Provider Status for Pharmacists: It’s About Time
During American Pharmacists Month, and as the country uses all available health care resources to address COVID-19, there has never been a better or more important time to grant provider status to pharmacists.
Throughout the coronavirus disease 2019 (COVID-19) global pandemic, we have—rightly —seen an outpouring of support for frontline workers risking their lives for the benefit of others. Companies, schools, and community organizations have offered support through donations and free services. In New York and cities around the world, residents regularly cheered their health care heroes from their homes to thank them for their work addressing this crisis on the frontlines.
Pharmacists have been central health care heroes in the frontline fight against the spread of COVID-19. Throughout the pandemic, pharmacists have played a critical role in the COVID-19 response in several ways. These efforts include standing up mobile testing facilities, working alongside their colleagues to draft protocols and response plans, reinforcing messages about how to control the spread in their communities, providing curbside delivery, conducting virtual consultations, and compounding hand sanitizers.
Because they are trusted by patients, readily accessible in most American communities, and are highly skilled, pharmacists are vital to our COVID-19 recovery. However, unlike their acute and physician office counterparts, pharmacists’ legal capacity to assess, prescribe, and administer biological products varies from state to state.
For example, although pharmacists in all 50 states, Washington, DC, and Puerto Rico are permitted to administer vaccines, state laws limit the types of vaccines they can administer and restrict the types of patients they can serve. Furthermore, without provider status under Medicare Part B, pharmacies often experience hurdles obtaining reimbursement for emergency services provided during public health emergencies.
To effectively respond to COVID-19, our country is being asked to use all available health care resources to the fullest, which is why there has never been a better, or more important time, to grant provider status to pharmacists.
Fully leveraging pharmacists in COVID-19 response efforts
The Department of Health and Human Services (HHS) has recognized the important role that pharmacists will play in COVID-19 relief. On September 9, 2020, HHS issued guidance under the Public Readiness and Emergency Preparedness Act (PREP) authorizing state-licensed pharmacists to order and administer COVID-19 vaccinations to patients 3 years of age and older, preempting any state and local laws that prohibit ordering or administering vaccines.
In addition to vaccine administration, pharmacists can also help to relieve the strain on resources COVID-19 has caused if they are leveraged more fully. To preserve scarce hospital and acute setting resources, pharmacists should also have broad access to test for COVID-19, as well as flu, strep and minor ailments.
A list of joint COVID-19 recommendations by several major pharmacy organizations, including APhA, NCPA, ASHP, AACP and others goes even further, advising that pharmacists should also be allowed to order testing, conduct and interpret results, counsel patients and initiate treatment for infectious diseases where appropriate. During a time in which every provider is a vital resource, more patients receiving these services at the pharmacy frees up physician offices and hospitals for more urgent care. Additionally, integrating pharmacists into direct patient care has been shown to improve patient outcomes across health care settings and disease states.
Ensuring that patients can access testing, vaccines and necessary care will be critical to public health. Unfortunately, a physician shortage was already in place prior to the start of the pandemic, a situation that has only become exacerbated by providers becoming infected with COVID-19 and/or an increasing caseload.
According to the American Association of Medical Colleges 2019 report, there is currently a shortage of nearly 43,000 physicians. There is also a significant number of patients living in health care “deserts,” where access to care is limited.
The National Center for Biotechnology Information states approximately 20% of the US population, more than 50 million people, live in rural areas whereas only 9% of the nation’s primary care physicians practice in these communities. Pharmacists are uniquely positioned to help address this need. Ninety percent of Americans live within 5 miles of a pharmacy and, through the use of telepharmacy, pharmacists can deliver care remotely to medically underserved areas.
The urgent need for provider status
Although pharmacists are valued community health care providers and their ability to improve outcomes as part of a patient’s care team has been proven, as of October 2020, only 37 states allowed pharmacists to qualify as medical providers under the rules of Medicare Part B. Because of this, pharmacists face administrative barriers when seeking reimbursement for clinical services provided.
As was the case in past public US health emergencies, such as the H1N1 outbreak and Hurricane Katrina, pharmacies often experience financial burdens resulting from their response operations. In its 2017 report on public health and community partnerships, the Johns Hopkins Center for Health Security noted that some pharmacies historically have been unable to obtain reimbursement from payers for emergency services provided outside of their normal authorized scope of practice. If pharmacists are permitted to order and administer COVID-19 vaccinations, per the recent HHS guidance, they must also be permitted to make claims.
Additionally, the ability for pharmacists to participate in COVID-19 relief efforts varies widely across the country, because legal scopes of practice (SOP) vary. Before a pharmacist can legally provide services, their state must first authorize these services under its legal SOP. If they are granted Medicare Part B provider status, more pharmacists would be authorized to provide patients with an expanded set of services, reducing the current burden on other sites of care.
Currently, there are more than 40 pending pieces of legislation pertaining to provider status and the level of integration pharmacists should experience in the field. These range from bills about the prescription of hormonal contraceptives to the administering of COVID-19 injectable medications. Nonetheless, pharmacists were ostracized from the HEALS Act, the Senate’s $1 trillion coronavirus stimulus legislative package, excluding them from the expansion of testing and immunization.
A statement was issued by Scott J. Knoer, executive vice president and chief executive officer of the American Pharmacists Association proclaiming that, “Now is the time for an all-in push for the inclusion of temporary pharmacist provider status in Medicare Part B.” And he is not alone in this sentiment.
At present, the National Association of Chain Drug Stores, the American Public Health Association, the National Community Pharmacists Association, and numerous other organizations are all working toward this common goal: to encourage realization of the viability of pharmacists as qualified providers.
The success of the eventual distribution and uptake of the COVID-19 vaccine with depend on the seamless coordination of manufacturing, delivery, and administration across all states and territories. Ensuring pharmacists are equipped and able to be adequately reimbursed for their services prior to the release of the vaccine will be vital to this process, especially to ensuring that rural and vulnerable populations have access to the vaccine.
Pharmacists are already an integral part of the US health care system, providing invaluable guidance to their patients and advocating on their behalf, improving patient outcomes, improving efficiency, and reducing the cost of care. During this public health care crisis, pharmacists’ position as accessible and trusted community health providers will be vital to the success of our COVID-19 response and immunization effort.
In order to fully realize the potential of pharmacists to fill in gaps in care, address underserved populations, and relieve a health care system straining for resources, the time to grant pharmacists provider status is now.