The words “provider status” have been a fixture of pharmacy industry discussions for years. But with the onset of the COVID-19 pandemic (now entering its third year), those discussions started to ramp up. How do you get medical resources like testing, treatment, and vaccinations to more people, including those in medically underserved areas? You make health care as accessible as possible.
In April 2021, representative G.K. Butterfield (NC) and 22 co-sponsors introduced H.R. 2759, the Pharmacy and Medically Underserved Areas Enhancement Act. This is a bipartisan bill that provides for Medicare coverage and payment for services rendered by a pharmacist as long as those services (1) are provided in a medically underserved area, and (2) would otherwise be covered under Medicare if they were provided by a physician. H.R. 2759 is the latest of nine different bills that have been proposed over the last twenty years aiming to recognize pharmacies as health care providers.
Pharmacists should have provider status, full stop. And to explain why, first we need to delve a little bit more into what “provider status” really means.
What Exactly Is Provider Status?
On a federal level, “provider status” revolves around access to Medicare Part B, the part of Medicare that covers care from doctors and other health care professionals, outpatient care, and home health care. These pharmacists can bill Medicare Part B for the clinical services they provide, including immunization, point-of-care testing, medication therapy management, smoking cessation, and diabetes management.
Some states, like California, Washington, and Vermont, already give full provider status to pharmacists. Other states, like Illinois, Indiana, and Missouri, allow pharmacists to bill Medicare Part B for some clinical services, but not all — and those services vary from state to state. For instance, only 18 states allow pharmacists to prescribe hormonal contraceptive medications, while 26 states allow pharmacists to provide smoking cessation counseling.
However, the ability to provide care does not necessarily come with the ability to bill for that care. In many states, there are loopholes that make it difficult for pharmacists to get paid for the care they are legally allowed to provide. Some states only allow pharmacists to be reimbursed under state employee health plans or Medicaid. And even in states with full provider status, there is still the issue of billing the medical benefit for services provided — something many pharmacists have little experience doing.
Why Is Provider Status Needed for Pharmacists?
Pharmacies are the most accessible health care provider. 90 percent of people in the U.S. live within five miles of a pharmacy, and pharmacists have the training and the licensure to do more than simply dispense medication. In medically underserved areas, a community pharmacy might be the only health care provider for miles. While this isn’t typically an issue in larger cities, larger cities don’t make up the majority of the country. There isn’t always a doctor a few minutes away or a hospital on the other side of town, and the people who live in those areas deserve access to care as much as anyone else.
When a pharmacist has provider status, all kinds of doors open up not only for the pharmacy, but also for the community. With provider status, pharmacists can provide dozens of clinical services that will save patients a trip to the doctor, including point-of-care testing, immunizations, and medication therapy management. They can even reach out to community members who might have a hard time making it to the pharmacy with telehealth appointments for services than can be conducted over a video call.
Basically, pharmacists need provider status because their patients will benefit.
What Happens Next?
Conversations are still happening, and H.R. 2759 picked up its most recent co-sponsor as recently as January 2022, so it’s still not dead in the water. Pharmacists all over the country are calling and writing to their local representatives and asking them for help. Not sure how to get in touch with your state representatives? House.gov can help you with that. If we make enough noise, they can’t ignore us.
Provider status is the ticket to pharmacists being recognized (and paid) as health care providers. It’s also a way to bring much-needed health care services to people in underserved areas. And — full disclosure — there are a lot more medically underserved areas than you think.
When pharmacists have provider status, everybody wins. Let’s make it happen.
Sources:
https://www.drugtopics.com/view/road-provider-status
https://www.pharmacytoday.org/article/S1042-0991(21)00178-X/fulltext
https://grassrootsrph.com/2021/04/25/provider-status-explained-what-pharmacists-can-do-to-advocate-for-provider-status/