Alexandria, Va. - February 4, 2013 As federal officials work to advance the establishment of innovative health care delivery systems such as accountable care organizations (ACOs), the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) are calling for them to take regulatory action to expand the role pharmacists can play in such efforts.
The Center for Medicare and Medicaid Innovation (Innovation Center) is the federal office tasked with testing and evaluating new medical care delivery and payment systems. In a joint letter to the agency, NACDS and NCPA asked the Innovation Center to use its authority under section 1115(A) of the Social Security Act to expand the role of pharmacists in new ACO models, community-based transitions of care and bundled payment initiatives. Current Medicare law does not recognize pharmacists as providers, potentially limiting their participation in new health care models.
"Permitting pharmacists to practice to their maximum capabilities within these new delivery models would help increase medication adherence and coordination between healthcare settings, result in higher rates of vaccinations, and reduce the burden of the physician shortage, particularly with the influx of new patients in 2014 through the Health Care Marketplaces and the expansion of Medicaid eligibility," the groups wrote.
"Because pharmacists have the proven ability to provide services which lead to better clinical outcomes and lower healthcare costs, we urge the Innovation Center to use its authority to find mechanisms for pharmacists to participate in these programs, such as granting pharmacists provider status for the purpose of participating in Innovation Center projects," NADCS and NCPA added in the letter. "Doing so would allow pharmacists to join other healthcare professionals in the new patient care opportunities taking place at the Innovation Center. Without this action, pharmacists may be unable to provide and bill for their services and are therefore not being utilized by participants to the maximum extent possible. This may be limiting the ways in which pharmacists can contribute to meeting the Innovation Center's goals."
The costs of patients who do not take their medication as prescribed have been estimated as high as $290 billion annually in other health care expenses. Those costs could be reduced by pharmacist-delivered services such as face-to-face medication therapy management (MTM) counseling and medication reconciliation. In addition, pharmacists are an increasingly critical provider of immunizations against influenza and other diseases. By taking the regulatory action recommended by NACDS and NCPA, the Innovation Center could facilitate pharmacists' ability to provide these and other services to improve health outcomes and to be reimbursed for them through ACOs and other emerging health care models.