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Call to action: Provider status top of mind at APhA2015
L. MICHAEL POSEY AND LOREN BONNER
It’s time to “get the recognition pharmacists have always deserved.” The difference one person can make in the political processes of our
nation was fully evident at the Political Leadership Reception on March 27 at APhA2015 in San Diego.
Held on an outdoor terrace as the sun set over the beautiful San Diego Bay, the reception honored excellence in advocacy by APhA
member pharmacists and student pharmacists and roused attendees to keep supporting the provider status movement through their actions
and resources.
“I only learned about provider status because pharmacists came to my office and explained it to me,” Rep. Scott Peters (D-CA) told a crowd
of more than 300 attendees. Peters was the newest cosponsor of H.R. 592, the House version of the Pharmacy and Medically Underserved
Areas Enhancement Act (H.R. 592/S. 314).
“I would have no way to know anything about your job and how it is affected by the local, state, or federal government unless you explain it
to me,” Peters said in explaining how he came to understand the potential roles pharmacists can play in the future health care system.
“Send articulate folks [to Capitol Hill], sometimes pharmacists themselves, to explain these kinds of issues,” Peters said. “Keep it up. … Stay
active. Help us solve the health care crisis” by developing new ways of delivering pharmacists’ services.
Recognizing excellence
APhA’s top award in this area, the Hubert H. Humphrey Award, went to Minnesota’s Brian J. Isetts, BSPharm, BCPS, FAPhA. A faculty
member at the University of Minnesota, Isetts recently served at CMS as a health policy fellow. In this role, he was able to bring pharmacy’s
message to the top tiers of staff at the agency as policies were set for medication therapy management and pharmacists’ roles in direct patient
care. “Our voices are being heard,” Isetts assured the crowd.
Receiving the Good Government Pharmacist of the Year Award was Sandra Leal, PharmD, MPH, FAPhA, CDE, of Tucson, AZ. Leal has
worked continuously as an advocate for pharmacists’ direct patient care services. By initiating a Change.org petition in 2012, Leal was
instrumental in demonstrating the scope and breadth of support for seeking provider status in Congress. This effort led to the formation of the
Patient Access to Pharmacists’ Care Coalition and the current effort to gain provider status recognition for pharmacists.
Leal thanked the APhA–PAC for the award and said, “The real reward will come when we get provider status.” The Good Government
award recognizes an individual pharmacist who actively contributes to the community through his or her involvement in the political process.
Sarah Barden of Virginia Common-wealth University (VCU) was recognized as the Good Government Student Pharmacist of the Year.
She was recognized for her passion in getting student pharmacists at VCU engaged in and excited about the legislative process, said
emcee Steve C. Firman, BSPharm, MBA, APhA–PAC Board of Governors Chair.
Top priority
It’s no secret that achieving provider status is the number one priority for APhA. In an education session earlier that day, Stacie Maass,
BSPharm, JD, APhA Senior Vice President of Pharmacy Practice and Government Affairs, gave a comprehensive overview of provider status
and the progress that is being made in several different ways.
APhA is part of a broad coalition, called the Patient Access to Pharmacists’ Care Coalition, made up of pharmacy organizations and
stakeholders united in promoting patient access and coverage to pharmacists’ patient care services.
“I’ve never seen pharmacy so united on an issue,” said Maass.
Any way that patients have a greater opportunity to access pharmacists’ patient care services is a provider status success, according to
Maass. “Provider status is not just one pathway,” she said. “It’s not just at one level of government.”
L. Michael Posey, BSPharm, MA, Editor, and Loren Bonner, Reporter
Photo Caption:
Rep. Scott Peters (D-CA) is welcomed to APhA2015 by APhA Immediate Past President Matt Osterhaus (left) and former APhA
President Steve Simenson (right).
More cosponsors support H.R. 592, S. 314 as New York senators sign on
DIANA YAP
The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314) has accumulated 107 cosponsors in the House
and 11 cosponsors in the Senate as of April 23.
If enacted, the bipartisan legislation would enable patient access to, and coverage of, Medicare Part B services by pharmacists in
medically underserved communities. It would improve patient access to health care through pharmacists and their patient care services.
H.R. 592 was introduced by Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Todd Young (R-IN), and Ron Kind (D-WI) on January
28, 2015. S. 314 was introduced by Sens. Chuck Grassley (R-IA), Robert Casey (D-PA), Mark Kirk (R-IL), and Sherrod Brown (D-OH) on
January 29, 2015.
As Pharmacy Today went to print, more than 18,000 provider status advocates in APhA’s Pharmacists Provide Care campaign had
sent nearly 19,300 letters to Members of Congress since the bills were introduced in late January. During APhA’s Annual Meeting in San
Diego, more than 1,100 supporters joined APhA’s Pharmacists Provide Care campaign, and 670 advocates sent 2,010 e-mails to
legislators.
The letters thanked Members of Congress for their support of provider status and asked them to support and cosponsor H.R. 592 or S.
314.
Strong state advocacy—including state pharmacy associations and student pharmacists—has helped garner support for the
legislation.
The latest senators to sign on to be cosponsors of S. 314 are both from New York—Sen. Kirsten E. Gillibrand (D-NY) and Sen. Chuck E.
Schumer (D-NY).
“We did respond to the call to action from APhA and had members make contact with the senators,” Tracy Russell, CAE, Executive
Director of the Pharmacy Society of the State of New York, told Today. Students at the state’s seven schools of pharmacy also were
encouraged to send letters requesting support.
“We are fortunate to have senators who are pharmacy friendly. It did not take a lot to have them sign onto the bill. They understand the
benefit of pharmacy interactions with patients’ improved outcomes and have always been supportive,” Russell added.
Diana Yap, Editorial Director
Massachusetts bill would recognize pharmacists as providers
DIANA YAP
On April 9, pharmacists and student pharmacists packed the Massachusetts State House in Boston to advocate for HB 2041, An Act
Recognizing Pharmacists as Healthcare Providers, sponsored by Massachusetts state Rep. Angelo Puppolo (D-Springfield).
“The turnout of pharmacists and student pharmacists was a great way of showing the passion we have for the profession,” said APhA
Academy of Student Pharmacists National President Lucy West of Northeastern University School of Pharmacy.
According to the Massachusetts Pharmacists Association, the legislation would recognize registered pharmacists as health care providers. It
would allow pharmacists to bill MassHealth and the plans offered by the Group Insurance Commission for “drug therapy management
services” to chronic disease patients when acting under the authority of a signed collaborative drug therapy management (CDTM) agreement
with a physician; amend the current CDTM law to eliminate the list of disease states eligible for a CDTM agreement in a community setting to
allow pharmacists and physicians to team up on any disease that the physician requests; and further amend the CDTM law to allow
pharmacists to administer medications ordered by a prescriber. It also would permit pharmacists to dispense nicotine replacement therapies
and hormonal contraceptives by protocols established jointly by the state boards of medicine and pharmacy.
Diana Yap, Editorial Director
Photo Caption:
Student pharmacists from MCPHS University School of Pharmacy’s Worcester, MA, campus—Tiffany Bui, Daisy Powers, Junelle Empleo,
and Jessica Goeters (left to right)—state their case to Erik Mayberg, Chief of Staff for Massachusetts state Rep. John Mahoney (DWorcester), during the Face of Pharmacy day at the Massachusetts State House.
Four wins for provider status in North Dakota
LOREN BONNER
Gov. Jack Dalrymple of North Dakota recently signed four bills into law that include provider status language for pharmacists.
“This is the first time we’ve done this collectively with this many bills at once,” Mike Schwab, Executive Vice President of the North Dakota
Pharmacists Association (NDPhA), told Pharmacy Today. NDPhA and its members have been paramount to the effort.
In general, the North Dakota legislature has been supportive of the profession and practice of pharmacy in the state. North Dakota’s
collaborative practice act has existed for almost 20 years, and designation for pharmacists as a health care provider has been in the act
and insurance code for a number of years.
Bills vary, but same objective
From the perspective of NDPhA, the bills vary, but the objective for each was the same: to include “pharmacist as a provider” anywhere
and in as many bills as possible.
S. 2173 expands pharmacists’ roles in North Dakota’s collaborative practice agreement in several different ways. Pharmacists will be
included alongside nurse practitioners in collaborative practice agreements with physicians, and the institutional re-quirement on the
practice setting will no longer exist, making it possible for care to take place regardless of practice setting.
“That’s normally a barrier states have in their collaborative practice agreements,” said Schwab.
In addition, the bill opens up the door for North Dakota pharmacists to initiate patient assessments and do point-of-care testing by
removing previous language from the legislation.
Student pharmacist testimony
Shelby Monson, a 2015 PharmD candidate at North Dakota State University and NDPhA intern during the legislative session, helped get the
bill passed by testifying before the North Dakota Health and Human Services Committee.
“I discussed things from the point of view of a future pharmacist, and as a pharmacist working in a [community] pharmacy, about how
having a collaborative practice agreement is beneficial,” Monson told Today.
For instance, she told the committee that cholesterol guidelines for patients on a cholesterol-lowering medication should recommend
that patients have a lipid panel done 4 to 12 weeks following initiation of medication therapy.
“Instead of going to the doctor’s office for an appointment and lab tests, the patient would be able to come into the pharmacy and have
their cholesterol, LDL, and HDL checked at a pharmacy—and if necessary, the pharmacist could adjust the medication and assess for
drug-related effects and [adherence] as well,” said Monson about her testimony.
MTM for Medicaid patients
A second bill, S. 2320, creates a medication therapy management program for Medicaid-eligible individuals. Schwab said the bill met a
little resistance because of a fiscal note but passed the House and Senate with only four nay votes combined. Dalrymple recently
signed S. 2320 into law as well.
Workers’ compensation
Two other bills that have been signed by Dalrymple give pharmacists provider status under certain circumstances. H.R. 1102 defines
pharmacists as a provider of service for pain programs and other services under workers’ compensation in the state.
Prescriptive authority for naloxone
A fourth bill, S. 2104, expands the prescriptive authority for naloxone rescue kits, which are used to prevent deaths from drug overdose.
Two sections in that particular bill define pharmacists as health care providers alongside physicians, nurse practitioners, and others and
gives pharmacists limited prescriptive authority for naloxone rescue kits.
Schwab said this bill was heavily influenced by NDPhA through a Reducing Pharmaceutical Narcotics Task Force and was sponsored
by a senator who also happened to be a pharmacist.
“We have a great active network of members around the state, and our members are extremely effective and engaged,” said Schwab.
“We’ve also been able to develop great relationships with legislators and state officials over the years.
Loren Bonner, Reporter
.
Photo Caption:
Joined by North Dakota state Sen. Howard C. Anderson Jr. (R-8), BSPharm, and North Dakota Pharmacists Association Executive
Vice President Mike Schwab, North Dakota State University student pharmacists represent the College of Pharmacy, Nursing, and
Allied Sciences APhA Academy of Student Pharmacists chapter on Legislative Day at the state capitol on February 25.
Patient with diabetes makes dramatic turnaround with pharmacist coach
Sonya Collins
When “Tom” first enrolled in health coaching at the Kroger Pharmacy in Houston, his diabetes had been uncontrolled for years. His
glycosylated hemoglobin (A1C) was greater than 11%. He weighed about 250 pounds. And he was taking three oral medications.
“I gave him a year of education about his disease state, food and nutrition counseling, and lots of encouragement about physical activity,”
said Jennifer Trang, PharmD, who is a patient care clinical pharmacist at Kroger.
Trang provides health coaching to patients whose health insurance plans opt into the Kroger program. Patients can get coaching on
diabetes, heart disease, weight management, and smoking cessation. After an initial hour-long visit, Trang typically follows up with patients
every few weeks or few months. In some coaching sessions, Trang even walks the aisles of the supermarket with her patients to show them
how quickly they can add a few hundred more steps to their pedometers.
Over the year that Trang worked with Tom, he lost more than 50 pounds through diet and exercise. His A1C plummeted below 7%. And
he now takes only one oral medication. “He made a complete 180,” Trang says.
Tom was able to make dramatic improvements that relatively few people with diabetes can.
He is also one of relatively few people whose insurance gives him access to patient care services provided by a pharmacist. According to
CMS, pharmacists are not health care providers and thus cannot bill insurance for their services unless they have a preexisting arrangement
with the insurance company. This greatly limits the impact that Trang, and the other pharmacists profiled in this series, can make.
Maximizing med benefits
“Unfortunately, not everybody has this health plan, so that makes it harder to provide this service to everyone,” Trang said. “There are so
many people out there that have diabetes. He’s just one of a million whom a pharmacist could help.”
In fact, Tom is one of nearly 28 million Americans who have type 2 diabetes. The vast majority are only covered to get care from
physicians and nurses in physicians’ offices, where providers cannot dedicate the time to education and coaching that Kroger Pharmacy’s
health coaching model does.
“A lot of people have medications, but they don’t know how to maximize the benefits of the medications,” Trang says. “It’s not just about
the medication. It’s about lifestyle modification and understanding how your actions and decisions can impact your disease state.
Pharmacists can play a big role in providing that education.”
Intensive, comprehensive care
Trang met Tom in person about six times for an hour each time during the year they worked together. Between visits, Trang stayed in touch
with Tom and tracked his progress by phone. She notes the stark contrast between this model and the 15-minute visits patients get with their
endocrinologist or their primary care doctor.
“It’s very intensive care because it’s not just about the diabetes. It’s about weight management, sometimes there are cardiovascular
issues, and all the medications,” Trang says. “So it’s very comprehensive. Physicians just don’t have that extra time.”
If pharmacists could bill insurance for their services, they could lighten the load on an already overtaxed and shrinking physician
workforce. In addition to health coaching on some of the issues that burden the health care system most, Trang—like many other
pharmacists nationwide—offers health screenings, immunizations, and medication therapy management. But she can provide these services
only to a subset of insured people whose plans cover it, like Tom.
Tom worked hard to improve his condition, but he gave Trang all the credit. “One day he brought his son into the store,” Trang recalled.
“And when he introduced his son to me, he said, ‘This is the woman who saved my life.’”
Sonya Collins, MA, MFA, contributing writer
.
Photo Caption:
Jennifer Trang