Pharmacist as provider: A view of the future
Business and Operations
Three steps for pharmacists to become full providers
In brief:
- Pharmacists are the most accessible healthcare professionals in America.
- Pharmacists’ scope of practice continues to expand. Pharmacists can provide immunizations and dispense certain medications in most states without a prescription.
- Pharmacists are increasingly being paid for professional services, but further policy changes are needed to increase reimbursement.
- The ultimate goal for pharmacists is full provider status, which requires federal legislation. Everyone must advocate for it.
Major healthcare challenges
Among the most significant problems facing America’s healthcare system are:
- A looming physician shortage. The Association of American Medical Colleges estimates that by 2030 there will be 100,000 fewer doctors than the country needs to meet demand.1
- Rising healthcare costs. Experts predict health expenditures will grow almost 6% per year through 2025.2
A shortage of physicians and rising costs put pressure on the healthcare system to find solutions. One solution — advocated for by McKesson and by pharmacists — is for pharmacists to be recognized as providers, allowed to practice at the top of their license.
America’s most accessible health professionals
Pharmacists are the most accessible healthcare professionals in the U.S. About 95% of Americans live within five miles of a pharmacy, and Americans go to their pharmacy frequently.3
Visiting with a pharmacist is easier for most patients than seeing a doctor, and having pharmacists provide various medical services is less expensive than providing services in higher-cost venues.
Steps to pharmacists as providers
McKesson thinks about pharmacists as providers as following a series of steps.
Step 1: Expanded scope
Pharmacists’ scope of practice varies by state. Across the country scope of practice continues to expand.
- All 50 states allow pharmacists to provide immunizations.
- Some states have given pharmacists even more authority, like the ability to dispense certain medications without a prescription. Examples include naloxone, contraceptives, epinephrine, tobacco cessation products and travel medications.
In 2017, more than 10 states enacted legislation to expand pharmacists’ scope even further.
Expanded scope of pharmacist practice in each state4
Step 2: Collaborative practice and increased reimbursement
Collaborative practice agreements between pharmacies and physicians often partially enable expanded scope of practice.
More importantly, step 2 is about getting paid for delivering more services. In many states pharmacies are beginning to see increased reimbursement. This often starts with Medicaid, but is expanding to private payers.
| State Medicaid agencies are increasingly paying for pharmacists’ services | Private payer reimbursement mandates are starting to emerge |
Covered pharmacist services include MTM, smoking cessation counseling, administration of vaccines and more, depending on the state. | Washington is the first state to mandate that private health plans must recognize pharmacists as patient care providers for covered benefits. Private plans must include an adequate number of pharmacists in their provider networks. Payers will reimburse pharmacists for services covered as “essential health benefits.” Pharmacists will need to learn how to bill for medical benefits. |
Step 3: Full provider status
The ultimate goal is for pharmacists to attain full provider status. Achieving this goal requires changes in federal policy. A way to frame this for legislators is to help the government save money by shifting the care setting from high-cost to lower-cost venues, like pharmacies.
Legislators have introduced a bill in Congress — the Pharmacy and Medically Underserved Areas Enhancement Act. This Act would allow Medicare beneficiaries in medically underserved communities to receive covered Medicare Part B services from a pharmacist.
The Act calls for reimbursing pharmacists at 85% of the Medicare physician fee schedule. This is consistent with the precedent for nurse practitioners and physician assistants. This bill would increase access to services, achieve savings for the healthcare system and increase the reimbursement for pharmacists.
McKesson supports this bill and is advocating for it. It is important for pharmacists across the country to advocate, as Congress cares about hearing from local small business owners. Make your voice heard!