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Serving underserved populations
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Serving underserved populations

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Association Perspective

Ilisa BG Bernstein PharmD, JD, FAPhA

Access and health disparities continue to impact patient care. Action is needed for patients to have ready access to critical medications to sustain their quality of life. Pharmacies are often the only health care destination available in a community, and the growth of pharmacy deserts in many underserved areas of the country is sobering. In our efforts to promote patient care and ensure equity, it’s vital that community pharmacies maintain their ability to keep their doors open and serve as access points for medications and their community.

Photo of ILISA BG BERNSTEIN PharmD, JD, FAPhA Interim Executive Vice President and CEO American Pharmacists Association

There are several avenues for supporting our pharmacies and underserved communities. One is to remedy the mischief around pharmacy payment and reimbursement, where DIR fees, clawbacks, below-cost payments, and other actions from Goliath companies threaten the financial viability of pharmacies.

Fixing this is multifaceted and we are working with Congress, the Administration, CMS, FTC, state policymakers, the commercial sector, and others to drive needed change. Policymakers across the country are ready for these conversations in 2023, and APhA will be your voice in these discussions. 

APhA is proud to work with our partners in state organizations, who are making advancements in payment for pharmacists’ patient care services. An increasing number of states have passed laws that require payment for pharmacists’ patient care services “in parity” with other health care professionals. The types of services covered—and billing codes used—can vary, but these developments provide both a revenue stream to support pharmacists’ time to provide clinical care and a new opportunity for service growth, addressing equity, and strengthening community pharmacies.

Commercial health plans are also independently seeing the benefits of pharmacists’ patient care services. I’m seeing pockets around the country where arrangements are brokered so that plans pay pharmacists for patient care. I’m encouraged by the positive outcomes and efficiencies being generated from these arrangements. They will no doubt support advocacy efforts to scale this up for multifaceted coverage, such as in fee-for-service or value-based payment, across payer types.

The care and impact of pharmacy on health disparities is premised on expanding state scope of practice through legislative directives, statewide protocols, or enhancements to collaborative practice authority. There has been a lot of activity in the states to make permanent authorities for COVID-19-related services in addition to advancements for test-and-treat, HIV PrEP and PEP, hormonal contraception, nicotine cessation, furnishing naloxone, and more. State legislators and public health officials see firsthand the level of care pharmacists provide, and with this recognition we expect to see further advancement in scope authorities aligned with pharmacists’ education and training. The future is bright for scope of practice expansion wins.

New tensions between federal and state authorities emerged in June 2022 with the Supreme Court decision that placed the regulation of abortion services with individual states. States have adopted a myriad of often-confusing requirements related to medications that have multiple purposes but could cause the loss of a pregnancy. The most recent rule change by FDA allows certified pharmacies to dispense medication for abortion, but pharmacists and pharmacies remain caught in the middle of this issue. It’s still too early to know which pharmacies will become certified; the quest for clarity will likely continue throughout this year.

Structural and system inequities persist to this day, contributing to health disparities and inequities. As one of the most accessible health care resources for underserved communities, pharmacists stand at the forefront of patient care and advocacy. There is still a lot of work to be done, and we continue to move forward with solutions that help our patients, our communities, and our colleagues in pharmacy. We move forward together. ■

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