The Push for Pharmacist Provider Status

From a grassroots petition launched by a PharmD candidate to a concerted effort among CEOs of national pharmacy associations, the push is on to win health care provider status for pharmacists.

A chorus is rising in the pharmacy community, calling for the profession to be accorded health care provider status. From a Doctor of Pharmacy candidate who has started an online petition calling on President Obama to join the cause to the CEO of one of the country’s largest pharmacist associations who has identified it as a top priority, many feel that 2013 just might be the year when pharmacists win the right to be paid for the role they play in patient care.

The current goal is to have pharmacists designated as patient-care providers eligible for reimbursement under Medicare, which requires an act of Congress, but the hope is that other insurers will follow the program’s lead once this is achieved. In a blog entry posted on January 2, 2013, American Society of Health-System Pharmacists (ASHP) CEO Paul Abramowitz, PharmD, FASHP, announced that attaining provider status is one of the association’s “top strategic priorities.”

“The data are conclusive: Pharmacists improve medication-use outcomes for patients when they are included on the patient-care team,” Dr. Abramowitz wrote in an accompanying column in ASHP’s Intersections. “Therefore, a logical next step is making the services pharmacists provide eligible for recognition and payment by Medicare, Medicaid, and other third-party payers, including states and private health plans.”

Dr. Abramowitz noted that attaining provider status will require a great deal of concerted effort on a grassroots as well as state and national level. Toward the latter end, he wrote that he and the CEOs of other national pharmacy organizations will be meeting to plot a strategy for a successful campaign.

On the grassroots level, Steve Soman, a PharmD candidate at St. John’s University College of Pharmacy and Health Sciences, has launched a campaign on “We the People,” the White House’s petition site, requesting that pharmacists be recognized as Medicare providers. “By changing the compensation structure allowed under Medicare, we can ensure that patients have access to the medication expertise of pharmacists,” the petition reads. “Studies have shown that when a pharmacist is directly involved in patient care, patients have fewer adverse drug reactions, experience improved outcomes, and health care costs are reduced.”

Soman modeled his campaign on a similar petition placed on Change.org by Sandra Leal, PharmD, CDE, director of clinical pharmacy at El Rio Health Center in Tucson, Arizona, which has received more than 22,000 signatures. Soman’s petition was created on December 27, 2012, and had received more than 16,000 signatures as of January 8, 2013. In order to trigger a response from the Obama Administration, it must receive at least 25,000 signatures by January 26, 2013. (Update: The petition passed the 25,000-signature threshold on January 9, 2013.)

Soman’s goal is to gain support from the general public as well as the pharmacy community. “We need the average Joe on the street to say, ‘How come pharmacists are not health care providers? I go to the pharmacist for my son’s vitamins. I go to the pharmacy for my grandma’s flu shots.They provide health care to me on a daily basis, make recommendations. So, as such, how come they are not health care providers?’” he said in an interview.

Provider status has the potential to bring pharmacists greater compensation and respect, Soman says, but also greater responsibility and demands for verification of their contribution to patient care. “Pharmacists will need to accept change, because when Medicare provides compensation, it’s not going to be free money,” he said. “They’re going to say, ‘You have to meet benchmark A, benchmark B, and goal C in order to get compensation.’”

A December 2012 report from the American College of Clinical Pharmacists (ACCP) announcing that its primary legislative goal is to attain Medicare provider status for qualified clinical pharmacists fills in some details on what pharmacist services might be eligible for compensation and what qualifications might be necessary in order to be considered a provider. Services eligible for compensation, the report proposes, would “rely on direct observation of and interaction with the patient.” In order to be recognized as Medicare providers, pharmacists would need to have a PharmD, or BS in Pharmacy with evidence of equivalent pharmacotherapeutic knowledge or clinical experience, and fulfill a number of other criteria. For all the details of the ACCP’s proposal, click here to read the report.