Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
By the time you are reading this month’s column, states will have submitted their responses to HHS’s request for proposals (RFP) in support of the Rural Health Transformation Program. If you’ve not been keeping up with this program, let me briefly bring you up to speed because it has the potential to have a significant impact on the engagement of pharmacists in primary care, including payment for services.
The One Big Beautiful Bill Act (Section 71401 of Public Law 119-2) appropriated $10 billion per year for 5 years ($50 billion total appropriation) that “empowers states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem.” Half of the money must be given equally to the states that apply, while the other half of the funds are to be allocated based on the strength of the application from the state and the proportion of rural facilities in that state versus other states.
The bill states, “Under the program, states may apply for financial allotments to improve the access and quality of care of services in rural areas, such as through enhanced technology, strategic partnerships, and workforce training. States must submit detailed rural health transformation plans and certify that no funds will be used to finance the non-federal share of Medicaid or CHIP. CMS must approve or deny applications by December 31, 2025; states that receive approval do not need to reapply each year. States are not required to contribute any matching funds with respect to program allotments.”
This program might just be the catalyst pharmacies and pharmacists are looking for in relation to payment for pharmacist services. APhA is aware that several states have included engagement of pharmacies and payment for pharmacist care services as a component of the care transformation and strategic partnerships.
Also, in the CMS call for proposals, the agency pushed states to truly engage in transformational activities. CMS will provide favorable scoring to states adopting scope of practice changes for health care professionals, which allow health care providers in rural areas to practice “at the top of their license,” including allowing pharmacists to prescribe. (Members can read more about APhA’s efforts around pharmacist prescribing and scope of practice on our website.)
Here is the reality: Many rural communities do not have any health care except for that provided by pharmacists. And increasingly, it is becoming quite difficult for organized medicine to oppose using pharmacists for more than local dispensing of medications. I’m certain that seeing CMS reference pharmacist prescribing and expansion of scope in the states triggered protectionists within medicine to circle their wagons. Yet how long can physicians who have this protectionist mentality continue to deny consumers access to care by putting up artificial barriers?
Beyond practice authorities that may advance as a result of the HHS RFP process, another major advancement is the use of technologies to advance patient care. Creative solutions for bidirectional interoperability of pharmacy systems and electronic medical records are real possibilities. States can apply for use of funds for such interoperability to improve care. Telehealth expansions are also likely, and pharmacists can be an integral part of those solutions as well.
It’s common sense. Pharmacists and pharmacies are vital to the rural health care infrastructure of our country. It’s good to see that our government has finally also seen this light and is making allowances through regulation and financing to institute change. In the long term, we’ll still need congressional action, and these big steps by HHS have the potential to change pharmacy practice in local communities for the better and forever.
For every pharmacist. For all of pharmacy. ■