With a push from pharmacy, provider status bill introduced in Congress

Hub on Policy and Advocacy

Rep. Todd Young (R-IN) and APhA Executive Vice President 
and CEO Thomas Menighan on Capitol Hill

A pharmacists’ provider status bill was introduced in the U.S. House of Representatives on March 11. Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), and Todd Young (R-IN) introduced legislation to amend Title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services. 

The bill (H.R. 4190) was referred for consideration to the House Committee on Energy & Commerce and the House Committee on Ways & Means.

“There is currently no mechanism for pharmacists to be reimbursed by the Medicare program. This common-sense bill creates a means for pharmacists to be reimbursed for these services they are already allowed to perform, when performed in medically underserved areas,” according to a news release posted on Guthrie’s congressional website.

Pharmacy’s reaction

The Patient Access to Pharmacists’ Care Coalition (PAPCC) applauded the bill. PAPCC is leading the push for the passage of federal legislation to enable patient access to, and reimbursement for, Medicare Part D services by state-licensed pharmacists in medically underserved communities, the coalition announced March 3. APhA is a member of the coalition.

“We must deploy our highly trained pharmacists to help improve medication use, and the pathway is through coverage and payment of pharmacists’ patient care services in the Social Security Act,” wrote APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, in a CEO Blog post published March 11 on pharmacist.com.

Two days after the introduction of H.R. 4190, more than 400 community pharmacists, pharmacy executives, student pharmacists, and other pharmacy advocates from 40 states participated in the National Association of Chain Drug Stores’ (NACDS) RxIMPACT Day on Capitol Hill, according to an NACDS news release.

During the NACDS fly-in, Menighan and APhA Senior Lobbyist Michael Spira joined a delegation from Indiana to visit eight congressional offices in the House and Senate. “In every meeting we talked about the value that pharmacists bring to the heatlh care team and how the newly introduced H.R. 4190 will allow us to better serve our patients—their constituents,” Menighan wrote in a March 14 CEO Blog post. “We had a great response from every office. Even the offices that were a bit hesitant—for instance, Rep. [Todd] Rokita [R-IN] was concerned about the cost of the bill—believed there is a need for including pharmacists on the health care team.”

What’s in the bill

If enacted, the legislation would require Medicare to cover pharmacists’ patient care services that the licensed pharmacist is legally authorized to perform in the state; that would otherwise be covered if furnished by a physician or incident to a physician’s service; and when provided in a health professional shortage area, in a medically underserved area, or for a medically underserved population. 

The proposed legislation also would require Medicare to pay pharmacists an amount equal to 80% of the actual charge or 85% of the physician fee schedule amount. The effective date for Medicare to start covering pharmacists’ patient care services would be January 1, 2015. The bill would further require the U.S. Department of Health & Human Services to develop pharmacist-specific codes, as necessary, under the physician fee schedule.

Coalition membership

PAPCC’s current membership includes 9 pharmacy associations, 11 chain pharmacies, and 2 drug wholesalers. These include Albertson’s, American Association of Colleges of Pharmacy, APhA, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, Amerisource Bergen, Bi-Lo Pharmacy, Cardinal Health, CVS Caremark, Food Marketing Institute, Fred’s Pharmacy, Fruth Pharmacy, International Academy of Compounding Pharmacists, National Alliance of State Pharmacy Associations, NACDS, National Community Pharmacists Association, Rite Aid, Safeway Inc., SuperValu Pharmacies (Cub, New Farm Fresh Pharmacy, New Shoppers Pharmacy, and Shop’n Save Pharmacy), Thrifty White Pharmacy, Walgreens, and Winn-Dixie.

“This group will be knocking on the doors of Congress to ensure that pharmacists are formally recognized for their work as health care providers under federal law,” Menighan wrote in a March 4 CEO Blog post. “This will take time, but we are in it for the long haul.”