Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
My last position was as Dean of Pharmacy at Loma Linda University in Southern California. I was very fortunate to be a part of a campus where the interprofessional team is valued, and every member of the team respects each other. In fact, at Loma Linda there was an open-minded approach to engaging every professional to the top of their training in ways that would ensure patients received the very best whole-person care. “To Make Man Whole” is their motto, and they live it every day.
However, pharmacist team members at Loma Linda and at health systems across the nation struggle when they work in ambulatory care settings because there is often very little if any revenue generated to offset the salaries of the pharmacists. In capitated, pay-for-performance models, systems will invest in a pharmacist because they know that having a pharmacist on the team improves quality ratings and reduces cost of care. However, in traditional fee-for-service models, health insurers largely refuse to recognize pharmacists as providers or credential them as in-network, and thus the system is faced with a very tough situation—either charge the patient directly for the services of the pharmacist or take a loss by employing one. Since neither of those options is ideal, the practice often simply does not utilize a pharmacist.
As a result, a growing number of physicians are recognizing that the value pharmacists provide to the team is simply so great that they can no longer stay silent. Despite the opposition of organized medicine, physicians are beginning to stand up and say “Yes, we need to recognize pharmacists as providers and they should be compensated in the same way other providers are compensated.”
Perhaps the most poignant example of this was when Akila Weber, MD, a board-certified obstetrics and gynecologist physician and California District 79 Assembly member, sponsored a bill (AB 317) signed into law by the governor that mandates health insurers to allow pharmacists to enroll in commercial health plan networks for services within their scope of practice. It further stipulates that the commercial insurers must compensate pharmacists in a manner consistent with how other providers are compensated.
Beyond California, physician voices are beginning to be heard directly and indirectly on federal legislation (i.e., HR 1770), allowing pharmacists to bill Medicare for testing and treatment of a variety of respiratory illnesses, as well as for vaccines. For example, Vin Gupta, MD, chief medical officer of Amazon (@VinGuptaMD on X) said in 2022, “Pharmacists should be able to directly prescribe more meds. They are invaluable colleagues, incredibly detail oriented and know what questions to ask…this isn’t a question of qualifications. It’s about modernizing outdated policy.” More recently, Gupta has issued his direct support of the passage of HR 1770.
In addition to Gupta, one of the largest supporters in health care of HR 1770 is the National Forum for Heart Disease & Stroke Prevention. The National Forum is comprised of dozens of health care organizations and patient advocacy groups. Its board is a who’s who of medicine—physician leaders from the Association of State and Territorial Health Officials, several schools of medicine, and physicians within the federal government. This includes the Honorable Jerome Adams, MD, 20th Surgeon General of the United States. The National Forum has submitted a formal letter to Congressional leadership issuing its strong support of passage of HR 1770. In addition, Adams has spoken publicly in a number of venues sharing his support.
If all of that wasn’t enough to convince you that organized medicine doesn’t have this one quite right, let me share a couple more examples. Patrick Conway, MD, a pediatric hospitalist who has been inducted into the National Academy of Medicine, and is now CEO of Optum Rx, stated the following in congressional testimony: “When many areas in the United States are facing acute shortages of primary care providers, it makes little sense to prohibit pharmacists from performing health care services for which they are trained and can administer safely and according to clinical guidelines. Congress can aid in this effort by enacting legislation that would allow pharmacists to provide appropriate services for Medicare beneficiaries in medically underserved areas.” While Conway and Optum Rx fundamentally disagree with APhA on the role of PBMs in health care, we fully agree on the role of pharmacists, and we appreciate him taking such a stand.
Finally, few physicians have been better vocal supporters of the pharmacist’s role on the health care team than Kyu Rhee, MD, an internal medicine specialist with residency training in pediatrics, as well. Rhee is currently the CEO of the National Association of Community Health Centers, an organization that fully supports team-based care. Rhee has spoken at dozens of conferences and written many editorials, as well as been quoted in the media, speaking out strongly in support of greater utilization of pharmacists to address primary care shortages and meet public health needs.
So, pharmacy professionals, I know sometimes you see that organized medicine opposes what we do. I want to let you know that there are many who are willing to support us in our quest to ensure that patients have access to the care services of pharmacists. Let’s partner with those who share our focus on moving patient care forward rather than bicker with those who are closed-minded. When patients are the center of what we do, then we will be successful.
For every pharmacist. For all of pharmacy. ■