Gaining provider status is a complex and multifaceted objective.
US Representative Earl L. “Buddy” Carter, the only pharmacist in Congress, recently penned a passionate op-ed in The Hill to make a case for pharmacist provider status.
In his op-ed, the first-term US Congressman, House Community Pharmacy Caucus co-chair, and Carter’s Pharmacy, Inc, owner lamented that “pharmacists have become the most over-trained and under-utilized professionals in America” because of their lack of provider status.
Gaining provider status is a complex and multifaceted objective, but at its heart is the quest to include pharmacists in sections of the Social Security Act, as their current exclusion from it prevents many state and private health care plans from compensating pharmacists for patient care services, such as medication coordination, medication therapy management (MTM), chronic disease management, and patient education.
“A pharmacists’ role in patient care goes well beyond dispensing medications,” Rep. Carter wrote. “[Pharmacists] are the front line of the health care team and often see patients more than any other provider.”
Beyond the fact that pharmacists are already clinically trained to handle these expanded roles, Rep. Carter explained that the entire US health care system stands to benefit from provider status with respect to health care spending, as he noted that medication-related issues drive spending patterns.
“Inappropriate medication use costs the American health system—meaning each one of us who is a patient—nearly $290 billion annually,” he wrote.
He also noted that affording pharmacists the opportunity to provide more comprehensive MTM services could help curb the exorbitant costs related to treating chronic diseases.
In fact, the CDC indicates that 86% of the $2.9 trillion in annual US health care spending is directed toward providing care for patients with chronic conditions. The agency forecasts that the number of individuals living with these conditions will reach roughly 171 million by 2030.
Meanwhile, medication nonadherence resulting in unnecessary hospitalizations leads to an additional $100 billion in costs to the US health care system.
“No one is better suited to eliminate this waste than your pharmacist,” Rep. Carter claimed, although he stopped short of expressing that pharmacists could be lone wolves in providing patient care services.
“While doctors should remain the quarterbacks, pharmacists must be given ‘provider status’ so the profession is able to be the integral part of the health care team we are trained to be and optimize outcomes for patients,” he said.
He concluded his op-ed by urging Congress to “move forward with common sense reforms…to improve access to quality and affordable care for all Americans.”
Rep. Carter expressed similar sentiments when he spoke to Pharmacy Times earlier this year about his pharmacy past and political progress.
He said that 3 federal pharmacy-related bills—HR 244 (pharmacy benefit manager transparency), HR 793 (“any willing pharmacy”), and HR 592 (pharmacist provider status)—are all “paramount to the advancement of pharmacies and pharmacists.”
Although the pursuit of federal pharmacist provider status has faced some roadblocks, a number of state laws have given advocates cause for celebration. Click here for a more detailed look on which states have passed provider status laws thus far.