Expert: The Fight for Provider Status for Pharmacists ‘Has Just Begun’

Pharmacy Times® interviewed Scott J. Knoer, MS, PharmD, FASHP, the EVP and CEO of the American Pharmacy Association (APhA), on how the recently introduced Pharmacy and Medically Underserved Area Enhancement Act may impact pharmacy and health care outlooks.

Alana Hippensteele: So how has a lack of adequate payment for certain services affected pharmacies especially during the pandemic?

Scott Knoer: Yeah, it's been horrible. So, here's an example that really was eye-opening to me: APhA and other pharmacy organizations worked at the beginning of the pandemic to say pharmacists can immunize 3 to 18 year olds.

We were like, ‘We won this is great!’ And a lot of our pharmacies in very busy stores are like, ‘What, how am I going to do that? I have to fill so many prescriptions because of the reimbursement, now I'm immunizing pediatric patients?’

Pharmacists are doing it, and it's very rewarding, but there's so much piled on, and then they have these insane metrics about different things they have to do. Again, they're not reimbursed for doing the right things—we've got to pay pharmacists to do the things that keep patients healthy.

Alana Hippensteele: Yeah. What are some next steps you see as being important for pharmacy in terms of improving issues that have come to light during the pandemic in relation to pharmacists’ role on patient care teams?

Scott Knoer: Yeah. So, we have a very robust strategic plan at APhA, which is available online. It covers lots of things. But for simplification purposes, the 3 biggest areas impacting pharmacy and patient care are: number 1, payment reform; 2, payment form; and 3, payment reform. It all comes back to an unsustainable model.

So APhA is attacking this on 3 fronts. I'm pointing to the capital, which you can't see: federal. State: that's exactly what the bill that dropped yesterday is doing. Once you pass that, the third part of that is also you have to get insurance companies to do it, because a lot that they can, doesn't mean that they do.

So just like in Ohio, we're educating payers—I'm going to show you. This is my beautiful patio here. So, you see there's Lincoln over there. On this patio, we're going to host a summit of payers, and the folks that are paying Ohio, Tennessee, Washington, and many other states we're going to get them here together, we're going to say, ‘Yeah, we had to pay pharmacists. Guess what? Quality went up and total cost of care went down.’

So next steps, all these are happening at the same time. The next steps are the viewers of this: Contact your senators, your representatives—really easy, go to APhA, go to the grassroots, click it, put in your address, it'll send things out.

A lot of pharmacists are very engaged in their communities. They may know or maybe your mom knows a senator or something. Look them up, call them up, have them come visit your pharmacy during the pandemic, have them see you giving immunizations. So, there's lots of steps.

This was hard to get sponsored, but now the tough work begins. We need members all over the place to engage, and quite honestly, my shameless plug: APhA is fighting hard for members. You can see it. We need your support. AMA has got [sic] lots of lobbyists. We need members to support us financially. We're a nonprofit. So was Cleveland Clinic, my hospital. My CEO always said, ‘Yeah, that means we're not for profit, but no margin, no mission.’

If we don't take in money, we cannot invest in lobbying, we cannot invest in practice, we cannot invest in education. So next steps, your members—if you're not a member, join APhA—and follow us. We'll tell you what to do. We're very out there on social media, we're leading the charge. It's just this fight has just begun.

Alana Hippensteele: Yeah, absolutely. How would granting pharmacists full provider status on the federal level change Americans’ health care opportunities?

Scott Knoer: This is huge. The biggest payer in the US is Medicare, and who's on more meds than elderly patients, right? I mean, my mom's on multiple meds.

So, provider status globally is super good. Right now, provider status in underserved areas is super good. This is not going to solve everything; there's no magic wand. This will help with racial disparities in health care; this will help with immunizations; this will help controlling diabetes.

Then here's the simple example, again, your pharmacist audience understands this, but if someone's diabetes is under control, you pay the pharmacist here, but you don't have their foot cut off. If hypertension is controlled, they don't have strokes, they don't have admissions to hospital, they don't have mortality.

So, this will have a tremendous impact. Now, will it happen with a snap of a finger? No. We have trained pharmacists on how to bill and all that, but there's no single thing that can be done at the federal level to improve population health than having pharmacists remunerated appropriately, so that we have a sustainable model where they're incentivized for the right things.

Alana Hippensteele: Yep, absolutely.