Payment for Pharmacist's Patient Care Services
Payment for Pharmacist's Patient Care Services are not included in
key
sections of the Social Security Act (SSA), which determines
eligibility
for health care programs such as Medicare Part B. In the case of
Medicare Part B, the omission of Payment for Pharmacist's
Patient Care
Services limits Medicare beneficiaries’ access to pharmacists’
services
in the outpatient setting. Pharmacists have demonstrated their
value
while playing a crucial role in COVID-19 pandemic response by
being
available and accessible as front-line health care
professionals. APhA
encourages Congress to pass legislation that recognizes Payment
for
Pharmacist's Patient Care Services in Medicare Part B and as
integral
members of the health care team to provide patients with access
to and
coverage for our quality patient care services.
Pharmacist and Pharmacy Payment Reform
The pharmacy reimbursement and drug pricing scheme in the U.S. has
grown out
of control, with misaligned incentives that neither benefit the
patient
nor lead to better health outcomes. These misalignments are
causing
pharmacies across the country to shut their doors, leaving
patients
without access to their local pharmacies. APhA supports
transparency and
accountability in reimbursement and pricing and is thus
concentrating
policy efforts to 1) support pharmacists’ ability to focus on
patient
care and to be appropriately paid for these services and 2)
reform
pharmacy payment and PBMs’ actions and activities that are
disrupting
the pharmacy ecosystem. Recent advocacy and legal
action led to CMS issuing a final rule that
eliminates
harmful retroactive direct and indirect remuneration (DIR) fees.
Other Improvements to Medicare
As scientific innovation leads to medications that are exponentially
more
complex, we believe that pharmacists, as the medication experts,
need to
be key players on patient health teams. APhA advocates for the
expansion
and enhancement of the Medicare Part D Medication Therapy
Management
(MTM) program. Further, APhA supports CMS’s efforts to increase
patient
access and choice by requiring Part D plans and pharmacy benefit
managers (PBMs) to contract with any pharmacy willing to accept
the
PBM’s contractual terms and conditions for network participation
(i.e.
“any willing pharmacy” requirement). In addition, APhA will
continue to
advocate for increased transparency regarding Part D plans,
including
efforts to provide beneficiaries with up-to-date information
about
actual access standards and cost-sharing information.
Compounding
APhA urges policymakers to defer to existing state laws related to
traditional compounding, including laws related to “office-use,”
and has
asked FDA to clarify that its guidance is not designed to
infringe on
the practice of pharmacy as historically regulated by the
states. APhA
also remains concerned that arbitrary limitations on the
out-of-state
distribution of compounded drug products may adversely impact
patient
access to medically-necessary medications.
Reproductive Health Care
APhA is committed to advancing equitable access to comprehensive
reproductive health care for all patients. The association
advocates for
policies that ensure access to essential reproductive services
and
opposes legal actions against pharmacies and pharmacists who
provide
care within their scope of practice. APhA strives to ensure that
pharmacists play a vital role in facilitating informed,
patient-centered
reproductive health care.
Vaccinations
Pharmacists, pharmacy technicians, and interns are essential partners
in
ensuring patients have access to timely, evidence-based
vaccination
services.To maintain this access, state laws and regulations
must be
clear, flexible, and consistent with the standard of care.
The Guiding Principles for State Policy on Pharmacy
Personnel-Administered
Vaccines, developed collaboratively by 13 national pharmacy
organizations, provides a roadmap for states to modernize
vaccination
policy. The document outlines best practices to preserve
pharmacist
authority, support appropriate delegation, remove age
restrictions, and
ensure fair payment for vaccination services.
State Legislative Activity Tracker
To support pharmacists, student pharmacists, pharmacy technicians and
state
associations engaged in advocacy across the country, APhA tracks
key
pharmacy-related legislation in all 50 states and the District
of
Columbia. This interactive map provides a real-time snapshot of
state
legislative activity aligned with APhA’s priority advocacy
issues.
The map allows users to explore active and recently introduced bills
by
state, view bill summaries, and link directly to legislative
text and
status updates. Issues reflected in the map include, but are not
limited
to, pharmacist scope of practice, payment for
pharmacist-provided
services, pharmacy benefit manager reform, workforce and
workplace
protections, and patient access to care.
This tool is intended to:
- Increase transparency around state-level policy activity
impacting
the profession
- Help pharmacists and advocates quickly identify issues
advancing in
their state
- Support coordinated advocacy efforts between APhA and state
pharmacy
associations
Legislative data displayed in the map is updated daily and is
provided for
informational and advocacy-support purposes. Inclusion of a bill
does
not imply endorsement unless otherwise stated.
Pharmacy Well-being & Workplace Policy
Explorer and
Comparison Tool
To support pharmacists, pharmacy technicians, student pharmacists,
state
associations, policymakers, and patient advocates working to
improve
pharmacy practice environments, the APhA Well-being Advisory
Committee
has developed the Pharmacy Well-being & Workplace Policy
Explorer
and Comparison Tool. This interactive map allows users to
explore state
laws and regulations related to pharmacy workplace and
well-being
policies across the country.
The tool allows users to assess and compare state policy approaches
related
to pharmacy staffing and workload, breaks and rest periods,
working
conditions and safety, and pharmacy technician scope and
responsibility.
Users can use the drop-down feature to highlight specific policy
areas,
visualize trends across states, and identify opportunities to
advance
safer, more sustainable pharmacy practice environments.
This tool is intended to:
- Increase transparency around state-level policies impacting
pharmacy
workplace conditions and well-being.
- Help pharmacists, pharmacy technicians, and advocates
quickly
identify relevant laws and regulations in their state.
- Support comparison of policy approaches across states.
- Inform advocacy efforts to improve pharmacy practice
environments
and patient care.