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.
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.
Federal Provider Status Legislation
Currently, there is no pending legislative action to amend the Social Security Act to include pharmacists’ clinical services under Medicare Part B. However, there have been multiple efforts in this direction. In 2004, a bill was introduced that outlined payment for clinical pharmacy services provided by a Pharmacist Clinicians or Clinical Pharmacist Practitioners. In 2008, the bill was reintroduced as H.R. 5780. The latest version of the bill was introduced in 2010, which would have permitted pharmacists (mid-level providers) with advanced training to bill Medicare Part B at 85% of the physician reimbursement rate. For exact bill language, see below.
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 .