BETHESDA, MD 26 April 2013—A bill to recognize California pharmacists as "health care providers who have the authority to provide health care services" was introduced on February 21 in the state senate and amended on April 1.
"There’s the potential it could be signed by the governor in September," said Dawn Benton, executive vice president of the California Society of Health-System Pharmacists (CSHP), a cosponsor of the bill.
"It could move fast," she said, "or it could turn into a two-year bill."
The bill, which Benton said CSHP wrote with the California Pharmacists Association, would allow pharmacists to
- Furnish prescription smoking-cessation drugs and devices,
- Provide Centers for Disease Control and Prevention-recommended prescription preventives for people traveling outside the country
- Furnish self-administered hormonal contraceptives in accordance with protocols developed and approved by the state boards of pharmacy and medicine,
- Train and educate patients about drug therapy, disease management, and disease prevention,
- Participate in multidisciplinary reviews of patient progress and have appropriate access to medical records for that activity, and
- Order and interpret tests as part of therapeutic drug monitoring.
In addition, the bill would create the designation "advanced practice pharmacist." Such a pharmacist would be allowed to
- Perform physical assessments,
- Order and interpret drug therapy-related tests,
- Refer patients to other health care providers, and
- Initiate, adjust, and discontinue drug therapies and evaluate and manage diseases and health conditions in collaboration with other health care providers or as a participant in a system of care.
Senator Ed Hernandez, an optometrist, introduced the bill as part of a threesome on health care providers.
The three bills seek to expand the scopes of practice for optometrists, nurse practitioners, and pharmacists.
California, according to Hernandez, already has a "serious" shortage of primary care providers.
That shortage will worsen next year when as many as 7 million residents seek health care coverage under the federal Affordable Care Act, he has said.
Nearly all those residents will receive coverage through Medi-Cal, the state’s Medicaid program, and no longer qualify for safety-net health care, said Ryan Gates, senior clinical pharmacist at 222-bed Kern Medical Center in Bakersfield.
"If this [bill] doesn’t pass and we don’t get recognized as providers, the future of clinical pharmacy in the outpatient setting is very uncertain," he said.
Gates is the CSHP-appointed cochair of the pharmacy groups’ 25-member Joint Provider Status Task Force.
He is one of two pharmacists running the medical center’s diabetes clinic.
Most of the clinic’s patients are "county safety-net patients" for which the medical center receives a lump sum from the state for providing health care services, he said.
"Kern Medical Center can provide [those] services however they see fit," Gates said. "That’s why they have clinical pharmacists seeing patients, because of proven quality of care and it’s cheaper than the physician."
But next year those safety-net patients are Medi-Cal enrollees, and the state currently does not allow facilities to bill its Medicaid program for pharmacist-provided health care services.
And in Kern County, which has almost the highest rate of diabetes-related deaths in the state, Gates said, no endocrinologist participates in Medi-Cal.
"For all intents and purposes, myself and my colleague Matthew Dehner, clinical pharmacist, are really the only providers of diabetes specialty care to our county’s Medi-Cal patients," he said.
The Medi-Cal patients receiving that care, Gates said, must be enrolled in the one Medi-Cal managed care plan, a locally owned one, that credentialed him and Dehner.
Enactment of Hernandez’s pharmacist legislation would not force Medi-Cal to pay pharmacists for providing health care services, Benton and Gates acknowledged. Nor would it force any of the Medi-Cal managed care plans to credential pharmacists as providers.
The legislation, Gates said, "is permissive, it’s not proscriptive."
CSHP knew last year that Hernandez wanted to deal with the shortage of primary care providers through legislative means, said Jonathan Nelson, the organization’s legislative and regulatory analyst.
Hernandez has been the chair of the Senate Committee on Health since 2011. This legislative session he is also a member of the Business, Professions, and Economic Development Committee, which exercises oversight over several professional regulatory boards, including the board of pharmacy.
CSHP, Nelson said, decided to work on legislation that responds to the state’s need for more primary care providers and simultaneously acknowledges pharmacists’ current skills.
The result is a bill that would allow the state’s pharmacists to provide "basic" health care services to the general public, he said.
Although CSHP would not offer an estimate of how many of California’s approximately 40,000 pharmacists qualify now for the "advanced practice pharmacist" designation, Nelson said the number should increase quickly.
"The health provider shortage isn’t something that’s happening in the future—that reality is now," he said. "We didn’t want to build a system that excluded the bulk of pharmacists from being able to become an advanced practice pharmacist."
According to the bill, a pharmacist seeking recognition as an advanced practice pharmacist would have to have a state license in good standing, meet one of three practice-related criteria, file an application, and pay a fee.
Benton said the task force started work on the bill’s language in December 2012 and finalized it in mid-March 2013.
Hernandez introduced his three bills on February 21, one day before the deadline for the first half of the 2013–14 legislative session.
On April 1, the first day after the legislature’s spring recess, he amended the bills with the language that the Business, Professions, and Economic Development Committee was scheduled to examine on April 22.
According to the state’s legislative calendars, the senate must pass the pharmacists bill by May 31 for it to remain on schedule for possible signature by the governor this year.