Provider Status: What It Means to Pharmacy Practice


Provider status would recognize pharmacists as a valued part of the health care team.

Pharmacists have extensive specialized education and training in the use of medications to treat, manage, and prevent disease, as well as decrease the incidents of adverse drug reactions and interactions. When pharmacists are involved members of the health care team, costs are reduced and patient outcomes are improved.

Consider all patient care services available from pharmacists, such as patient education, medication therapy management (MTM), comprehensive medication reviews (CMR), ongoing medication monitoring, disease management, and prevention and wellness services. Some of these services, such as immunization delivery, have business models that allow for extensive implementation, while others are given minimal compensation, thereby limiting patient access to valuable pharmacists' patient care services like MTMs and CMRs.

Pharmacists, alongside many of the services they provide, have been excluded from the sections of the Social Security Act that determine eligibility for compensation by health care plans such as Medicare Part B. This exclusion not only limits the services available to Medicare Part B patients, but many other state and private health plans also cite this exclusion from Medicare Part B as a reason for lack of coverage on their part.

Because pharmacists are not recognized as providers, the contribution they make as part of the health care team is not documented. Without appropriate provider status and payment models in place, optimal pharmacists' patient care services cannot occur.

Acknowledging pharmacists as providers is especially important now in order to optimize the use of pharmacists' patient care services in newly integrated care delivery models, such as medical homes and accountable care organizations promoted by the Affordable Care Act.

Congress is under immense pressure to find savings within the health care system. More than 1.5 million preventable medication-related adverse events occur in the United States annually, and the health care system spends nearly $290 billion annually to treat adverse events from medication misuse. If pharmacists obtain provider status, then patients will have access to pharmacists' care services that will be valued and appropriately compensated.

To gain support for the provider status campaign, it's up to pharmacists to educate patients, other health care providers, and pharmacy colleagues about the impact that these patient care services would have on the health care system. Contact a member of Congress as a constituent and ask for support and co-sponsorship of the federal bill. It's time to be recognized as valued members of the health care team!

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