In a recent blog, we discussed a few of the most significant ways pharmacists could further aid in the ongoing effort to combat the COVID-19 pandemic if they were granted national provider status. As we noted, pharmacists are playing a pivotal role in our nation's response but are being handcuffed because they lack such provider status, thus "preventing them from maximizing their contribution to this battle."
While that blog focused on how pharmacists can add more value during the health crisis, granting pharmacists with national provider status would further strengthen our healthcare system and the overall delivery of care concerning issues and challenges other than the novel coronavirus. In this blog, we will summarize where things stand concerning national and state-level provider status rules for pharmacists and then discuss four of the ways that granting pharmacists with national provider status — as well as making provider rules universal across states — would add value after the worst of the COVID-19 pandemic is behind us.
Federal and State Pharmacist Provider Status Overview
On the federal level, pharmacists lack provider status. As Krystalyn Weaver, vice president of policy for the National Alliance of State Pharmacy Associations, told Drug Topics, "At the federal level, 'provider status' describes access to Medicare Part B. Provider status is shorthand for ensuring that patients can get access to the clinical services that pharmacists provide and that pharmacists get reimbursed for providing those services."
There is a push on the federal level to grant pharmacists provider status. This could be accomplished with the passage of "The Pharmacy and Medically Underserved Areas Enhancement Act." As ASCP notes, this legislation that would "… allow pharmacists to practice at the top of their license and bill Medicare Part B for their services." The bill has been introduced in the 114th and 115th Congresses and ASCP stated that it garnered widespread bipartisan support in both houses of Congress.
Unfortunately, as of this writing, the bill remains in limbo despite significant lobbying for it during the health crisis. A dozen pharmacy groups issued a joint statement outlining policy changes they said will allow pharmacists to more effectively support COVID-19 efforts. Among the calls to action: "Immediately include the Pharmacy and Medically Underserved Areas Enhancement Act in emergency legislation to respond to the COVID-19 crisis."
On the state level, things are less cut and dry. As Weaver notes in Drug Topics, pharmacists are already classified as providers in most states. Sounds good, right? But what exactly that means varies greatly by state and is determined by matters including where in the law provider status is granted, pharmacists' scope of practice as described in state law, and the rules on reimbursement.
While the future of federal legislation concerning pharmacist provider status remains unclear, states are not waiting for federal direction to take their own actions. In a March letter, Thomas Menighan, executive vice president and chief executive officer of the American Pharmacists Association, highlighted some of the more recent efforts and successes on the state legislative level. After noting that 34 states considered 109 provider status recognition bills in 2019, he stated, "I'm blown away by the work state pharmacy associations are doing to advance and raise the profile of policies that increase patient access, promote team-based care, gain recognition and coverage for pharmacists' patient care services, and ultimately reduce costs for the entire health care system."
Benefits of Provider Status for Pharmacists
Now let's highlight some of the more significant ways that granting pharmacists with national provider status and eliminating state-level limitations on pharmacist provider status will improve delivery of care following the pandemic.
1. Delivery of telepharmacy services
The pandemic has further demonstrated the tremendous value of using virtual care technology to deliver services remotely. While it remains unclear how many of the emergency regulations issued during the pandemic will remain in place, it is clear that they have helped contribute to the meteoric rise in adoption and usage of telehealth and telemedicine. The eventual end of the pandemic is expected to do little to stifle the significant demand and growth for these services. and some have been advocating for expanded telemedicine access to remain in place after the pandemic subsides.
One such service receiving greater attention and consideration is telepharmacy. We strongly believe in the value of telepharmacy, which is why Cureatr leverages it in the delivery of our services — and started doing so well before the pandemic. We provide real-time, universal access to accurate medication data for over 265 million patient and high-quality interventions by board-certified telepharmacists.
Telepharmacists are in a strong position to provide a wide range of much-needed services. As Eric Maroyka, director of the American Society of Health-System Pharmacists Center on Pharmacy Practice Advancement recently told Drug Topics, "Telepharmacy has demonstrated value in medication selection, order review, and dispensing; sterile admixture verification; patient counseling and monitoring; and the provision of clinical services."
An article from the Reason Foundation argues for the continued adoption of telepharmacy, stating, "State level reforms to allow increased use of telepharmacy services would help address the current crisis and expand access to care after the pandemic subsides."
Granting pharmacists with provider status would help eliminate many of the obstacles hindering telepharmacy while motivating and enhancing the ability of pharmacists to deliver virtual services that can improve patient wellness and access, strengthen care coordination, and reduce costs, among many other benefits.
2. Medication management
We've written frequently about medication management and the risks associated with poor management, which include increased likelihood of harm and waste. We have also argued for greater involvement of pharmacists in medication management, which would include putting pharmacists in charge of the process or at least better engaging pharmacists as active members of the patient care team. Pharmacists have the training, knowledge, and often the access to data required to deliver medication management services (perhaps via telepharmacy). This includes comprehensive medication management (CMM), medication therapy management (MTM), comprehensive medication reviews, transition of care services, adherence interventions, and eConsults.
The value of pharmacist involvement in medication management is well-documented. For example, an Agency for Healthcare Research and Quality Patient Safety Primer article notes that a cluster-randomized trial of pharmacist involvement in medication management planning on hospital admission showed a dramatic reduction in medication errors within the first 24 hours of hospitalization, while a meta-analysis of 13 studies of pharmacist interventions at transitions of care estimated a 37% reduction in medication errors and a decrease in emergency department visits after hospital discharge.
Any limitations placed on a pharmacist's ability to become more involved in medication management, either at the request of a clinician, patient, or caregiver, will make ensuring patient medications are appropriate, effective, safe, and able to be taken more difficult. This is not good for anyone, and yet it is an unintended result of limitations placed on provider status.
3. Testing and treatment (and more)
Testing and treatment are two services we discussed in our COVID-19 provider status blog, but there is no reason to limit the ability for pharmacists to test and treat patients to just the novel coronavirus. Pharmacists with provider status can could and should be enabled to do much more.
In fact, we are already witnessing what pharmacists are capable of from a testing and treatment perspective, albeit with limitations (a recurring theme). In some parts of the country, pharmacists are providing testing and treatment services via point-of-care testing.
As Bruce Kneeland, senior advisor at Kneeland Services told Pharmacy Times, "There's two or three things about point-of-care testing that are intriguing. First and foremost, in the broadest sense, we're talking about the pharmacist's ability to, under protocol, under a collaborative practice agreement with a physician, do a simple swab tests with patients that will indicate whether or not they're suffering from flu or whether they're suffering from strep throat. In either case, there's appropriate medical therapy that they can then deliver after the test, but the real benefit is just being able to have people come into the pharmacy without an appointment [and] present to the pharmacy or the pharmacist's staff with a concern that they have." Both Walgreens and CVS already offer clinical walk in clinical services.
As a January Florida Today article notes, "Currently 17 states allow for pharmacists to test and treat for the flu and strep and provide treatment under a supervising physician." That number should be 50 and these services should not require physician supervision, which can be made possible via granting of provider status.
Beyond testing, screening, and treating minor health conditions, pharmacists should have the unrestricted ability to provide point-of-care blood testing to help identify people at risk of heart attack, stroke, and diabetes, for example, and provide services to help manage chronic conditions. Pharmacists are also in a position to help patients by delivering counseling/consulting services, such as those associated with smoking cessation.
Not only are pharmacists capable of delivering these services and more, consumers view pharmacists as highly trustworthy. In fact, only nurses, engineers, and medical doctors ranked higher than pharmacists for honesty and ethical standards among professionals in the United States, according to Gallup. Physicians edged pharmacists by 1 percentage point (65% vs. 64%). Granting provider status to pharmacists would enable even more patients to take advantage of numerous testing, screening, treatment, and counseling services delivered by skilled and honorable professionals.
Finally, let's briefly touch on vaccinations. When the day (hopefully) comes that a vaccine for COVID-19 is approved, we will want as much as access as possible to increase the speed and efficiency of which consumers can receive it. Pharmacists should be in a position to administer this vaccine and all others without restrictions.
Pharmacists have some vaccine authority, but there are numerous caveats, as Drug Topics summarizes: "Although pharmacists in all 50 states have been given the authority to administer influenza vaccines to adult patients, pharmacists in some states are still limited by which vaccines outside of influenza they are able to administer, the age of patients they are able to administer to, and whether a patient needs a prescription before getting a vaccine at the pharmacy."
These roadblocks to improve immunization are unfortunate, to say the least. Rates of recommended vaccination for adults in the United States are low. Pharmacists can help bolster vaccine use, as an AJMC article notes. "With awareness among adults about needed vaccinations lacking, pharmacists are more than qualified to fill that need. In their interactions with patients, pharmacists can provide up-to-date information about the importance of vaccines and which are recommended. Community pharmacies and pharmacists act as community educators not only by providing literature on vaccinations and where to receive them, but by screening all patients for missing or recommended immunizations."
The article later goes on to state, "Pharmacists are easily accessible healthcare providers whose training and certification prepares them for fully participating in all aspects of community vaccination delivery. Most importantly, pharmacists can readily connect the dots for patients, from offering education, advice, and guidance to providing the venue for and the administration of important adult vaccinations."
If patients had easier and expanded access to vaccines, and received regular education about their importance, vaccination and immunization rates would rise. Granting pharmacists with provider status would help eliminate logistical, financial, and regulatory roadblocks to vaccination that are jeopardizing health and wellness.