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.