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.