The National Governors Association is encouraging states to consider amending laws and regulations to give pharmacists a bigger role in delivering care. The organization released a paper on Tuesday (Jan. 13) that highlights approaches some states have taken, including medication management and letting pharmacists directly care for beneficiaries.
“Although they are most often associated with dispensing medications in retail pharmacies, their role is evolving to include providing direct care to patients as members of integrated health care provider teams,” the paper states.
Integrating pharmacists into chronic-care delivery teams is one of the more promising approaches to improving health outcomes because pharmacists play a critical role in medication management of chronic disease. The group states that a limited number of studies indicate that pharmacists who provide medication therapy management improve outcomes and reduce costs.
California, Montana, New Mexico and North Carolina created what they call an advanced practice pharmacy designation to expand pharmacists’ scope of practice. That designation allows pharmacists to care for patients directly, including primary care. Also, some states, such as Minnesota, Mississippi, and Ohio allow team-based models that rely on medication therapy management pharmacy services for chronically ill patients or patients who are unlikely to take their medications.
Administrative barriers limit pharmacists from practicing to the top of their professional training and education, the paper states. Recognizing pharmacists as providers in state laws and regulations is a key step toward making better use of pharmacists, NGA says.
Currently most states pay fees for drugs and the dispensing of them, and that product-based reimbursement drives pay policies for pharmacy services rather than the direct-care that pharmacists provide. Medicare and Medicaid also often prohibit pharmacists from practicing, particularly within integrated care teams. Medicare Part B does not define pharmacists as providers so they cannot bill for patient care services. Many state and private health plans align pay policies with Medicare policies and as a result do not let pharmacists bill for patient care services.
Pharmacists also are not recognized as providers in accountable care organizations, which CMS champions as the epitome of team-based health care built on fee-for-service.
Conversely, Medicare Part D reimburses for medication therapy management when provided under contract with prescription drug plan sponsors, but those services under Medicare Part D are defined narrowly to include medication review but not services such as chronic disease management, care coordination or other follow-up care
Health information technology is another barrier to broadening the scope of pharmacists role in health care, NGA says. — John Wilkerson (firstname.lastname@example.org)