US Senate Joins House in Sponsoring Legislation Expanding Medicare Access to Pharmacy Services

Bipartisan legislation has been introduced in the US Senate that would give millions of Medicare patients in medically underserved communities access to critical primary health care services delivered by pharmacists across the country.

Bipartisan legislation has been introduced in the US Senate that would give millions of Medicare patients in medically underserved communities access to critical primary health care services delivered by pharmacists across the country.

Introduced by senators Charles E. Grassley (R-IA), Robert P. Casey, Jr. (D-PA), and Sherrod Brown (D-OH), the Pharmacy and Medically Underserved Area Enhancement Act would allow pharmacists to deliver Medicare Part B services that are already authorized by their respective state laws.

Since pharmacists are the most accessible health care provider in the country with nearly 90% of Americans living within 5 miles of a pharmacy, this expanded access for Medicare patients would improve health outcomes and cost savings for these patients.

“A lot of people in rural Iowa have easier access to a pharmacist than a doctor,” Grassley said in a press release. “Where that pharmacist is licensed to provide a service, Medicare ought to pay the pharmacist for it. That’s what this bill does. It’s good for pharmacists because they get paid for providing services to rural seniors. And it’s good for rural seniors because they keep access to their local pharmacist and don’t have to go to the doctor for straightforward medication management.”

The American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) announced their support of the bill. APhA EVP and CEO Scott J. Knoer, MS, PharmD, FASHP, explained that the legislation is critically important for the pharmacy field because the bill would allow pharmacists in underserved areas to establish a more sustainable practice model.

“This will have a tremendous impact,” Knoer said. “We have trained pharmacists on how to bill, but there's no single thing that can be done at the federal level to improve population health that’s greater than having pharmacists remunerated appropriately, so that we have a sustainable model where they're incentivized for the right things.”

For many pharmacies that have been hard hit by the struggles of the COVID-19 pandemic and the efforts it required, this federal acknowledgement of pharmacies’ role on the health care team could provide some necessary relief so that community pharmacies across the country aren’t forced to close their doors.

“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 these underserved areas,” Knoer said.

The services that the bill would authorize pharmacists to provide to Medicare patients include:

  • Medication management
  • Management of chronic conditions, such as diabetes and hypertension, and related medications
  • Cholesterol testing
  • Point of care testing (eg, COVID-19, influenza, strep)
  • Immunization screening and administration not currently covered by Medicare Part B and D
  • Tobacco cessation services
  • Transition of care services

Although the bill does not expand of scope of practice for pharmacists, it does bring Medicare rules into alignment with the authorities that have already been granted to pharmacists in many states through credentialing and privileging programs. Without this legislation, Medicare patients in these states would not have the same access to pharmacy services that other patients in the state have been granted.

“The ongoing COVID-19 pandemic has further illustrated how difficult it is for some patients living in medically underserved communities to access care and achieve optimal medication therapy outcomes,” said ASHP CEO Paul W. Abramowitz, PharmD, ScD (Hon), FASHP, in a press release. “This legislation recognizes that pharmacists can play an integral role in addressing these longstanding disparities and helps ensure that our most vulnerable patients can access the care they need.”

This bill also helps to acknowledge the extensive education and training pharmacists receive to deliver these patient care services that Medicare does not recognize or reimburse pharmacists for delivering. Considering pharmacists receive a Doctor of Pharmacy (PharmD) degree that requires between 6 and 8 years of higher education to complete, barriers to reimbursement by Medicare exist as a lack of recognition and acknowledgement by the federal government of pharmacists’ qualifications and training.

Beyond obtaining a PharmD, many pharmacists also go on to complete 1 to 2 years of post-graduate residency training before receiving their certification in a specialty by the Board of Pharmacy Specialties.

“I don't think society has truly appreciated what pharmacy really does,” Knoer said. “What's different now is we've had a pandemic.”

In light of the greater awareness of the role of pharmacy in helping the country recover from the COVID-19 pandemic, similar legislation, H.R. 2759, was also introduced in the US House last week by representatives G.K. Butterfield (D-NC) and David McKinley (R-WV).

“Pharmacy is literally saving the world through immunizations. We lost pharmacists. We didn't have PPE at the beginning of this, we didn't have plexiglass shields—pharmacists went to work,” Knoer said. “The COVID-19 heroes—pharmacists—died, and so did nurses, and so did physicians. So, there's an awareness now of our role.”

REFERENCE

U.S. Senate Joins House in Sponsoring Legislation Expanding Medicare Patients’ Access to Pharmacist Services. Washington, DC: American Pharmacists Association; April 26, 2021. [email]. Accessed April 28, 2021.