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2/12/2017

Proposed Legislation, CMS Guidance Portend Advancements for Pharmacists

Cheryl Thompson

Cheryl A. ThompsonDirector
News Center

Federal efforts to advance pharmacists’ role in healthcare got off to a fast start in January with developments including the following:

  • On January 12, Senator Charles E. Grassley (R-IA) and 26 colleagues reintroduced the Pharmacy and Medically Underserved Areas Enhancement Act in the Senate.
  • On January 17, a component of the Centers for Medicare and Medicaid Services (CMS) issued a guidance addressing “flexibilities that states may have to facilitate timely access to specific drugs by expanding the scope of practice and services that can be provided by pharmacists.”
  • On January 20, Representative Brett Guthrie (R-KY) and 107 colleagues reintroduced the Pharmacy and Medically Underserved Areas Enhancement Act in the House of Representatives.

Congress

The Senate and House bills (S. 109 and H.R. 592, respectively) would allow the Medicare program to pay for pharmacist services provided to beneficiaries in underserved communities.

Grassley originally introduced the Senate bill 2 years ago; Guthrie has now introduced the House bill 3 times.

The legislation is supported by the Patient Access to Pharmacists’ Care Coalition, of which ASHP is a leading member.

“We have reason to believe that we’re going to have an opportunity to move the legislation this session,” said Joseph Hill, director of the ASHP Government Relations Division.

This congressional session, Hill explained, differs from recent sessions, during which legislation to secure provider status for pharmacists did not progress after referral to a committee and very few Medicare bills passed Congress.

“Now, in 2017, there are a couple of Medicare-related issues that Congress will have to deal with,” he said. And the coalition is eyeing them.

Congress in recent years, Hill said, has tended to roll up Medicare issues into a huge package, with legislators apparently more willing to tackle the issues in a single broad bill rather than discussing and passing a series of more narrowly focused bills.

CMS Guidance

The guidance (actually an informational bulletin), issued by the Center for Medicaid and Children’s Health Insurance Program services, explains how states have been leveraging pharmacists’ scope of practice to address 4 “national public health challenges”: (1) ensuring that naloxone is available for life-threatening opioid emergencies, (2) initiating tobacco-cessation treatments, (3) preventing influenza viral infections, and (4) improving Medicaid beneficiaries’ access to emergency contraception.

To Gloria Sachdev, chair of the ASHP Council on Public Policy, the guidance almost coordinates with the provider status legislation.

Yet each addresses a distinct aspect of pharmacist services, said Sachdev, a faculty member at Purdue University College of Pharmacy who is president of the Employers’ Forum of Indiana, a healthcare coalition.

She said enactment of the federal legislation would have “no impact on pharmacists” scope of practice," which is determined by individual states.

The legislation pertains to Medicare payment for services that a pharmacist is already authorized to perform in the state where he or she is furnishing them.

The CMS guidance encourages all state Medicaid agencies to advance their state’s scope of practice for pharmacists and utilize it, Sachdev said.

The guidance, however, does not address Medicaid payment for services other than dispensing or administering specific pharmaceuticals.

“I sent this to our state health commissioner,” Sachdev said of the guidance, “because we have a bill . . . to have a statewide protocol that he would sign off on and that would be maintained by the state board of pharmacy for immunizations.”

Sachdev cochairs the Indiana Pharmacists Alliance’s legislative and regulatory efforts.

She said the organization worked with Indiana Representative Steven Davisson, a pharmacist, to introduce House Bill 1540. The bill would, in part, allow the state health commissioner to issue a standing order, prescription, or protocol that allows pharmacists throughout the state to administer federally recommended vaccines to persons 11 years of age or older.

“Back in the day when it was an individual pharmacist signing a collaborative practice agreement with an individual physician, that was great,” Sachdev said.

Now, as large physician practices with a cadre of ambulatory care pharmacists become more the norm, she said, one-on-one agreements don’t work well—hence the need for a statewide arrangement.

Efforts to Secure Payment for Services

Although pharmacists have made “significant headway” in working with state Medicaid agencies to gain recognition as healthcare providers, Sachdev said, the recognition has not easily translated into payment.

“I think we thought—as a profession—that if we were recognized as a provider, then payment would just automatically follow suit,” she said. “That hasn’t been the case.”

The Pharmacy and Medically Underserved Areas Enhancement Act combines recognition with payment by adding pharmacist-furnished pharmacist services to the list of Medicare Part B–covered “medical and other health services” and stating a payment rate: 80% of the actual charge or 85% of the rate in the Part B physician fee schedule, whichever is less.

ASHP’s Hill said the Patient Access to Pharmacists’ Care Coalition surpassed its goal to get the legislation reintroduced with 20 cosponsors in the Senate and 100 in the House.

“We think that sends a very strong message about the support that the legislation had and continues to have, based on the numbers from last year and even going back to 2014,” he said.

The numbers last year, Hill said, enabled the coalition to tell legislators, “A majority of you think this is good policy,” but the numbers did not automatically trigger anything in the legislative process.

Getting the provider status legislation into a package of Medicare bills that has momentum will require the efforts of the coalition and, to a certain degree, the bills’ sponsors, he said.

Discussions, Hill said, have already begun.

[This news story appears in the March 1, 2017, issue of AJHP.]

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