Scope of Practice
Loren Bonner
A new law in Hawai’i that recognizes pharmacists as providers—and enables reimbursement for their services—is being hailed as a major victory for patients and for the pharmacy profession in Hawai’i.
In early July 2025, Hawai’i Gov. Josh Green signed SB 1245 into law, mandating that beginning July 1, 2026, private and public health plans in Hawai’i must reimburse licensed pharmacists for covered health services when those services are delivered within the pharmacist’s scope of practice.
“In a state facing significant provider workforce shortages, especially in rural and underserved communities across our neighbor islands, this law elevates pharmacists as an essential part of the solution,” said Corrie Sanders, PharmD, executive director of the Hawaii Pharmacists Association (HPhA). “It truly shifts the ability to include pharmacists in the conversation as preventative health care providers.”
Pharmacists will be formally recognized in statute as health care providers, and Sanders said the designation will serve as the backbone for billing for services within pharmacists’ scope of practice.
Provider shortage
With provider status recognition, pharmacists in Hawai’i can be reimbursed for services already within their scope of practice through collaborative practice agreements, including immunization prescribing and administration, point-of-care testing, comprehensive medication management, smoking cessation services, hormonal contraception counseling and prescribing, and chronic disease state management.
“This isn’t about taking away services from any other health care provider,” said Lily Van, PharmD, HPhA’s president. “Instead, it’s about augmenting the care that’s already being provided—filling in the gaps between visits, reinforcing treatment plans, and being part of the health care team that we have been trained alongside for decades.”
Filling in gaps in care in underserved areas is especially needed in Hawai’i.
“On our neighbor islands, especially, pharmacists may be the only health care provider a patient sees regularly,” said Sanders. “This law allows us to expand those services, meet patients where they are, and allows pharmacists to leverage themselves in a team-based care model.”
Van said she has patients who will tell her on a daily basis how difficult it is to fly to different islands just to get basic health care.
“In our state, our health care provider shortage is at a tipping point,” she said. “We have providers who take turns flying to different islands to bring the care to our rural communities. Knowing the accessibility of our pharmacists, it only made sense to become that bridge.”
In order to prepare for provider status, Sanders said pharmacists in Hawai’i should become familiar with billing processes, documentation standards, and quality metrics that other providers already use.
Training in patient assessment, collaborative practice, and value-based care will also be important, noted Sanders.
“Equally critical will be building confidence to step into this provider role. This is an exciting opportunity, but it also comes with responsibility—we must demonstrate the high-quality, patient-centered care we can deliver,” she said.
Across the finish line
To get the legislation passed, Sanders said they worked closely with legislative champions who understood the urgency of addressing Hawai’i’s provider shortages. But success was ultimately possible because of a unified coalition with HPhA members, University of Hawai’i Daniel K. Inouye College of Pharmacy faculty and staff, student pharmacists, pharmacy leaders, Hawai’i health systems, and community advocates. Many of these supporters provided testimony, shared stories, and showed legislators the real-world impact of pharmacy care, according to Sanders.
“We brought together pharmacists from different practice settings—community, health-system, ambulatory care—and aligned our message with the broader health care community,” said Van.
Sanders said framing the legislation as a win for patients, providers, and payers helped them gain traction as well.
“The current statute mandates billing for pharmacists included in health plan networks, and we are excited to explore networking opportunities with plans in coming years,” Sanders said. ■
Complex and varied provider status landscape
According to a Journal of the American College of Clinical Pharmacy article from 2024 where authors identified a total of 36 states with some legislative or regulatory support for the payment of pharmacist clinical services, 13 of those states have enacted commercial coverage requirements that have mandated broad payment parity for pharmacists. Meanwhile, four states have mandated payment parity for a narrow scope of services.
Authors pointed out that in contrast, Medicaid payment parity has been broadly established in 16 states—with a wide range of restrictions and implementation considerations—with 17 states establishing parity for a narrower scope of services.
Minor changes have been enacted since 2024. ■