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Washington state leads way with provider status

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Pharmacists to be included as network providers under new law

OLYMPIA, Wash. — A law that makes Washington the first state to grant provider status to pharmacists goes into effect this summer.

Washington Gov. Jay Inslee, with State Sen. Linda Evans Parlette at his left, signs legislation making Washington the first state to grant health care provider status to pharmacists.

Washington Gov. Jay Inslee (D.) earlier this month signed into law the Engrossed Substitute Senate Bill 5557 (ESSB 5557), which will require health insurance carriers to include pharmacists as network providers. The law takes effect on July 24.

State Sen. Linda Evans Parlette (R.), who sponsored the legislation, said the law establishes pharmacists as part of an integrated health care team and will enable them to take a more active role in caring for patients, especially in managing medications for chronic illnesses.

Until now, health insurance carriers recognized pharmacists only for dispensing medication, which blocked patients from receiving medical care from pharmacists practicing within their scope of practice, noted the Washington State Pharmacy Association.

“Removing these barriers will allow pharmacists to directly care for patients in all practice settings,” Jeff Rochon, chief executive officer of the Washington State Pharmacy Association, said in a statement. “This commonsense solution encourages greater collaboration among health providers and brings health care to patients in our communities.”

Now pharmacists in the state will be able to provide a broad spectrum of patient care services, which will help reduce emergency room visits and hospital readmissions as well as benefit communities with shortages of primary care physicians, the association said.

“We are excited that pharmacists will have opportunities to increase collaboration within the health care team in patient-centered medical homes and accountable care organizations, with the focus being on quality and safety,” Rochon added. “This is a huge development within our health care system, and we’re excited that pharmacists will finally be able to utilize all our skills to help patients.”

The National Association of Chain Drug Stores described the ESSB 5557 as “a positive step forward for pharmacy patient care.”

The bill implements a law that was passed in 1993 requiring insurers to pay all categories of providers for services they provide within their scope of practice if they are covered under the insurance plan. The initial “any category of provider” legislation was passed in 1993 but was challenged by insurers in the courts until it was eventually upheld in 2001.

The net effect for pharmacists is that insurers will be required to pay them for services they provide if other providers are paid for the same services and if they are covered services under the insurance plan, an NACDS spokesman explained.

“Millions of Americans already lack adequate access to health care due to primary care physician shortages in their communities, despite many of these patients having health insurance coverage. This problem is expected to worsen as more people obtain health insurance,” commented National Community Pharmacists Association CEO Douglas Hoey. “Pharmacists are capable of playing a greater role in the delivery of health care services to help close gaps in care. Pharmacists who practice at the fullest extent of their education, training and license can provide services that include health and wellness screenings, chronic disease management, immunization administration, medication management, and working in and partnering with hospitals and health systems to advance health and wellness and reduce hospital readmissions.”

According to Parlette, ESSB 5557 also implements a staged credentialing for certain health groups beginning in 2016 and creates a workgroup to determine the credentialing process for other community pharmacists by 2017.

“The passage of ESSB 5557 simply means that patients will have greater access to high-quality care services,” stated Don Downing, clinical professor at the University of Washington School of Pharmacy. “Most people only know pharmacists as their trusted prescription partner, but now pharmacists will more closely partner with each patient’s medical provider as an exquisitely trained medication specialist.”


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