Reimbursement
Loren Bonner
"If you’ve seen one state, you’ve seen one state,” Brandy Seignemartin, PharmD, executive director of the Alaska Pharmacy Association, often says when speaking about payment reform.
The slow progress on the federal level for pharmacists to receive payment for clinical services has been met with state-based legislation to expand coverage for pharmacists under state Medicaid and commercial health plans.
Just as no U.S. states are alike, neither are their laws that support pharmacist payment for clinical services.
In Alaska, pharmacists can bill both Medicaid and commercial health plans for services performed because payers in the state cannot discriminate against pharmacists who practice in Alaska.
“From my understanding, states have [reimbursement] in either commercial or Medicaid, but not a lot have both,” said Seignemartin. “We are lucky to have both.”
Success
Seignemartin said they have seen the biggest long-term successes in federally qualified health centers (FQHCs) and tribal health center sites in Alaska since pharmacists can enroll as rendering providers and get paid for their services through the medical benefit while affiliated with a pharmacy professional group, Tribal Health Organization, FQHC, or Rural Health Clinic.
For instance, Valerie Bixler, PharmD, from Anchorage Neighborhood Health Center, an FQHC, sees patients with diabetes and other chronic conditions. Data showing an improvement in patients’ A1Cs when she was involved in care helped drive the passage of Alaska’s HB 145 in 2022, which amended the pharmacy act to define a pharmacist as a provider eligible to deliver patient care services in exchange for compensation. HB 145 also added pharmacists to the list of providers who may not be discriminated against in the provision of services covered under a group health insurance policy.
The COVID-19 pandemic created the enrollment pathway for pharmacists in Alaska to bill for services in Medicaid, and the work pharmacists did and were recognized for during the pandemic also drove HB 145 forward, according to Seignemartin, and got it “across the finish line.”
The legislation was also a joint effort between the Alaska Pharmacy Association, the college of pharmacy in Alaska, and the Alaska Board of Pharmacy. Seignemartin said this “successful triad” working together gave them a strong voice when advocating for the pharmacy profession.
As a small state in terms of population, pharmacists across practice sites in Alaska can more easily work together than they could in a larger state. “That’s our advantage as a small state,” Seignemartin said.
There are roughly 500 practicing pharmacists in Alaska.
However, resources are more limited for small states. Seignemartin said she hopes the Rural Health Transformation Program, which was authorized by the One Big Beautiful Bill Act, will support expansion for health care in Alaska.
Challenges
Of course, challenges remain in any state when pharmacists are billing insurance. Seignemartin said commercial providers are still not credentialing Alaska pharmacists.
“But at least they are still getting paid,” she said.
Once a covered benefit for patients has been authorized, pharmacists may enroll and be credentialed as plan network providers and submit payment claims for the patient care services delivered. Many state associations work with members to learn these steps. APhA is also working with pharmacist members, leaders, and health plan partners to help navigate this new territory for pharmacists.
Different practice sites also present different challenges, according to Seignemartin. Pharmacists working in independent community pharmacies in Alaska have limited options with EHR systems and face an expensive credentialing process. However, health system pharmacists can more easily hit the ground running because they have internal systems in place already, noted Seignemartin.
“But medical staff bylaws in hospitals have to be updated with pharmacists,” she said. “That’s an additional barrier.”
She said it took 1 year to get through that update—even before credentialing could happen.
“Even if policy is passed, there are many more steps to get through,”
Seignemartin said. ■