Pharmacists as Providers
The current shortage of primary care providers in Texas leaves patients, especially in underserved and rural communities, without appropriate access to healthcare. With continued challenges in the future, such as the aging population and the Affordable Care Act, the lack of access will be even more problematic. It is essential that pharmacy and other healthcare professions be utilized to help fill this void and expand healthcare access to all patients. Legislative and regulatory changes need to occur before pharmacists are able to provide the type of healthcare services that can alleviate this growing issue. Pharmacists need to be a designated as healthcare providers, expand their scope of practice, and have a means to bill for patient services. Other states, most recently California, have passed legislation to advance these goals. California state senator Ed Hernandez, optometrist and sponsor of SB 493, recognized the need to better utilize other healthcare professionals, including pharmacists, optometrists, and nurse practitioners. He recognized the potential that existed and championed pharmacists as being "completely over-trained and underutilized.”
Clearly, pharmacists are highly trained and capable providers who can alleviate the growing access problem in the healthcare system. To do so, however, various actions and programs need to be implemented to allow pharmacists to expand their role.
Building on the innovative foundation created in Texas law in 1999, Texas Pharmacy Association (TPA) has already begun working with other organizations and associations in several arenas. TPA is developing potential legislation to address the following concerns: Designation: Pharmacist recognition as a healthcare provider in all delivery settings and under all programs. Scope: Pharmacist knowledge and training supports an expanded scope of practice. Reimbursement: Pharmacist reimbursement for professional services.
DESIGNATION It is imperative that pharmacists be recognized as providers. This is the first step to expansion of the scope of practice, increased involvement in patient care, and acquiring reimbursement. Thirty-four states recognize pharmacists as providers in some fashion [Click Here to read more], but in Texas the definition of healthcare providers is not consistent. It is important that there be an overriding definition that includes pharmacists and is applicable to all existing and future statutes.
SCOPE Pharmacists are highly trained and should be better utilized to increase quality of patient care as well as access to care. Several states allow pharmacists to perform a wider range of duties compared to Texas. Often, pharmacists with expanded scopes of practice require additional training which ranges from simple certificate programs to board certification in specialized areas or residency training.
Many states, including Texas, allow collaborative drug therapy management (CDTM). CDTM involves pharmacists and physicians entering into collaborative practice agreements. In Texas, there are restrictions to certain practice settings for sections of CDTM that pertain to implementation and modification of drug therapy, including prescriptive authority. For more information on which states allow CDTM and what their laws detail Click Here. To read the Texas Administrative Code regarding CDTM Click Here.
The following states allow pharmacists to obtain DEA numbers for prescribing controlled substances: New Mexico, North Carolina, Montana, California, Massachusetts, Minnesota, North Dakota, and Washington.
A few states including New Mexico, North Carolina, and most recently, California have established an "advanced pharmacist” with an expanded scope of practice compared to all other pharmacists (e.g. Advanced Practice Pharmacist in California). Pharmacists must meet certain criteria to acquire these advanced designations.
For additional information regarding "advanced pharmacists” in other states: REIMBURSEMENT A national effort is ongoing to establish pharmacists as providers and establish a payment mechanism at the federal level under Medicare Part B. It is important for Texas to not wait for federal legislation to be passed, but to work toward achieving state-level provider recognition so that Texas pharmacists have leverage in acquiring reimbursement. Click Here to read about proposed federal legislation, H.R. 4190.
CALIFORNIA LEGISLATION: SB 493 Recently, California passed SB 493 which identifies pharmacists as healthcare providers, expands pharmacists’ scope of practice, and establishes an Advanced Practice Pharmacist (APP) with expanded capabilities. Click Here to read SB 493.
SB 493 allows all pharmacists to perform the following: Administer drugs and biologics ordered by a physician, including by injection Training, consultation, and education about disease management and drug therapy Access to medical records for multidisciplinary progress review Provide self-administered hormonal contraceptives Provide travel medications suggested by the CDC that do not require diagnosis (e. g. malaria prophylaxis) Provide prescription nicotine replacement products Administer ACIP-recommended routine immunizations to patients ≥ 3 years Order and interpret tests for managing and monitoring the efficacy and toxicity of drug therapies
SB 493 establishes an "advanced pharmacist” titled Advanced Practice Pharmacist (APP). APPs have an expanded scope of practice compared to those without this designation and must acquire certain training before attaining their title. |
