Pharmacists and Provider Status

What is provider status?  Why is it important to the profession to gain?

Pharmacists and pharmacists’ patient care services are not included in key sections of the Social Security Act (SSA), which determines eligibility for health care programs such as Medicare Part B. In the case of Medicare Part B, the omission of pharmacists as listed providers limits Medicare beneficiaries’ access to pharmacists’ services in the outpatient setting. Other health care professionals who are listed as providers in Part B of the SSA include physicians, physician’s assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives, and certified registered nurse anesthetists. In addition to providers, Part B provides the list of medical and other health services covered.

Many state and private health plans often cite the omission from Medicare Part B as a reason for lack of coverage for beneficiaries or lack of compensation of pharmacists for providing comprehensive, patient-centered care. Omission from Medicare Part B can also result in barriers to optimizing the use of pharmacists’ patient care services in emerging integrated care delivery models promoted by the Affordable Care Act (ACA), such as medical homes and accountable care organizations (ACOs), which are located in another section of the SSA.

The American Pharmacists Association has a full page of the hows and whys.

The American Society of Health-System Pharmacists is on board as well.

California has passed legislation and just like most bills starting in CA, it will sweep the country.

Here's a summary of what was passed in California last year:

Pharmacist Provider Status Legislation SB 493 (Hernandez) Summary

Now that the pharmacist provider status bill has been signed by the Governor, many pharmacists are asking: “what does this bill do for me?” SB 493 grants all pharmacists certain authorities in all practice settings that had previously been limited to inpatient settings or integrated systems. The bill also establishes a new “Advanced Practice Pharmacist” recognition. This recognition can be granted when specified experience and/or certification requirements are met. The Advanced Practice Pharmacist recognition is not mandatory, but it does allow pharmacists to provide additional services. Below is a summary of SB 493’s changes, which take effect January 1, 2014, though some provisions require regulations by the Board of Pharmacy and will not take effect until those regulations are approved.

  • Declares pharmacists as healthcare providers who have the authority to provide health care services.
  • Authorizes all licensed pharmacists to:
  • Administer drugs and biologics when ordered by a prescriber. Previously, this was limited to oral and topical administration. SB 493 allows pharmacists to administer drugs via other methods, including by injection. 
  • Provide consultation, training, and education about drug therapy, disease management and disease prevention. 
  • Participate in multidisciplinary review of patient progress, including appropriate access to medical records. 
  • Furnish self-administered hormonal contraceptives (the pill, the patch, and the ring) pursuant to a statewide protocol. This authority is similar to the existing emergency contraception protocol. Once a statewide protocol is adopted by the Board of Pharmacy, it will automatically apply to all pharmacists. 
  • Furnish travel medications recommended by the CDC not requiring a diagnosis. 
  • Furnish prescription nicotine replacement products for smoking cessation pursuant to a statewide protocol if certain training, certification, recordkeeping, and notification requirements are met. Once a statewide protocol is adopted by the Board of Pharmacy, it will automatically apply to all pharmacists. 
  • Independently initiate and administer immunizations to patients three years of age and older if certain training, certification, recordkeeping, and reporting requirements are met. A physician protocol is still required to administer immunizations on children younger than three years of age. 
  • Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies, in coordination with the patient’s primary care provider or diagnosing prescriber. 
  • Establishes an Advanced Practice Pharmacist (APP) recognition, and authorizes APPs to:  
  1. Perform patient assessments
  2. Order and interpret drug therapy-related tests in coordination with the patient’s primary care provider or diagnosing prescriber. 
  3. Refer patients to other healthcare providers. 
  4. Initiate, adjust, and discontinue drug therapy pursuant to an order by a patient’s treating prescriber and in accordance with established protocols. 
  5. Participate in the evaluation and management of diseases and health conditions in collaboration with other healthcare providers. 
  6. Requires pharmacists seeking recognition as APPs to complete any two of the following three criteria: Earn certification in a relevant area of practice, such as ambulatory care, critical care, oncology pharmacy or pharmacotherapy. Complete a postgraduate residency program. Have provided clinical services to patients for one year under a collaborative practice agreement or protocol with a physician, APP pharmacist, CDTM pharmacist, or health system.

I want recognition for the value brought to patients and the health care team.

Pharmacists are an integral part of the healthcare team.  I hope to see this sweep across the country in the next few years and that board certification propels us into a whole new recognized role.



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