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Oregon enacts pharmacist provider status law
LOREN BONNER
After nearly 4 years of collaborative efforts among state pharmacy associations and other stakeholders, Oregon became the latest state to
enact provider status for pharmacists.
“We are very excited that Oregon pharmacists will now have the opportunity to more fully utilize their expertise to increase access to quality,
cost-effective health care across the state,” Gary DeLander, BSPharm, PhD, Oregon State Pharmacy Association (OSPA) President, told
Pharmacy Today.
OSPA, along with the Oregon Pharmacy Coalition and the Oregon Society of Health-System Pharmacists (OSHP), are recognized for
spearheading the legislative efforts with HB 2028, which went into effect immediately after Gov. Kate Brown of Oregon signed the bill into law
in June.
HB 2028 clarifies that pharmacists can be paid for clinical services, expands existing laws related to collaborative drug therapy management
(referred to in the legislation as clinical pharmacy agreements), and authorizes the Oregon Health Authority to work with the state Board of
Pharmacy to establish statewide protocols, primarily for postdiagnostic clinical services such as smoking cessation and travel medicine,
according to DeLander.
Both private and public health insurers in Oregon will reimburse pharmacists for the clinical services they provide under the new law.
The collaborative drug therapy management agreement that had been in place in Oregon for roughly 10 years was restrictive—between
only one patient and one provider, with a referral needed—and not used by enough pharmacists.
“We wanted to expand collaborative practice to these clinical pharmacy agreements that are for multiple patient populations, groups of
physician or health systems, and where multiple pharmacies can join,” Cory Huot, BSPharm, MBA, from the Oregon Pharmacy Coalition, told
Today.
DeLander and Huot worked with colleagues to draft the initial legislation. In the beginning, they encountered resistance from some health
care providers as well as legislative hurdles, but they persisted by educating lawmakers, the Oregon Medical Association, Oregon Nurses
Association, and other stakeholders, including newly formed Coordinated Care Organizations (CCOs) in Oregon, which are part of the state’s
Medicaid program.
Details of the law
HB 2028 “permits health insurers to provide payment or reimbursement for services provided by pharmacist[s] through [the] practice of clinical
pharmacy or pursuant to statewide drug therapy management protocol,” according to the law’s official language.
DeLander said there was an intentional effort not to include specific language in statute regarding the definition of clinical services because
“when it’s in there it’s hard to ever have it changed.” This also goes for requirements in statute for additional qualifications or education for
pharmacists. If appropriate or needed, any additional educational requirements will be defined by the payer or within the protocols.
“Having statewide clinical pharmacy agreements and the ability to seek reimbursement from third-party payers will lead to more pharmacist
involvement and strong, evidence-based programs,” Rachel DeBarmore, BSPharm, Rite Aid Pharmacy District Manager in Beaverton, OR,
told Today.
Preparing for the change
Many of the changes under HB 2028 will have less impact on health-system pharmacists who have been working as providers for some time
already.
However, the legislation does reinforce support for wider billing options for health-system pharmacists, particularly in ambulatory settings,
according to OSHP. The organization sees the new recognition as an opportunity to increase the number of pharmacists in ambulatory clinics
since the law provides the opportunity for reimbursement of cognitive services. The legislation could also open up more opportunities for
collaboration between health-system and community pharmacies because it creates a financial incentive for better alignment of health care
initiatives and goals—particularly in improving transitions of care and preventing unnecessary hospitalization for patients.
In preparation, OSPA and OSHP said they already have pharmacists from both inpatient and ambulatory sectors working on collaborative
therapy protocols.
For community pharmacists, the changes will be more evident. Amy Valdez, BSPharm, Clinical Division Lead at Albertsons Safeway
Portland/Seattle Divisions, said they are excited about the opportunity to take their pharmacy programs up a notch. “We have a strong suite of
clinical services currently, but we do have limitations in prescribing and interacting with patients,” she told Today.
For example, pharmacists at her chain provide diabetes disease state management but can’t adjust medications or initiate labs and insulin
therapy. “The new law would open up these opportunities,” said Valdez. They plan to train staff once the state-approved universal protocols
are established..”
Loren Bonner, MA, Reporter
Students, state associations: Advocacy for federal provider status
LOREN BONNER
The month before Members of Congress departed for August recess, student pharmacists from across the country were on Capitol Hill
advocating for the pharmacy profession and urging their Members of Congress to support the Pharmacy and Medically Underserved Areas
Enhancement Act (H.R. 592/S. 314), the federal legislation that would enable patient access to, and coverage for, Medicare Part B services
by state-licensed pharmacists in medically underserved communities.
Student pharmacists were taking part in the annual APhA Academy of Student Pharmacists (APhA–ASP) Summer Leadership Institute
(SLI), which took place July 10–12 in Washington, DC. They visited more than 100 offices in the House and Senate—one of the biggest
turnouts on record for student pharmacist Hill office visits. The visits garnered the support of nearly five new cosponsors and growing!
“Students want to be advocates for the profession,” said Michael Spira, APhA Senior Lobbyist. “They want to get in there and make a
difference, and they truly do.”
State associations: Support grows nationwide
As of press time, H.R. 592 had accumulated 174 cosponsors in the House, and S. 314 now has 25 senators signed on.
Last month, Pharmacy Today re-ported that New Mexico became the first state to have its entire congressional delegation sign on to
support the Pharmacy and Medically Underserved Areas Enhancement Act. Now, North Dakota has done the same. Its three Members of
Congress—Sen. John Hoeven (R-ND), Sen. Heidi Heitkamp (D-ND), and Rep. Kevin Cramer (R-ND)—are all cosponsors of the legislation.
Also, state pharmacy associations continue to take an important role in federal provider status advocacy efforts. The Texas Pharmacy
Association reached out to its members to encourage them to send letters to Sen. John Cornyn (R-TX) for his support of S. 314 due to his
leadership in the Senate and on key committees. Backing by members on the committees of jurisdiction for the legislation—House Ways
and Means, House Energy and Commerce, and Senate Finance Committees—are critical in getting legislation passed.
Student pharmacists: Enthusiasm, leadership skills
SLI is designed to help APhA–ASP Chapter Officers develop leadership skills. One day of the 3-day meeting is dedicated exclusively to
student pharmacists advocating for pharmacy by meeting with their Members of Congress on the Hill to promote legislative issues, such as
the Pharmacy and Medically Underserved Areas Enhancement Act. It’s also an opportunity for student pharmacists to develop relationships
with their congressional delegation. Even if a Member of Congress has already cosponsored the legislation, student pharmacists are
encouraged to meet with Members of Congress to thank them for their support and reiterate the importance of the legislation to help advance
its movement through Congress.
APhA prepares the students ahead of time through webinars on provider status and what to expect when visiting lawmakers’ offices.
As some of the most enthusiastic voices for the profession, student pharmacists’ advocacy efforts are not just limited to events like SLI,
however.
Advocacy advice: From one student to another
Carson Klug, a 2016 PharmD candidate from Drake University College of Pharmacy and Health Sciences, met with Rep. Ron Kind (D-WI),
one of the original cosponsors of H.R. 592, during a recent meet-and-greet fundraiser organized by the APhA Political Action Committee.
“I was excited about the fact that he [Kind] was very open to talking to [student professionals] and didn’t look down on the fact that I was a
student rather than a graduate,” said Klug.
He said he would advise fellow students to make sure they thank their Members of Congress for taking the time to talk with them, as well as
to keep in contact with their respective Members to inform them of the progress of current legislation or advances in the profession.
Loren Bonner, MA, Reporter
Photo Caption:
Rep. Ron Kind (D-WI), an original cosponsor of H.R. 592, meets with Carson Klug, a 2016 PharmD candidate at Drake University College
of Pharmacy and Health Sciences.V
Provider status coalition launches media campaign for Hill audience
DIANA YAP
The Patient Access to Pharmacists’ Care Coalition (PAPCC) recently launched a media push, including radio and print ads, to reach
readers of Capitol Hill newspapers and listeners “inside the Beltway” in the Washington, DC, area.
The goal of the media initiative is to promote the role that pharmacists can play in addressing challenges seniors face with inadequate
access to health care services in medically underserved communities throughout the nation, according to a PAPCC news release in March.
PAPCC is a group of more than 35 organizations representing patients, pharmacists, pharmacies, and other stakeholders. APhA is a
founding member of PAPCC. The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314) would provide
Medicare beneficiaries access to pharmacist-provided patient care services as authorized by state laws and regulations in medically
underserved communities.
Print, digital advertising
The coalition is running print and digital advertising in Capitol Hill media outlets over the course of the congressional calendar.
One of the print ads presents the story of “Vivian,” a 70-year-old senior with asthma who “can’t get appointments that fit her schedule,”
according to the print ad. In large blue letters, the ad asks, “Where can she turn for help?” The answer, according to the ad, is that “today’s
pharmacists are ready to help.” The ad also calls for passage of the Pharmacy and Medically Underserved Areas Enhancement Act.
The Vivian ad has run in Hill newspapers as well as the June 16 edition of the Washington Post. A Vivian sticker, roughly the size of a
business card, ran on the front cover of every copy of Politico on June 23.
A similarly themed ad depicts an older man sitting by himself at a bus stop. The text says that he’s 68 years old. He had one heart attack
and doesn’t want another—and it takes two bus lines to reach his appointments.
One answer is that seniors can turn to pharmacists, but the problem is that Medicare patients “do not have access to pharmacistprovided services under state laws,” according to the ad. “Pass H.R. 592/S. 314, the Pharmacy and Medically Underserved Areas
Enhancement Act, to provide Medicare coverage for pharmacist-provided pa-tient care services,” it urges.
See for yourself
Want to see what PAPCC has been up to for yourself?
To see full-size print ads and listen to a radio advertisement, visit the PAPCC website at PharmacistsCare.org or APhA’s
Pharmacists Provide Care website at www.pharmacistsprovidecare.com/campaign-update-archive.
Patient wants pharmacist on her care team
SONYA COLLINS
Cathy Kuhn, PharmD, might lose track of a patient or two in the follow-up process. Between their daily lives and their regular doctor’s
appointments, it can be difficult for patients to schedule follow-up visits for health coaching with their community pharmacist. After several
months of failed attempts, Kuhn doesn’t expect to hear from the patient again. She was floored when “Beth,” a patient she hadn’t seen in
more than a year, reached out to her.
“She said she missed having a pharmacist as part of her care team,” said Kuhn, who is the pharmacist care coordinator in Kroger
Pharmacy’s Columbus, OH, division. Beth had gotten off track from her health goals since she stopped seeing Kuhn.
Most people don’t have the option of choosing to have a pharmacist on their health care team. Beth’s health insurance covers her
appointments with Kuhn, but this is a rare benefit. Because CMS doesn’t recognize pharmacists as health care providers, few health
insurance plans cover their clinical care services. Like other stories in this series, Kuhn said, “Health care provider status would afford more
patients the opportunity to get these kinds of services.”
Beth had seen Kuhn for diabetes coaching for 2 years. During coaching sessions, which take place about every 3 months, Kuhn weighs
her patients, takes their blood pressure, measures their lipids and glycosylated hemoglobin (A1C), and reviews their medications. Patients
drive the discussion based on their individual health goals. Over the 2 years that Beth worked with Kuhn, the pharmacist saw Beth’s
interest in her health grow. She moved closer to her goals. Her weight and her A1C began to fall.
“She saw improvements in her quality of life and understood that taking care of her health would help her be a better mother and
grandmother to her family,” Kuhn said.
In the year that Beth didn’t come in, she gained weight, her A1C rose, and she was hospitalized multiple times for cardiovascular events
related to her diabetes. When she returned to the pharmacy for health coaching, she told Kuhn that she felt her doctor didn’t hear her in the
way the pharmacist did.
“Of course doctors have restrictions, too, on the amount of time they can spend with patients and what they can be compensated for,”
Kuhn said. “[Beth] felt like she had a personal relationship with me, which held her accountable and helped her direct her health.”
So far Kuhn has seen her patient only once since they reconnected, but Beth is engaged and eager to get back in control of her health,
the pharmacist said. “She truly values what she learned through the coaching.”
Beth isn’t the first patient to reach out to Kuhn after she realized she missed the care of a pharmacist. Even Kuhn’s former patients
from South Carolina, where she lived previously, continue to seek her out. “From health coaching to diabetes to MTM, the pharmacist–
patient relationship really can transform,” she said.
For now, the transformative power of the pharmacist–patient relationship is limited to select patients. Without provider status,
relatively few patients know about the patient care services pharmacists can provide, and few are eligible for those services.
“We can affect the quality of patient care, provide cost-effective care, and increase access to care for patients,” Kuhn said. “We’re
making an impact on patients every day. Provider status would increase that impact.”
”
Sonya Collins, MA, MFA, contributing writer
Photo Caption:
Cathy Kuhn
Quote:
“We can affect the quality of patient care, provide cost-effective care, and increase access to care for patients.”