Expert: Provider Status for Pharmacists ‘Could Be Possible in 2024’

Pharmacy Times interviewed Ken Perez, MBA, Ken Perez, MBA, a health care marketing, strategy and policy consultant and vice chair of the American Society of Health-System Pharmacists Foundation Board, on recent developments toward provider status being introduced in legislation in Congress. Perez also highlights the progress, challenges, and potential outcomes related to the push for pharmacist provider status.

Pharmacy Times: What have been some of the developments regarding provider status for pharmacists that occurred in 2023?

Ken Perez, MBA: Pharmacist provider status has been a long standing cause or movement in the pharmacist profession. So, in 2023, there were 2 bills that were teed up, one in the House and then with an accompanying identical bill in the Senate, and then one in the Senate, and I'll talk about both of those. They are in response to the continued lobbying and advocacy work, but also just the realities of societal challenges which I’ll go into.

Back in March 2023, HR 1770 was introduced into the House and also Senate Bill 2477. And this provided for permanent coverage across the nation, for Medicare, reimbursement for pharmacists’ services for testing, vaccines, and treatment of COVID-19, influenza, RSV, and strep. So this approach was a narrow range of services across the entire nation. So broad geography, narrow range of services. So that's the that's kind of the first approach.

There's another approach which was introduced in in May, and that was Senate Bill 1491, and that was for Medicare payment for certain pharmacy services in what are called a health care provider shortage area [HPSA], and these are where there’s not enough primary care physicians. It was introduced in the Senate by Chuck Grassley from Iowa, and it had 12 co-sponsors—7 Democrats, 4 Republicans, and 1 independent—which is showing again, we have bipartisan support for this. So those are the 2 big developments.

The key thing is the fact that Tom Cotton, who is a very conservative senator out of Arkansas, and Raphael Warnock, one of the most liberal senators out of Georgia, a Democratic senator there, and they're co-sponsors of this. And I think this reflects a greater sense of bipartisanship and concern and interest in pharmacist provider status.

The 2 big things that people realize, and this is why there's bipartisan support, is that there are just kind of 2 realities that no one can deny. First of all, there's a primary care physician [PCP] shortage in the United States. HRSA has estimated that 17,500 PCPs is the shortage we have today. And a study by the AMC found that the projection is that we can have as many as a 48,000 [PCP] shortage by 2034. So, in 11 years from now, we could have a shortage of almost 50,000 [PCPs].

I mentioned HPSAs—there's a concept called food deserts, where you can't get healthy, nutritious fresh food due to a lack of grocery stores, basically. There's also a concept of PCP deserts, and HRSA has defined a PCP desert as basically being if you have one or fewer [PCPs] for every 3500 people, and that's an HPSA. The interesting thing about it is they add up all the numbers, and this is relatively new information, but in the last year, we totaled it up, there are 102 million Americans, which is 31% of our population, that live in these age HPSAs; 65% of these HPSAs are in rural areas. Because we have about 65 million Americans on Medicare as of March of last year, it's pretty clear that there's about 15 to 20 million Medicare beneficiaries who live in those age HPSAs. So this is a huge issue across many states, blue states, red states, it doesn't really matter what color the states are. This is a huge issue and the challenge of not having enough access to [PCPs] is a real one. So this is a very significant issue. 2023 teed up these basically 2 different legislative approaches. So that's what happened last year.

Pharmacy Times: Where are we now in terms of progress toward provider status for pharmacists?

Perez: Well, I think there's some encouraging news, which is that there's bipartisan support, as I mentioned, for Senate Bill 1491. I forgot to mention in HR 1770 that there are 96 co-sponsors, which is a very large number—49 Republicans and 47 Democrats, so that's significant. That's the good news.

The other good news is that these bills have not died. They're still in Congress and they've been referred to committees and then also to subcommittees—and the right ones, the powerful, for instance, the Energy and Commerce Committee, and their Subcommittee on Health has HR 1770. So those are the right groups that are dealing with these and considering these bills. They have not been voted on, though.

The other good news is that these bills have not died. They're still in Congress and they've been referred to committees and then also to subcommittees—and the right ones, the powerful, for instance, the Energy and Commerce Committee, and their Subcommittee on Health has HR 1770. Image Credit: © doganmesut - stock.adobe.com

There's a hope that this next year in 2024, that in a end of year financial package, a spending package, that because of the bipartisan support for one or more of these bills, they will be able to be part of a larger omnibus bill. So that's what the outlook is. It's possible that at the end of the year, so probably post-election, in a large omnibus bill, it could be included, that's what most people believe, is that it could happen this year.

Pharmacy Times: What are key takeaways from this progress toward provider status for pharmacists?

Perez: I think there's a lesson—I've always been asked this question about advocacy—about any tips on how to do advocacy well. Ten years ago, in the whole area of provider status, we saw opposition from the AMA. Physician groups would say, “This is infringing on our turf. Pharmacists don't do this, this is the work we do.” And now in 2024, because of the evidence of shortage and serious shortage of [PCPs] and lack of access to that kind of care in a significant part of the United States, the AMA and other physician groups cannot say, “Oh, there's no problem.” And they can't snap their fingers or wave a magic wand and say, “Oh, we'll just create more [PCPs].” The economic forces, the economic incentives to be specialists rather than [PCPs] are very significant. We've seen that trend for years, these numbers, both the current shortage as well as the projection of increased shortage of [PCPs] is inexorable. It's going to happen. It's a question of severity and significance. But we're going to have it, and it's affecting patients; it's affecting people and their access to care.

The advocacy tip is to always connect a cause with a societal problem. And this is what pharmacist’s providers has kind of morphed into or adopted. It has really not just been something about self-interest, but actually about the most important thing, which is the delivery of care. And these statistics, these numbers about lack of access to [PCPs] is not coming from pharmacists or pharmacies or the associations of those organizations. It's coming from the federal government. It's coming from independent studies that have been done, and it really reflects the realities of United States in terms of access to care, especially in rural areas. And that explains why Tom Cotton and Raphael Warnock are strange bedfellows in this particular cause. And I think this is almost a case study of how advocacy has to tap into societal problems and the needs of our society and explain how it's altruistic how it brings value ultimately for patients, and that means access to care for our population.

So, that's the key takeaway, I think. And it is really kind of a case study for how to do advocacy in appealing to the general public as well as obviously the legislators for a given cause and a given piece of legislation. So, I'm hopeful that this will continue to be compelling, and that we'll see progress within the next year or 2.

Pharmacy Times: What might that provider status for pharmacists look like, if the legislation is passed?

Perez: Well, I think it's pretty broad because it is going to be written that way in the legislation, although I would say that the community pharmacies and retail pharmacies in particular and clinics that we see across the United States are going to be the focal point because of the recent experience with a pandemic.

Most of the efforts—I shared 2 different approaches the HR 1770 and the companion Senate Bill 2477, this is the one with coverage across the nation by Medicare for pharmacists services that are focused on testing vaccines and treatment of COVID-19, influenza, RSV, and strep. That is based on the experience during the public health emergency and that bill wants to make it permanent. And I think that is going to be, from an experience standpoint, primarily in retail pharmacies. And that's where the pharmacies and pharmacist associations have put most of their effort in terms of lobbying. And there's a coalition, a large coalition, that includes those associations as well as the retail pharmacies, the large chains, the NACDs, and the NCPA—both support this, as well as the big drug wholesalers, the big 3 drug wholesaler support it as well. So, I think that's where most of the effort is from a lobbying standpoint. So, if you're betting on which approach is probably going to be adopted, I would say this one HR 1770 is probably going to be the one that will prevail ultimately.

Editor's Note: Ken Perez's title was updated on January 18, 2024 at 12 PM ET.