hubonpolicyandadvocacy
Provider status takes center stage as lawmakers speak at MRMs
DAVID SHAMAN
Advocating for change is a major focus of the APhA Academy of Student Pharmacists (APhA–ASP) Midyear Regional Meetings (MRMs),
held every fall across the country in eight regions. This year, the change MRM attendees seek is to enact federal provider status legislation
for pharmacists through the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314), which would enable patient
access to, and coverage for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. At press time,
H.R. 592 had accumulated 242 cosponsors, and S. 314 had garnered 36 cosponsors.
Three supporters of provider status for pharmacists, Rep. Debbie Dingell (D-MI), Rep. Marsha Blackburn (R-TN), and Rep. Bill Keating
(D-MA), spoke at the MRM conferences in Dearborn, MI; Nashville; and Plymouth, MA, respectively. MRMs also were held this year in
Richmond, VA; Minneapolis; Kansas City, MO; Portland, OR; and Las Vegas.
‘I am proud to be a cosponsor’
“Pharmacists deserve to play a bigger role in our health care system,” Dingell said in a statement to Pharmacy Today. She noted that pharmacists
sometimes see patients more frequently than doctors yet are not reimbursed for providing the same services.
“This isn’t right, and can actually serve as a disincentive for a pharmacist to open a business in a medically underserved area,” she
added. “Promoting access to care isn’t just the right thing to do—it makes economic sense as well. The quicker we get people the
care they need, the more likely they will avoid costly hospitalizations down the road. And that means providing more points o f
access to our health care system. That is why I am proud to be a cosponsor.”
Tim Frost, a 2017 PharmD candidate and president of the APhA–ASP chapter at the University of Toledo College of Pharmacy and
Pharmaceutical Sciences, noted that Dingell had spoken about having a lifelong friend who is a pharmacist.
Pharmacists ‘meet a great need’
“When I think about improving access to affordable health care, I think of pharmacists as being on the front line,” Blackburn said in a
statement to Today. “In Tennessee, 93 of 95 counties are considered medically underserved, so I see pharmacists as being able to meet a
great need in our state.”
Blackburn noted that her appreciation for pharmacists was from personal interaction as well as from years of working with pharmacists
on a variety of public health issues, including compounding and access to care.
“Congresswoman Blackburn’s key message is that pharmacists are the most accessible member of a patient’s health care team and
therefore are the most trusted,” said Alexandra Cervantes, a 2018 PharmD candidate at the University of North Carolina’s Eshelman
School of Pharmacy and president-elect of the Carolina Association of Pharmacy Students.
‘Frontline health care providers’
“I have seen firsthand how patients rely on their pharmacists,” Keating said in a statement to Today. “H.R. 592 will make law what so many of
us already know: pharmacists are frontline health care providers.” Patients, physicians, and pharmacists “all need to work together to make the
system work,” he said.
“Pharmacists need to be included under Medicare for a fully integrated health care system to be realized.”
Said Alison Svoboda, a 2017 PharmD candidate and president of the APhA–ASP chapter at Midwestern University Chicago
College of Pharmacy who attended the Dearborn meeting, “The major theme from this year’s MRM was the more we work together,
the more we can accomplish.”
David Shaman, APhA Communications Consultant
Captions: Dingell, Blackburn, Keating
Funk helps complex patients at nurse practitioners clinic in Minnesota
SONYA COLLINS
“Mike” was taking multiple psychiatric medications when the psychiatrist who was managing him took an extended leave of absence. Mike
didn’t have a primary care physician, and suddenly, he was without mental health care as well. He made an appointment at University of
Minnesota Health Nurse Practitioners Clinic, where he saw a team of providers.
“We commonly perform team visits where we go in the room together. The nurse practitioner performs the physical exam, and I am an
integral part of the medication management,” said Kylee Funk, PharmD, the team pharmacist at the clinic. “The nurse practitioners in the clinic
also send me referrals for patients who need medication management.”
Funk can help patients like Mike because she and Mike live in Minnesota, where pharmacists are recognized as health care providers.
Pharmacists in Minnesota can bill Medicaid and other payers for certain patient care services. Though patients like Mike, who take multiple
chronic medications and could benefit from monitoring by a medication expert, reside in all 50 states, not all states consider pharmacists to be
health care providers. In those states, it’s far more difficult for a complex patient to get care from a pharmacist.
“If pharmacists had federal provider status, we could bill on a routine basis. It is often difficult for a clinic to support the salary of a pharmacist
who can’t bill consistently for services,” Funk said.
No risky interactions with psychiatric meds
Mike’s medications were not the prescription drugs that a primary care clinic sees every day, but Funk was familiar with them. Because
several of his medications can cause heart rhythm irregularities, she recommended an EKG in addition to a few labs to monitor the meds.
During the visit, the nurse practitioner observed that Mike’s blood pressure was out of control. He needed to be on medication, but
standard antihypertensives could have risky interactions with his psychiatric meds. Funk recommended a drug that wouldn’t interact with
any of Mike’s current medications.
“The nurse practitioner said that this process made her a lot more efficient,” Funk said. “She said it would have taken her at least an hour to
work through the options and find the best medication for him, given the others that he was on.”
During the visit, Mike expressed an interest in pre-exposure prophylaxis (PrEP) therapy, which is a daily dose of
emtricitabine/tenofovir (Truvada—Gilead), to lower his risk of contracting HIV.
“This was something the rest of the team was not familiar with, so I was able to talk through whether he was a candidate for it, which he was,
and then set him up with a clinic that does the intense monitoring required with this medication,” she said.
Now Mike’s blood pressure is under control, he has a referral for a PrEP therapy consultation, he’s sought a new psychiatrist, and the nurse
practitioner, pharmacists, and other providers at M-Health Nurse Practitioners Clinic will be Mike’s primary care team.
Bringing pharmacists a step closer
Even in Minnesota, pharmacists are not reimbursed for services to the degree that physicians and nurse practitioners are. “We are reimbursed
for medication therapy management only for select patients,” Funk said.
The University of Minnesota subsidizes a portion of Funk’s salary at the clinic because the institution is interested in studying the impact of
the innovative model of care. In a fee-for-service system, unaffiliated clinics, which see just as much illness and chronic medication use as any
other clinic, couldn’t support pharmacists who can’t bill for the full spectrum of their patient care.
“Pharmacist services lead to lower costs for the health care system, and provider status would bring pharmacists a step closer to more
comprehensively providing those services,” Funk said. “If we are reimbursed more consistently, we can keep doing what we’re doing—
providing quality care for patients.”
Sonya Collins, MA, MFA, contributing writer
Photo Caption:
Kylee Funk