‘Pharmacy Is Literally Saving the World Through Immunizations,’ Says APhA CEO, EVP Scott Knoer

Pharmacy Times® interviewed Scott J. Knoer, MS, PharmD, FASHP, the EVP and CEO of the American Pharmacists Association (APhA), on the Pharmacy and Medically Underserved Area Enhancement Act that was recently introduced in Congress.

Alana Hippensteele: So, Scott, what is this act, and what does it potentially mean for pharmacies?

Scott Knoer: Yeah, so this is a pharmacy audience, Alana, so a lot of them have heard the term ‘provider status,’ and really what this will allow is to have pharmacists bill for cognitive services for Medicare patients.

Now provider status—you've got a pharmacy audience, so they'll know what that means—that's sometimes kind of a difficult concept for folks who aren't in the know, but really what I like to now say, as I'm trying to help understand it, is it makes pharmacists eligible providers under Medicare.

Right now, obviously, doctors, PAs, nurse practitioners, and—this is no insult intended whatsoever—but audiologists and nurse midwives are also providers. Pharmacists are the second most educated with PharmD's and our bachelor's pharmacists have been working 30 years with experience, and my audiologist, I have a hearing tested—God love her—she did a great job, but she's not trained at the level pharmacists are. So it's just ludicrous that pharmacists cannot bill for the services they all went to school for.

So—we'll get to this, I know you've got your questions, I'm sorry I give long answers to short questions—the problem is pharmacies are only reimbursed for product in the community setting, and 20 years ago that was okay because you got paid enough where I could talk to your mom about her diabetes. Now the PBMs have sucked so much money out of the health care system without providing any real value that all you can do is volume. That's why we've had reporter—just recently Adiel Kaplan at NBC news—talk about the challenges in chain pharmacies. I love chain pharmacies, but they tend to have busier pharmacies, people are stressed out, they're burned out, they're worried about making errors—so that was a long answer to what's this do—it allows for patients in underserved areas where—it's not everyone, but it's a good start—for pharmacists to bill for what they went to school for. For a sustainable practice model—it's not sustainable right now.

Alana Hippensteele: Right, absolutely. How has Medicare lagged behind existing responsibilities already granted to pharmacists in many states in the US, so for example, what are some specific areas where Medicare is lagging?

Scott Knoer: Yeah, so that's a great question. In the states, so I'm here I'd spin my camera around I'm gonna brag—we have the only privately-owned building on the National Mall; I'm looking right at the Lincoln Memorial, I got the Capitol right there, I can see it—if I was young like you, I could throw a rock to it. But getting anything done to the Federal government with all the partisanship and stuff we've got is really difficult.

I was chief pharmacy officer at Cleveland Clinic for 9 years, I've only been here a year, and I saw in Ohio—there's many states that have providers, I talk about Ohio a lot, I love the other states, but I know Ohio—this right here is the cover of Modern Healthcare from September—pharmacists moved to the center of a care revolution. In Dayton, [this pharmacist] is billing for clinical services like MTM, and they can adjust doses and things, and getting paid for it. That's because the state of Ohio passed a provider status law. Federal is Medicare; state is Medicaid. So, Ohio and many others, Washington, Tennessee I apologize for anyone not in Ohio, I use them as an example, APhA loves our pharmacists in every state.

I mean you can get stuff done in the state, getting stuff done here is hard. We're gonna do it, but it's hard. So yeah, I guess long answer to a short question: The federal government is not doing what many states are doing—that's paying pharmacists for using their brains, not for counting as fast as they can and manning drive-throughs.

Alana Hippensteele: Right, right. What may be some of the reasons that Medicare has lagged behind? You mentioned perhaps the issue of partisanship and issues with things getting passed, but how would federal acknowledgement for pharmacists’ role change Medicare patients health care opportunities and why might this have taken so long?

Scott Knoer: Okay I'll take a couple notes—that was a long question for a short answer, I give long answers for short questions—why did it fail? A couple things. I don't think society has truly appreciated what pharmacy really does. As a pharmacist, I know that now what's different is we've had a pandemic. This is not an exaggeration: Pharmacy is literally saving the world through immunizations. We lost pharmacists. This is like pharmacies’ 9/11. The first responders ran toward burning buildings. We didn't have PPE at the beginning of this, we didn't have plexiglass shields, not sure they work anyway. Pharmacists went to work. We just celebrated our annual meeting. The COVID-19 heroes—pharmacists—died, and so did nurses, and so did physicians. So, there's an awareness of our role.

What else is going on: Important stuff like racial disparities in health care. This unsustainable financial model over a 10-year period closed 10,000 community pharmacies. Where did they close? Did they close where I live? No, they closed in inner cities, they closed in communities of color. So, it's a public health issue, and this bill is focused on underserved areas.

So, what else made it fail? Well, quite honestly, we had some opponents, which I mean, you wouldn't think the AMA, American Medical Association, rabidly opposes anyone—PA’s, nurse practitioners—with expanding scope of practice.

It's a sort of a turf war for them. They're seeing the world as a pie, and if someone else gets some pie, then they don't get pie, and that's not the way to look at it. It's not about finance, it's about being able to take care of patients. If the pie is bigger, everybody is able to get renumerated appropriately, so they can provide patient care.

At Cleveland Clinic, my pharmacists worked with doctors everywhere; we were a partnership. The AMA is not looking at this from a public health perspective, they're looking at it as a turf war, which it isn't. So that's been a major problem, and guess what, they have more money and more lobbyists than we do. The AMA and the American Academy of Pediatrics came out against Health and Human Services that said pharmacists can vaccinate 3 to 18 year olds in the pandemic. Why did they say that? Because parents couldn't go out to clinics, they were closed. Pharmacists are the most accessible profession. So, we've got work to do with helping educate the horribly misinformed, misaligned AMA, who's looking out for turf, they're not looking out for public health—they've got to change. The AMA has got to start looking out for patients.

There was a study, I'm not good at quoting, but like by 2030, there's gonna be a shortage of 130,000 primary care physicians. If they wanted to, they couldn't see every patient in the United States. There's not enough—it's math. Use the whole health care team. The physician is the quarterback; we're here, put us in coach. You need a nurse, you need a dietician. So again, I'm sorry—long answer, short question—I've had a lot of coffee today.

Alana Hippensteele: No, that was excellent. I appreciate all those points.