More states address pharmacists’ provider status recognition

Hub on Provider Status

As state legislatures across America look for ways to improve constituents’ health and lower health care costs, interest in pharmacist-provided care evidently is increasing. Compared with this time last year, related state legislative activity is up. Last year, 26 bills had been introduced. So far this year, 75 state bills addressing some aspect of patient access to pharmacists’ care have been introduced, as Pharmacy Today went to press. Even more activity is possible this year because many states still have time to introduce bills in this session (see Figure 1).

Figure 1. State provider status legislative activity in 2015


This year’s increase in state legislative activity could be caused by more momentum at the federal level, starting with 2014’s H.R. 4190 and continuing with January 2015’s H.R. 592 and S. 314, and/or evidence gathered over the years reaching a tipping point and showing that pharmacists’ services are too beneficial to ignore. Regardless of cause, there is still much work to be done. At the federal and state levels and in the private sector, provider status recognition is a constantly evolving effort to help patients have access to all that pharmacists have to offer. Because no single effort will provide access for all patients, advocacy at the state and federal levels and in the private sector is critical.

Legislation that has been introduced can be categorized in one of the following three areas:

  • Designation as a provider. This serves to decrease barriers to insurance coverage for services, pharmacist access to health information technologies, and even medical liability provisions in place for other providers.

  • Scope of practice. States continue to revise their pharmacy practice acts in order to align state laws and regulations with the education and training with which today’s pharmacists are equipped. 

  • Payment for services. Identifying methods for covering services provided by pharmacists via state or privately funded means can sometimes be the best way to provide patients with the pharmacists’ services they need.

Designation as a provider

Although 38 states currently designate pharmacists as a provider somewhere in their state code or Medicaid provisions, much room for improvement remains. Twelve states continue to face barriers caused by the lack of definition as providers; for the 38 states that do have the designation, changes related to provider designation still need to be made to state laws. Health care providers may be defined in many different areas within state law: professions and occupations laws, insurance laws, public health laws, medical liability laws, etc.

At the time this article was written, seven states had legislation introduced to include pharmacists in the definition of a provider somewhere in their state code. These include Maine and Massachusetts, 2 of the 12 states that do not currently have the designation. The other five states with new bills currently have pharmacists designated as providers in at least one place in state code or Medicaid policies but not in all of the areas that define health care providers. 

Scope of practice

Pharmacists are frequently referred to as the most underutilized health professional. In part, this can be attributed to the sometimes antiquated pharmacy practice acts currently in use. As pharmacist education and training have evolved, pharmacists’ scope of practice has not kept up with the pace of advancement. 

To align pharmacist education and training with scope of practice, states are making incremental improvements to their pharmacy practice acts. Through efforts often led by state pharmacy associations, 40 bills have been introduced this year in 21 states addressing issues ranging from immunization authority to collaborative practice agreements, and more. 

Currently, nine states have active legislation addressing pharmacist collaborative practice authority. Several seek authority for nurse practitioners—and, in some cases, physician assistants—to be authorized to enter into a collaborative agreement with pharmacists. As primary care evolves to a more team-based approach and nurse practitioners and physician assistants play a larger role in chronic disease management, these members of the health care team must be able to access pharmacists’ medication expertise. Under current law in 20 states, nurse practitioners and pharmacists can work together under a formal collaborative agreement. 

Of note, the state of New York’s collaborative practice laws on the books today restrict collaborative practice activities to the state’s teaching hospitals, leaving most of the state’s pharmacists with no option to use collaborative agreements. New York AB 5805 would expand collaborative practice authority to all practice settings and allow for collaboration with nurse practitioners and physician assistants. The bill “reflects the growing role of pharmacy in today’s health care system,” said John McDonald, BSPharm, a Member of the New York State Assembly. “Now more than ever, our health care system is dependent on providers working in a collaborative manner to enhance the care for patients and to achieve positive outcomes.” As Today went to press, the bill was in committee for consideration.

Payment for services

The final—and often considered the most important—component of state-level provider status is payment for the professional services provided by pharmacists. State policy to address the need for an alignment of incentives that allows pharmacists to practice at the top of their license and provide much-needed services can take the form of coverage by state payers or a mandate that private insurers cover pharmacists’ services.

Thus far, 22 bills have been introduced that relate to payment for pharmacists’ patient care services, including 7 bills calling for Medicaid coverage of pharmacists’ services. Five states would provide new coverage, and one state, Minnesota, proposed expansion of the Medicaid-eligible population. Currently, 10 states have payment for pharmacists’ services, such as medication therapy management (MTM), in Medicaid. 

Washington state’s SB 5557 would make it illegal for insurers to categorically exclude pharmacists from being eligible to be paid for services that are within their scope of practice and that are covered when provided by other health professionals. SB 5557 closes a loophole in an existing law passed in 1995. “We just want pharmacists to be treated like every other health care provider,” said Jeff Rochon, PharmD, CEO of the Washington State Pharmacy Association. “Pharmacists are willing to comply with the same rules and credentialing process; they just need to be on the team.” SB 5557 has already passed the Washington State Senate and is in process in that state’s House.

Making it happen—together

Pharmacists who want to help advance efforts to obtain provider status recognition should join—and participate in advocacy led by—their national, state, and local pharmacy associations. To learn more about what’s happening in your state and at the federal level, check out APhA’s Pharmacists Provide Care campaign. Click on your state in the interactive U.S. map to see current provider status–related bills, upcoming state meetings, and a link to your state pharmacy association’s website.

Triple play in North Dakota

Pharmacists in North Dakota are going after state-level provider status from all angles this year. With bills introduced—and advancing through the legislative process—in all three state provider status areas, the North Dakota Pharmacists Association (NDPhA) and its members are keeping busy this legislative session. It’s all about association member involvement, according to Mike Schwab, NDPhA Executive Vice President. “North Dakota pharmacists and their pharmacy staff are the greatest asset to the association. They are a very active group of professionals,” he said. What Schwab has seen in North Dakota can likely be generalized to all states. “When more pharmacists join and engage with the association,” he added, “there is a higher potential for legislation that is good for patients and pharmacists.”