Congratulations to the states making strides toward provider status
According to the National Alliance of State Pharmacy Associations (NASPA), 34 states considered 109 provider status recognition bills in 2019. I’m blown away by the work state pharmacy associations are doing to advance and raise the profile of policies that increase patient access, promote team-based care, gain recognition and coverage for pharmacists’ patient care services, and ultimately reduce costs for the entire health care system.
The New Mexico state legislature recently sent a provider status bill to Gov. Michelle Lujan Grisham’s desk, and we will know on Wednesday, March 11 if she will sign it. APhA signed on to a letter in support of the legislation.
New Mexico’s HB 42 would require health plans to reimburse network pharmacist clinicians authorized to provide services within the state’s scope of pharmacy practice at the same rate the plan reimburses licensed physicians and nurse practitioners for that service.
In other words, the New Mexico bill mandates that health plans will not discriminate against pharmacist clinicians who provide a service they are authorized to provide, and those pharmacists should be compensated at the same rate paid to licensed physicians and nurse practitioners. The bill would have the biggest positive impact on patients who live in underserved areas and have reduced access to services, and would give health systems financial incentive to invest in the pharmacist clinician model—allowing the patients they serve to reap the benefits of team-based care.
Meanwhile, I just read a meeting recap from our friends in Ohio, who are leveraging their legislative success by continuing the push toward implementation and provision of covered services as envisioned within Ohio’s passed provider status law. The Ohio Pharmacists Association and the seven pharmacy colleges in the state are all working together to maintain their fantastic momentum!
I’ve also had my eyes on my home state of West Virginia, where the state Senate and House of Delegates just passed a bill that would cover services that fall within a pharmacist’s scope and are ordinarily covered when provided by other health care providers. The bill also passed the state Senate which approved the House’s amendments. If signed by West Virginia’s governor, the bill would apply to plans issued or renewed on or after January 1, 2021. Gov. Jim Justice has up to 15 days to sign the bill into law—so by March 22, we will know if the bill has been signed into law. Also, if the West Virginia Governor does not take any action, it will automatically become law. To have their services reimbursed under the West Virginia bill, pharmacists must be included in the plan’s network of participating providers or be employed or contracted by a credentialed facility. APhA signed onto our own letter and a joint pharmacy letter supporting that bill.
For all the big questions dominating discussions about health care—drug prices, workforce conditions, the upcoming Supreme Court case on state PBM oversight—it’s imperative that the pharmacy community keeps their foot on the gas for provider status with the federal government, states, and the private sector. Success at the state level will influence action at the federal level. Provider status has the potential to positively affect all the issues that are currently in play for both pharmacists and patients.
Watch this space for all the latest on provider status progress at the state and federal levels.