Why Pharmacists Need to Practice at the Top of Their Licensure

Pharmacists have an important role in improving patient health in their communities, but to reach their full potential, they must practice at the top of their licensure by expanding their services from just medication dispensing to chronic disease management, point-of-care testing, patient education, and medication therapy management.

In recent years, pharmacists have increasingly become recognized as essential contributors to patient care and community health. This is because pharmacist involvement in care has been proven to result in better outcomes for patients with diabetes, hypertension, and cardiovascular disease.

For example, a systematic review of 298 studies showed that patient outcomes—which accounted for factors such as hemoglobin A1C, cholesterol, blood pressure, and adverse drug events—improved substantially in response to pharmacist-provided direct patient care when compared to conventional or alternative care, according to a report from the University of Washington’s Center for Health Workforce Studies.¹

Despite this evidence, many pharmacists still do not practice at the top of their licensure, primarily due to current state regulations and restrictions in insurance reimbursement, which raised concerns that graduates of 4-year Doctor of Pharmacy programs are “overeducated for dispensing-only roles and underused in delivery of care,” according to the report.

Failure to correct this problem may result in a missed opportunity to use the skills and talents of pharmacists to assist the rest of the health care system in managing our growing disease burden, particularly among the nation’s growing elderly population, the report states. Community pharmacists are the most accessible health care providers and uniquely serve rural and medically underserved areas.The power of this accessibility is greatly diminished if pharmacists face challenges that threaten top-of-license practice.

A Transition to Patient Care That Has Already Begun

Virtually everyone who has encountered the health system intuitively understands that pharmacists are experts at dispensing medications, confirming proper dosages to ensure patient safety and similar functions. However, fewer are likely familiar with pharmacists’ abilities and expertise in providing medication therapy and engaging patients in chronic disease management, health promotion, and disease prevention.

The good news, for both the US health care system and pharmacists, is that pharmacists in recent years have increasingly embraced their expanded roles of providing more patient care services. A recent study in the journal Pharmacy revealed that, in 2019, 52% of US pharmacists contributed a significant portion of their time to patient care service, up from 40% in 2014. Similarly, the study found that fewer pharmacists devoted their time primarily to dispensing medication in 2019 (34%) compared with 2014 (40%).²

Nonetheless, pharmacists' roles in patient care vary widely, depending on the setting in which they practice and their states' scope-of-practice laws. In an ideal health care world, pharmacists would serve as an integral part of the patient care team, helping patients improve their medication use, increase outcomes, and reduce their overall use of health care resources.

How to Spark Change

Variation in state scope-of-practice laws and regulations limits pharmacists’ ability to consistently practice at the top of their license and can make it confusing for other providers to know the extent to which pharmacists can be used on a care team, according to the University of Washington report.

These 3 steps would help enable pharmacists to practice at the top of their licensure and play a more active role in patient care:

• Modernize reimbursement: Traditionally, pharmacists’ pay has been based on dispensing drugs rather than obtaining reimbursement for delivering patient care services, meaning that time devoted to patient care and education generally is not reimbursed. Medicare does not recognize pharmacists as eligible providers, rendering pharmacists unable to bill directly for most patient care services (with a few exceptions).

Similarly, Medicaid varies by state regarding the types of patient-care services for which pharmacists can be reimbursed. Medicaid reimburses pharmacists in 14 states for patient care services, including medication therapy management, vaccine administration, and counseling for smoking cessation. For pharmacists to deliver services beyond their dispensing role, they must be recognized as eligible reimbursable providers by Medicare, Medicaid, and commercial insurers.

The Pharmacy and Medically Underserved Areas Enhancement Act (HR 2759/ S. 1362) aims to amend section 1861 (s) (2) of the Social Security Act and add pharmacists to the list of nationally recognized providers. Although this is not the end game for provider status and reimbursement recognition, it would represent a key milestone along the path of federal recognition.

• Adopt universal licensure: All US states grant pharmacists the authority to dispense prescriptions, but policies around the formal or informal collaboration between pharmacists and providers are constantly in flux, according to the University of Washington. This uncertainty can create hesitance by pharmacists to explore the viability of adding new patient-care services to their practices.

To avoid this problem and provide greater clarity to pharmacists, patients, and providers, the federal government should overcome state limitations by adopting a universal licensing program that establishes comprehensive national rules and regulations around pharmacists’ scope-of-practice, fully embracing the accessibility of this professional. State variations will always exist but raising the baseline at the federal level will better enable equitable reimbursement for clinical services while generating clarity, consistency, and greater accessibility.

• Open the aperture in pharmacy education programs: Now is the time to expand pharmacy education to embrace the innate entrepreneurial spirit within the pharmacy student, encourage innovation, and design new models of care. Programs that guide learners, both students and licensed pharmacists alike, on the practical application of clinical care services, as well as the overall business opportunity, will set the stage for long-lasting growth and adoption. A better understanding of the medical billing process, collaborative practice, interoperability, and how to effectively market clinical services in the community will help promote top-of-license practice.

To keep pace with a changing health care market and evolving consumer needs, pharmacists need to expand their patient care roles and be recognized as reimbursable providers. Pharmacists have demonstrated their value in ensuring safe medications, improving medication adherence and patient outcomes, reducing hospitalizations, and helping to lower costs with alternative medications. Now, it is time to return the favor by enabling all pharmacists to finish what many have already started by embracing a more active role in patient care.

Jason Ausili, Pharm.D., is the Chief Clinical Officer at FDS Amplicare, where he focuses on delivering innovative clinical-based technology solutions that help mobilize pharmacists as care providers and practice at the top of their license. Jason received his Doctor of Pharmacy degree from Butler University in 2002 and has over 20 years of diverse industry experience. He has held a variety of roles across the spectrum of community pharmacy and throughout his career has stayed centered on his aim to expand the scope of pharmacy practice, improve healthcare quality performance, and ensure pharmacists receive equitable payment for clinical services and improving patient outcomes

REFERENCES

• Pollack SW, Skillman SM, Frogner BK. Assessing the Size and Scope of the Pharmacist Workforce in the U.S. Center for Health Workforce Studies- University of Washington. September 2020. Accessed September 16, 2021. https://depts.washington.edu/fammed/chws/wp-content/uploads/sites/5/2020/09/Pharmacist-Size-Scope_FR_Sep4_2020.pdf
• Schommer J, Doucette W, Witry M, et al. Pharmacist segments identified from 2009, 2014, and 2019 national pharmacist workforce surveys: implications for pharmacy organizations and personnel. 2020 March. 26; 8(2): 49. doi: 10.3390/pharmacy8020049. PMID: 32224863; PMCID: PMC7355503.