Op-Ed: Why We Need a Health Promotion Screening Law in Massachusetts

If there is something the COVID-19 pandemic has taught us, it would be that we must always remain nimble in our approach to delivering access to health care. State governments have been relying more heavily on the pharmacy workforce to provide patients with access to essential health care services, from COVID-19 testing to patient counseling and administration of certain drugs and immunizations.

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Pharmacists are well-trained to provide services that promote patient health, prevent disease, and reduce the total cost of health care. Collaborative community pharmacy-based models have proven safe and effective for the management of group A Streptococcus, influenza, and HIV pre-exposure prophylaxis.^1-3 Models such as these are used in several countries including the United States, Canada, England, and New Zealand.

Further emphasizing the need for access to health care professionals, data show that upward of 54% of individuals using these community pharmacy services report not having a primary care physician and 38% of visits occurred outside the traditional clinic hours for evaluation.¹ To implement these services, evidence-based algorithms incorporate risk factors and clinical presentations to guide pharmacists whether to refer patients to the emergency department, urgent care, or primary care physician when necessary, versus determining which patients require anti-infectives or over-the-counter symptomatic relief.² In fact, these models were initially created to develop infrastructure and skills to allow pharmacies to offer a higher level of care should a pandemic arise.

Without a doubt, pharmacists play a vital role in health care and public health. More than 91% of Americans live within 5 miles of a community pharmacy.⁴ Community pharmacies keep longer business hours than traditional medical offices, which means pharmacies are commonly used as care access points. Studies show that Medicare beneficiaries visit community pharmacies an average of 6 to 7 additional times per year compared to primary care physicians, with the largest discrepancies in rural areas.⁵ Not only are pharmacists highly accessible health care providers, but they are also consistently viewed as one of the most trustworthy professions.⁶

The implementation of these screening and testing services by pharmacists will expand access to care for patients, including patients who may not yet have a primary care provider, who cannot get timely appointments with their providers, or by providing extended appointment times beyond traditional clinic hours. Importantly, by providing these functions, pharmacies will provide an alternative option for patients who are currently presenting toemergency departments for non-urgent visits.

Current regulation prevents pharmacists from being able to provide these services consistently. Despite the research reaffirming these benefits, pharmacy professionals are restricted in their ability to provide optimal care.

Health promotion screening is needed in the United States to off-load valuable health care resources so that equitable and accessible preventative care is provided.

So where has the policy been on this issue?

On the federal level, pharmacy provider status has been the broader focus of health promotion screening. Pharmacy provider status has been an issue that has been advocated for on the federal level for over 10 years.

The last Congressional session saw the introduction of 2 bills; H.R. 2759 titled Pharmacy and Medically Underserved Areas Enhancement Act, sponsored by Congressman Butterfield (D-NC), as well as the Equitable Community Access to Pharmacist Services Act, H.R. 7213 (2021-22) sponsored by Congressman Kind (D-WI).

• The Equitable Community Access to Pharmacist Services Act (H.R. 7213), sought to “provide for continued coverage of pharmacist services relating to testing and vaccines for COVID-19 and influenza, as well as coverage of testing for respiratory syncytial virus and streptococcal pharyngitis (i.e., strep throat) and the initiation of drug regimens that are used to treat COVID-19, influenza, or strep throat. It also generally provides for coverage of pharmacist services during a public health emergency or to address health equity.”
• The Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 2759/S. 1362, sought to provide for Medicare coverage and payment with respect to certain pharmacist services that (1) are furnished by a pharmacist in a health-professional shortage area, and (2) would otherwise be covered under Medicare if furnished by a physician.

This Congressional session has seen the introduction of The Equitable Community Access to Pharmacist Services Act (H.R.1770) sponsored by Reps. Adrian Smith (R-NE), Brad Schneider (D-IL), Larry Bucshon (R-IN), Doris Matsui (D-CA), and pharmacists Buddy Carter (R-GA) and Diana Harshbarger (R-TN). The bill is supported by the American Society of Health-System Pharmacists (ASHP) and the American Pharmacists Association (APhA) as this proposed bill would ensure that pharmacists can continue to provide seniors with access to essential care and services for COVID-19, influenza, respiratory syncytial virus (RSV) services, and strep throat.

Specifically, H.R. 1770 would ensure patient access to essential pharmacist services for seniors and rural and other underserved populations, including testing for COVID-19, influenza, RSV, and strep throat; treatment for COVID-19, influenza, and strep throat; and vaccinations for COVID-19 and influenza.

The proposed bill can be viewed here.

On the state level, pharmacy provider status has varied based on state statutes for pharmacy scope of practice allowances, resulting in a broad range of abilities such as smoking cessation, diabetes and cardiovascular management, travel medicine, immunization programs, alcohol and drug abuse, diet and birth control.

Additionally, as pharmacists have been attempting to modernize outdated statutes to address the needs of the modern patient, pharmacists have found that there have been some professions that have been lukewarm to the need of having pharmacists expressly stated in law as part of the patient’s health care team. We at the Massachusetts Society of Health-System Pharmacists (MSHP) believe that now more than ever it is time to aggressively seek out new allies and have new conversations with parts of the health care system that may not be used to working with each other. Only then can we start to see the positive impacts of lowering health care costs and improving patient outcomes and start to explore the unlimited potential of personalized medicine.

That is why we are excited to be working with Senator Moore (D-Millbury), as he has sponsored S. 1425 titled “An Act Relative to Pharmacists as Healthcare Providers.” The bill can be read here.

Instead of trying to fit the needs of Massachusetts patients and our health care system into a broad and uneven theme of pharmacy provider status, we at MSHP decided to focus on endorsing health promotion screening as a strategy to meet the needs of our patients and health care system.

This bill helps support equitable access to care by allowing pharmacists to test for and treat certain conditions such as influenza, streptococcal infections, COVID-19, HIV, and other conditions authorized by the Board of Pharmacy. Additionally, if passed, this bill would help solidify reimbursement for these services. The bill is currently in the Joint Committee on Public Health.

MSHP looks forward to collaborating with fellow health care professionals to help our patients access the cost-effective care they need while also making our system more efficient. If you have any additional questions or concerns, feel free to contact us at legislative@mashp.org.

REFERENCES

1. Klepser DG, Klepser ME, Smith JK, et al. Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting. Res Social Adm Pharm 2018;14:356-359.

2. Klepser DG, Klepser ME, Murry JS, Borden H, Olsen KM. Evaluation of a community pharmacy-based influenza and group A streptococcal pharyngitis disease management program using polymerase chain reaction point-of-care testing. J Am Pharm Assoc 2019;59:872-879.

3. Zhao A, Dangerfield II DT, Nunn A, et al. Pharmacy-based interventions to increase use of HIV pre-exposure prophylaxis in the United States: a scoping review. AIDS Behav 2022;26:1377-1392.

4. Qato DM, Szenk S, Wilder J, Harrington R, Gaskin D, Alexander GC. The availability of pharmacies in the United States: 2007-2015. PLoS ONE 2017;12:e0183172

5. Berenbrok LA, Gabriel N, Coley KC, Hernandez I. Evaluation of frequency of encounters with primary care physicians vs visits to community pharmacies among Medicare beneficiaries. JAMA Network Open 2020;3:e209132

6. Gallup poll website. https://news.gallup.com/file/poll/388700/220112HonestyEthics.pdf. Accessed January 24, 2023.