Provider Status for Pharmacists

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The push for pharmacists’ provider status has reinvigorated over the last few years. To date, pharmacists are not recognized under Section 1861 of the Social Security Act as health care providers eligible for Medicare Part B reimbursement. Medicare Part D is the only means through which pharmacists can bill Medicare for select cognitive services, such as medication therapy management. However, this method of billing is restricted to a specific patient population and excludes the full range of services pharmacists are capable of providing other than dispensing.

Data collected on the impact of pharmacists’ professional services clearly exemplifies the importance of pharmacists’ clinical intervention. It is critical that pharmacists obtain recognition and compensation for these services at federal and state levels. Our advocacy efforts must highlight the key role of pharmacists’ expertise in achieving optimum person-centered health care.

As consultant pharmacists and experts in geriatric medication management, ASCP members are uniquely positioned to demonstrate the value of pharmacist-delivered direct patient care. Beginning in the 1960’s, the government recognized pharmacists’ ability to provide expert medication oversight and management of patients in the long-term care setting. This recognition established the profession of consultant pharmacy, which now has a decades-long track record of improving outcomes and reducing health care costs.

ASCP Position

To read ASCP’s full position statement, “Statement on Pharmacist Provider Status and The American Society of Consultant Pharmacists,” click here (PDF).

The American Society of Consultant Pharmacists advocates that pharmacists be recognized as health care providers. ASCP recommends that pharmacists have appropriate qualifications to care for patients with complex medication related needs. ASCP encourages payer systems to recognize and compensate pharmacists for services rendered as a health care provider. ASCP supports cooperation between pharmacists and payers in developing payment systems to facilitate pharmacist compensation for delivering comprehensive medication management services.

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Introduction of Legislation to Recognize Pharmacists as Providers 

On March 11, 2014, Reps. G.K. Butterfield (D-NC), Todd Young (R-IN) and Brett Guthrie (R-KY) introduced H.R. 4190 (PDF), which seeks to recognize pharmacists as providers of health care services under Medicare Part B. This effort was advanced by a newly formed coalition, the Patient Access to Pharmacists’ Care Coalition (PAPCC), a group of approximately 20 pharmacy and patient advocacy stakeholder groups, including ASCP. The bill would amend the Social Security Act to allow the provision of pharmacist services in medically underserved areas and populations and stipulates that pharmacists can act as a stopgap for the shortage of health care workers in these communities. Upon introduction, this bill was immediately referred to the Energy and Commerce Committee and the Ways and Means Committee in the House of Representatives. Simultaneously, there are efforts to introduce a companion bill in the Senate. ASCP will keep members up-to-date as this bill progresses through the various stages of the legislative process. 

ASCP Approves Key Policy Statement on Pharmacists Provider Status 

In July 2013, ASCP’s board of directors approved a policy statement on achieving provider status for pharmacists, a key issue in pharmacy practice. Pharmacists are not recognized under the Social Security Act under Section 1861 as health care providers and therefore are limited in scope of practice and reimbursement throughout the entire health care system. The final policy statement, which will serve as the foundation of ASCP’s framework for provider status advocacy, was published on September 12. Members are urged to participate tomorrow, September 19 at 1:00 pm EST, in a Webinar (members only) to hear a detailed overview of the provider status policy statement and the next steps in ASCP’s advocacy initiative. This will be a great chance for members to ask questions and provide feedback. 

There will be multiple opportunities and forums in the near future and over the long term for members to share their thoughts and ideas. Additionally, the Society invites members to contribute their ideas and to ask questions by e-mailing providerstatus@ascp.com and visiting our recently updated Provider Status Advocacy Center

State Provider Status Legislation

According to a survey conducted by the National Alliance of State Pharmacy Associations (NASPA), less than half of states recognize pharmacists as “providers” under state law (2). This designation may appear in established legislation such as the state’s insurance code or the health professional practice code. Some states have taken significant legislative steps to distinguish pharmacists as providers in separate legislation. For more information on state-specific initiatives and programs, click here.

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