Pharmacy Advocacy in Action: How Pharmacists Can Influence Policy and Expand Their Scope of Practice

In today’s rapidly evolving health care landscape, pharmacists are playing an increasingly vital role in patient care—but many policymakers remain unaware of the full scope of their expertise and contributions. In this interview, Tom Kraus, MHS, Vice President of Government Relations at ASHP, shares practical strategies for pharmacists to effectively communicate their value to legislators, engage with professional organizations to shape impactful legislation, and stay informed on key policy trends, including scope of practice expansion and 340B protections. With legislative momentum building across states, Kraus emphasizes the importance of grassroots advocacy and storytelling to drive recognition and reform in pharmacy practice.

Q: How can pharmacists best communicate the value of their role to legislators and policymakers who may not fully understand the scope of pharmacy practice?
Tom Kraus, MHS:
Yeah, this one is harder, right? Just because people's perceptions are so much shaped by their own experiences. The reality for pharmacy is that most policymakers’ exposure to pharmacists is in a community setting. Now, the good news is that in that community setting, more and more care is being provided. So, as I mentioned previously, there is a perception that pharmacists are more often care providers. That’s a good thing.

But it’s also true that many policymakers don’t even realize that there’s a pharmacist in a health system setting—maybe providing care in an ambulatory setting, maybe providing a broad range of primary care services. That really just comes down to saying, “Did you know I can do X, Y, and Z?” or “Did you know that you can access these services from a pharmacist?”

Telling stories is really important—stories like, “My specialty is in oncology, and here’s what I do to help a patient navigate complex therapy.” Those kinds of stories make it real for folks who may not have a full understanding of what a health system pharmacist is doing—or what pharmacists are doing in many different settings where they provide direct patient care.

Q: What role do professional organizations play in shaping pharmacy-related legislation, and how can individual pharmacists support or amplify that work?
Kraus:
Yeah. So, ASHP and other professional organizations influence legislation in a few different ways. One way is by serving as a resource to policymakers when they have questions. This happens to me all the time. For example, let’s say there’s an issue around drug shortages. A member of Congress is writing legislation, and they’ll reach out to ASHP and say, “Hey, we want your expert perspective on X, Y, and Z. What’s the best way to draft this bill to make it effective in responding to a drug shortage crisis, and how do we make sure that it works for pharmacists?”

Another way we get engaged is by drafting model legislation and supporting state affiliates. That’s where there is the most energy right now. I think ASHP has seven different model legislative proposals that folks can use—covering things like 340B contract pharmacy, scope of practice issues, and reimbursement issues.

If you’re not familiar with those, whether you’re part of a state affiliate, a health system government relations team, or just an individual pharmacist, go to ASHP’s advocacy website and look for the model legislation. You’ll see all these different templates you can take to your own government relations team or your state affiliate and say, “Do we have this authority in our state? If not, here’s a starting point.”

You’ll have to tweak it and work with it, but it gives you a foundation. Then reach out to ASHP—we are always happy to support state advocacy efforts, both through our affiliates and through health systems in those communities. It’s incredibly impactful when that advocacy happens organically in the community, building from these proposals.

We’ve seen really fast uptake. For example, we introduced model legislation around white bagging about five years ago, and now more than 20 different states have adopted it. We’re also seeing growing adoption of our scope of practice and contract pharmacy models. There's a good chance we’ll see 20 different states pass legislation protecting contract pharmacies for 340B this year.

So, just find those resources on our website. There are many opportunities to communicate with pharmacists in other states who have tried this—who can share what worked, what didn’t, what pushback they faced, and which talking points were most effective. Engage with us at ASHP, learn from those experiences, and take them forward in your own state. The proof is in those maps we love to track—showing progress over time in expanding scope of practice, reimbursement, and 340B protections. It’s really exciting to watch.

Q: Looking ahead, what legislative or policy trends should pharmacists be watching closely over the next year or two?
Kraus:
Let me start with the positives. I think the positive trends are undeniably about the growing role of pharmacists in patient care services, and the increasing recognition by policymakers of that role. You’re seeing that play out in the expanding scope of practice across different states. As I mentioned, around 20 states have already passed laws this year alone expanding scope of practice. Five states have expanded reimbursement. Those trends are clear, and they’re all moving in one direction—toward giving pharmacists more authority and greater recognition as providers.

At the same time, we have to be very conscious of the clear cost pressures and reimbursement challenges that health systems are facing. We see this manifesting through pushback on 340B, reductions in reimbursement for covered entities, and risks to site-neutral payment policies. These cost and reimbursement pressures on health systems are going to continue to be a pain point.

And it’s not just pharmacy. We’re also going to see pressure on Medicaid coverage for patients, with a potential increase in unreimbursed services and more uninsured or underinsured patients. All of these cost pressures will continue to add up and influence the broader health care landscape.