The Road to Pharmacist Provider Status

Contributed by: Anojinie Karunathilake, Class of 2017

P1070662Background of Pharmacy

Pharmacy practice has evolved from dispensing medications to a comprehensive clinical, consultative, educational and a more patient centered practice. The value of pharmacist services in collaborative drug therapy management is widely recognized. Pharmacists continue to hold highest ratings as the most trusted healthcare professionals in Gallup Poll. Given this recognition by patients, it is important that pharmacists continue to provide high quality patient care and increase services that are provided to patients, which can be further enhanced by pharmacists obtaining the provider status.

What is provider status?

‘Provider status’ at the federal level consists of a listing of healthcare professionals included in the Social Security Act (SSA) whose services are eligible for Medicare Part B reimbursement. These healthcare professionals include physicians, physician’s assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives and certified registered nurse anesthetists1.

Title XVIII of SSA that describes provider status does not recognize pharmacist services as eligible for reimbursement under Medicare.   In Medicare part B, pharmacists are omitted as listed providers which limits access to pharmacists services to Medicare beneficiaries2,3.

Legislation

HR 5924 (House of Representatives) and S. 3145 (Senate) are written to amend title XVIII of Social Security Act to provide coverage under Medicare program of pharmacist services. This act is also known as the ‘Pharmacy and Medically Underserved Areas Enhancement Act’

Role of the Pharmacist

Many Americans do not have access to primary healthcare and is expected to get worse as the Medicare enrollees are expected to grow in the future. According to Health Resources and Services Administration (HRSA)- U.S. Department of Health and Human Services, Medically Underserved Areas/Populations (MUA/MUP) is defined as “having too few primary care providers, high infant mortality, high poverty or a high elderly population”6. Many areas in West Virginia state are considered as medically underserved areas6. Pharmacists obtaining provider status will help patients in MUA gain access to pharmacists’ services, which increase their quality of life, health outcomes and cost-effectiveness.

According to a report brief published by Institute of Medicine, there are at least 1.5 million preventable adverse drug events (ADE) that occur in the U.S. every year7. These ADE are costly for patients as well as their employers, hospitals and insurance companies. Being a trusted healthcare professional with direct access to patients, pharmacists can provide educational services to reduce incidents of ADE.

Medication adherence also is an area where a pharmacist can make a significant impact. Poor medication adherence estimated to cost around $100 billion a year in the U.S., is a reason for 33-69% of all medication-related hospital admissions8. Especially, almost 50% of patients with chronic diseases do not take their medication properly9.   By increasing pharmacist services through provider status, pharmacists can help improve patients’ medication adherence as well as disease management.

Current Situation

Many pharmacy organizations and several chain pharmacies have been instrumental in advocating for the provider status for pharmacists. Many are involved in writing letters to their representatives in Congress encouraging them to support provider status bill. Currently, a majority of U.S. House have co-sponsored H.R. 59210.

With the momentum building and many more supporters joining to advocate for H.R. 592/S. 314, hopefully pharmacists’ contributions towards healthcare teams and patient services will be recognized as an integral part of healthcare in the near future.

References

  1. APhA. Provider Status: What pharmacists need to know now. 2013. http://www.pharmacist.com/provider-status-what-pharmacists-need-know-now. Accessed January 6, 2016.
  2. ASHP. A bill to amedn title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services. 2015. http://www.cqrcengage.com/ashp/app/bill/487919. Accessed January 5, 2016.
  3. O’Brien JM. How nurse practitioners obtained provider status: Lessons for pharmacists. Am J Heal Pharm. 2003;60:2301-2307. http://www.medscape.com/viewarticle/464663.
  4. Congress.org. HR 592- Pharmacy and Medically Underserved Areas Enhancement Act. 2015. https://www.congress.gov/bill/114th-congress/house-bill/592/text?q={“search”:[“HR+592”]}. Accessed January 6, 2016.
  5. Congress.org. S.314 – Pharmacy and Medically Underserved Areas Enhancement Act. 2015. https://www.congress.gov/bill/114th-congress/senate-bill/314/text?q={“search”:[“S.+314”]}. Accessed January 6, 2016.
  6. HRSA DHHS. MUA Find. http://datawarehouse.hrsa.gov/tools/analyzers/muafind.aspx. Accessed February 14, 2016.
  7. Medicine I of. Preventing Medication Errors: Report Brief. 2006. https://iom.nationalacademies.org/~/media/Files/Report Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf. Accessed January 6, 2016.
  8. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497. doi:10.1056/NEJMra050100.
  9. APhA. Improving Patient Care. 2015. http://www.pharmacist.com/sites/default/files/files/Making the Case (2015).pdf. Accessed January 7, 2016.
  10. APhA. An Update from Tom Menighan, CEO of APhA. 2015. http://echo4.bluehornet.com/hostedemail/email.htm?CID=31858955709&ch=59FBFD48BBC77F7D250F6152F0853DFB&h=101a58de85df02e6330c32f53b58b43c&ei=7dMpdFyNK. Accessed January 7, 2016.

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