Provider Status Dominates Pharmacy Policy Agenda

Provider status legislation may be the signature pharmacy policy issue of 2015.

In a session at the American Society of Health-System Pharmacists (ASHP) 2015 Summer Meetings and Exposition in Denver, several ASHP policy experts outlined critical pharmacy issues being addressed at various levels of government.

A large portion of this session was devoted to discussing provider status for pharmacists.

“Provider status is the biggest legislative issue in pharmacy right now…across the board,” Chris Topoleski, director of federal regulatory affairs for ASHP, told Pharmacy Times in an exclusive interview. “Virtually every pharmacy group is really focused on this.”

On the federal level, the Pharmacy and Medically Underserved Areas Enhancement Act was recently reintroduced in the US Senate and House of Representatives.

The federal companion bills, HR 592 and S 314, enjoy bipartisan co-sponsorship and focus on medically underserved areas as defined by the Health Resources and Services Administration, explained Joseph Hill, MA, ASHP’s assistant director for government affairs and director of federal legislative affairs.

Beyond meeting a medical need, the legislation would amend Medicare Part B rules to allow pharmacists to receive payment for their care services, thereby increasing patients’ access to essential services, including health and wellness screenings and chronic disease management.

Topoleski told Pharmacy Times the legislation focuses on allowing “pharmacists to practice for Medicare beneficiaries in medically underserved areas and medically underserved populations,” so the provider status movement “isn’t looking to compete with primary care.”

On the state side, ASHP’s director of state, grassroots, and political action, Nicholas Gentile, told session attendees that all state legislatures and regulatory bodies must review their scope of pharmacy practice and then expand it to incorporate more patient care services that licensed pharmacists can perform.

The reason for this is the language from the proposed federal provider status legislation includes “…which the pharmacist is legally authorized to perform in the State in which the individual performs such services.”

In an exclusive interview with Pharmacy Times, Gentile said generalizing state-level trends or updates on the provider status movement is “difficult” because the policy is a “moving target.”

“States deal with provider status in many different ways,” he said, noting popular methods include robust collaborative practice agreements and advanced credentialing.

In the policy session, however, Gentile did explain what a “good state provider status law should have.”

These standards should include the ability for a pharmacist to perform patient assessments, administer immunizations, provide medication therapy management services, manage drug therapy for chronic disease states, and initiate, adjust, or discontinue medications pursuant to collaborative drug therapy management.

Last month, Washington became the first state to require pharmacists to be included in health insurance provider networks. “That was a huge coup,” Gentile told Pharmacy Times.

When asked about resistance to the provider status movement, Gentile explained that it depends on the state.

“You know the old axiom—when you’ve seen one state, you’ve seen one state,” he chided.

Outside of the policy session, John Moorman, PharmD, an assistant professor in the Department of Pharmacy Practice at Northeast Ohio Medical University, provided some insight to Pharmacy Times about the major questions surrounding the provider status movement in Ohio.

Some of those doubts include: “Do pharmacists have proper training? How does the liability work?”

“These are fair questions,” he said. “But our argument has always been, ‘We’re not trying to pull patients out of physician practices. In fact, we’re trying to work alongside these physicians, nurse practitioners, and other providers in order to help patients have the best care possible.’”