interested stakeholders. Their mission is to develop and help enact a federal policy proposal that would enable Medicare beneficiary access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Their primary goal is to improve medically underserved seniors’ access to pharmacists’ services consistent with state scope of practice laws and regulations.

 

More Resources from APhA

apha_logo pharmacists provide care

Pharmacists Provide Care is APhA’s national advocacy campaign to achieve “provider status,” which will allow pharmacists to be recognized as health care providers under the law. Being recognized as health care providers is critical to creating and expanded job opportunities. Support our profession and join the Pharmacists Provide Care campaign today at pharmacistsprovidecare.com! This site also has numerous resources that can be used when discussing this initiative with Colorado Senators and Representatives.

More Resources from ASHP

The American Society of Health System Pharmacists has assembled a variety of resources that can be used for advocacy efforts. Check it out here.

 

Support for Provider Status

Developing Trends in Delivery and Reimbursement of Pharmacist Services
Avalere just released a white paper entitled,”Developing Trends in Delivery and Reimbursement of Pharmacist Services.”   The research was funded by NACDS.

Download the White Paper

NGA Support for the Expanding Role of Pharmacists
This paper by the National Governors Association highlights numerous states that have expanded pharmacists’ scope of practice, integrated pharmacists into chronic care delivery teams, and developed other team-based models of care that include pharmacists.

The paper includes policy considerations related collaborative practice provisions, provider recognition and compensation for pharmacist-delivered care services, and access to health IT systems.

Download the Paper

Improving Patient and Health System Outcomes through Advanced Pharmacy Practice
After decades of interprofessional collaboration and years of preparation, pharmacist leaders within the US Public Health Service (PHS) completed an evidence-based report entitled “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice” in 20111 . For the first time ever, a report on pharmacy practice was presented to a U.S. Surgeon General. Our 18th U.S. Surgeon General, Dr. Regina Benjamin, reviewed the report and issued a letter of support in January 2012. In conjunction with her support, six high-level physicians from across the country issued individual letters of support for expanded pharmacy practice.

Since their release to the public in January, the Report and Surgeon General’s support have already served as a call to action for the profession to transform pharmacy practice to better meet the needs of patients and the health care system. The Report provides evidence-based support for the importance of the pharmacist-delivered patient care, calls for the recognition of pharmacists as health care providers, and moves the discussion towards implementation of systems that support expanded pharmacy practice. Utilizing pharmacists to the maximum extent of their licensure and education to deliver patient care services is one of the most logical, evidence-based, successful, and time-tested strategies to improve outcomes. The endorsements by Dr. Benjamin and other high-level physicians provide the profession with excellent tools for advocacy and facilitate interprofessional discussions regarding the future of health care.

Download the Paper