Provider Status Legislation Reintroduced in Congress

As pharmacists and pharmacy students continue to work toward provider status, senators and representatives of the recently sworn-in Congress have reintroduced a bill that would bring the pharmacy profession closer to its goal.

Pharmacists are not currently recognized as health care providers under the Social Security Act (SSA), preventing many state and private health care plans from compensating pharmacists for patient care services such as medication coordination, medication therapy management, chronic disease management, and patient education.¹

The Pharmacy and Medically Underserved Areas Enhancement Act (S 109), introduced to the 115th Congress on January 12, 2017, by Senators Chuck Grassley (R-IA), Bob Casey (D-PA), and Sherrod Brown (D-OH), aims to partially rectify that exclusion by amending the SSA, allowing pharmacists to receive Medicare Part B reimbursement for services provided to underserved populations, particularly elderly patients in rural areas who have limited access to care.²

“A lot of people in rural Iowa have easier access to a pharmacist than a doctor,” Senator Grassley said in a press release. “Where that pharmacist is licensed to provide a service, Medicare ought to pay the pharmacist for it. That’s what this bill does. It’s good for pharmacists because they get paid for providing services to rural seniors. It’s good for rural seniors because they keep access to their local pharmacist and don’t have to go to the doctor for straightforward medication management.”³

“Across the country and in Pennsylvania pharmacists play a critical role in helping seniors receive access to routine healthcare services like wellness checks,” added Senator Casey. “This legislation will aid those in rural communities who may not live in close proximity to the doctor but do have regular contact with their pharmacist.”³

This marks the third attempt to pass the Pharmacy and Medically Underserved Areas Enhancement Act, which was originally introduced as HR 4190 in March 2014⁴; after the 113_th Congress failed to pass it, the bill was then reintroduced as HR 592 and S 314 in January 2015, although it expired once more at the end of the 114th Congress.^5-6

Most recently, a companion legislation to S 109, also called HR 592, was introduced by Representatives Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Tom Reed (R-NY), and Ron Kind (D-WI) on January 20, 2017.⁷

“Pharmacists in eastern North Carolina are helping people to live longer, healthier, and more fulfilling lives and saving taxpayers money. But providing those services doesn’t come without a cost to the pharmacist,” Representative Butterfield stated. “I am proud to join my colleagues on this bipartisan measure that will ensure our pharmacists can continue to provide care to those in need.”⁸

Both versions of the Pharmacy and Medically Underserved Areas Enhancement Act have received considerable bipartisan support, with S 109 and HR 592 having gained 33 and 146 cosponsors, respectively, from across both parties at time of writing.^2,7

The bill has also earned praise from provider status advocates and pharmacy organizations, who assert that the legislation reflects the growing value of the pharmacist and allows them to better use their skills and knowledge to improve patient health.

“Many states allow pharmacists to provide services such as health and wellness screenings, immunizations, and chronic disease state management. This legislation would expand access for seniors to these basic services at their pharmacy and free physicians in these underserved communities to focus their attention on other health needs,” said National Community Pharmacists Association CEO B. Douglas Hoey, RPh, MBA, in a press release. “Many independent pharmacies serve traditionally underserved rural and urban communities and are particularly well positioned to administer to the basic health care needs of these populations.”⁹

References

• American Pharmacists Association (APhA). The pursuit of provider status: what pharmacists need to know. APhA website. pharmacist.com/sites/default/files/files/Provider%20Status%20FactSheet_Final.pdf. Published September 2013. Accessed March 1, 2017.
• S.109 - Pharmacy and Medically Underserved Areas Enhancement Act. Congress.gov. congress.gov/bill/115th-congress/senate-bill/109. Accessed March 20, 2017.
• Grassley, Casey, Brown re-introduce popular bipartisan bill to help pharmacists provide medical services to older americans in under-served areas [news release]. Senator Chuck Grassley website. grassley.senate.gov/news/news-releases/grassley-casey-brown-re-introduce-popular-bipartisan-bill-help-pharmacists. Published January 12, 2017. Accessed March 1, 2017.
• H.R.4190 - To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services. Congress.gov. congress.gov/bill/113th-congress/house-bill/4190. Accessed March 1, 2017.
• H.R.592 - Pharmacy and Medically Underserved Areas Enhancement Act. Congress.gov. congress.gov/bill/114th-congress/house-bill/592. Accessed March 1, 2017.
• S.314 - Pharmacy and Medically Underserved Areas Enhancement Act. Congress.gov. congress.gov/bill/114th-congress/senate-bill/314. Access March 1, 2017.
• H.R.592 - Pharmacy and Medically Underserved Areas Enhancement Act. Congress.gov. congress.gov/bill/115th-congress/house-bill/592. Accessed March 20, 201
• Butterfield introduces bipartisan bill to improve health care in underserved communities [news release]. Congressman G.K. Butterfield website. butterfield.house.gov/media-center/press-releases/butterfield-introduces-bipartisan-bill-to-improve-health-care-in. January 23, 2017. Accessed March 1, 2017.
• National Community Pharmacists Association (NCPA). NCPA Supports Bill Recognizing Pharmacists as Health Care Providers [news release]. NCPA website. ncpanet.org/newsroom/news-releases/2017/01/13/ncpa-supports-bill-recognizing-pharmacists-as-health-care-providers. Published January 13, 2017. Accessed March 1, 2017.