In a move hailed by pharmacy trade groups, three congressmen have introduced legislation in the House of Representatives that would expand the scope of health care services that pharmacists provide under the Medicare program.

H.R. 4190, pharmacists, health care services, Medicare, Medicare Part B, reimburse, medically underserved communities, Brett Guthrie, G.K. Butterfield, Todd Young, National Association of Chain Drug Stores, NACDS, Steve Anderson, National Community Pharmacists Association, NCPA, B. Douglas Hoey

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Legislation aims to expand scope of pharmacist services reimbursed under Medicare

March 12th, 2014

WASHINGTON – In a move hailed by pharmacy trade groups, three congressmen have introduced legislation in the House of Representatives that would expand the scope of health care services that pharmacists provide under the Medicare program.

Under bill H.R. 4190, introduced Tuesday by Reps. Brett Guthrie (R., Ky.), G.K. Butterfield (D., N.C.) and Todd Young (R., Ind.), Title XVIII of the Social Security Act would be amended to allow pharmacists to be reimbursed under Medicare Part B for certain health services in medically underserved communities.

"This simple bill would benefit millions of seniors across the country and particularly those that live in rural and underserved areas," Butterfield said in a statement. "Expanding patient access to primary care through trained, qualified and licensed pharmacists, while also addressing the shortage in the delivery of care, is basic supply and demand."

The congressmen noted that many states allow pharmacists to provide health care services beyond prescriptions — such as immunizations, diabetes management, blood pressure screenings and routine health checks — but there's no mechanism for reimbursing pharmacists for these services under Medicare.

They said this "commonsense bill" enables pharmacists to be reimbursed for services they are already allowed to perform, when administered in medically underserved areas.

"I routinely hear from Kentuckians who rely on their pharmacists as their initial access point to health care," Guthrie commented. "Whether it's to inquire about medication, potential side effects or discussing other ailments and complications, many patients view their pharmacist as a critical member of their health care team. This legislation will increase patient access to basic services in a cost-effective and responsible way."

Young pointed out that the bill addresses the shortage of primary care providers in many areas of the country. "Many rural communities, like those spread across southern Indiana, struggle with inadequate access to doctors and other health care providers," he explained. "This legislation would begin to fill that void in those areas designated as 'medically underserved' by allowing pharmacists to offer clinical services within their current scope of practice to Medicare patients."

The National Association of Chain Drug Stores applauded the bill, which it said would designate pharmacists as health care providers under Medicare program.

"The provider status designation will amplify pharmacists' ability to do what they do best: serve patients and help them on the road to better health," NACDS president and chief executive officer Steve Anderson said in a statement.

NACDS noted that pharmacists spend more than six years obtaining professional education to earn their degree and license. And in addition to dispensing prescriptions, pharmacists counsel patients about the importance of taking those medications as prescribed, administer flu shots and other vaccinations, provide preventive health tests, and offer educational programs and services to help patients manage diseases and chronic conditions. Also, many patients in the Medicare Part B program rely on pharmacies to provide durable medical equipment and other supplies to help them manage chronic diseases or conditions, such as diabetes. 

However, the lack of pharmacist recognition as a provider by third party payors, including Medicare and Medicaid, has limited the number and types of services that pharmacists can provide, even though they're qualified to do so, according to NACDS.

"Retail pharmacies are oftentimes the most readily accessible health care provider. Research has shown that nearly all Americans (89%) live within five miles of a community retail pharmacy. Combined with their expertise and training, pharmacists as health care providers can serve their patients to their full capabilities," Anderson stated. "Expanding the role of pharmacists to meet the demands of more than 30 million newly uninsured patients can only help alleviate the increased need for health care services. And we are hopeful that this legislation is the first step towards the ultimate goal of achieving success for patient health."

H.R. 4190 also is endorsed by the National Community Pharmacists Association, which said the legislation broadens health care access by allowing state-licensed pharmacists in traditionally underserved communities to participate in and be reimbursed for a wider array of services via Medicare Part B.

"Independent community pharmacies often care for underserved patients in rural and urban areas alike. Most of these providers are located in smaller communities, and approximately 1,800 independents are the only pharmacy option in their rural communities," NCPA CEO B. Douglas Hoey stated. "In other areas, independent pharmacies cater to diverse populations for whom English may be a second language. In these scenarios and others, independent community pharmacists are ideally positioned to play a greater role in health care, so NCPA is proud to support this legislation."

Measures to recognize pharmacists as health care providers and widen their scope of services are already under way in some states, as well as in Canada.

This past fall, California enacted legislation that authorizes its state pharmacy board to recognize an "advanced practice pharmacist," expanding the ability of pharmacists to collaborate with other members of a patient's health care team. Pharmacists with that designation can perform physical assessments, order and interpret medication-related tests, and refer patients to other health providers.

And in October 2012, Ontario approved regulations enabling pharmacists in the province to provide a broader range of services. They include the ability to adapt and renew existing prescriptions; administering flu vaccinations; prescribing smoking cessation drugs; administering certain substances by injection or inhalation to a patient for education and demonstration purposes; and piercing the skin to support patient self-care and monitoring of a chronic disease, such as diabetes.

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