Last week, I read the article, “US Pharmacies could administer up to 100 million doses of Covid vaccine a month. Here’s how”, which describes how Dr. Anthony Fauci is calling upon pharmacists to serve our nation through administration of COVID vaccinations.
“How,” I wondered, “can pharmacists be this critical to the Community health and yet STILL not be recognized as a healthcare provider?”
Prior to the pandemic, mail-order prescription filling was threatening to obliterate the presence of brick-and-mortar pharmacies thanks to the convenience of online ordering and expedited shipping.
These past twelve months has made it glaringly apparent, however, that when a patient needs acute access to life-saving medicines and vaccines that are dependent on a face-to-face relationship, Amazon simply cannot replace the pharmacist-patient relationship.
Your pharmacist literally becomes the first line of defense for many and is indisputably now a life-saving healthcare team member.
As the country shut down due to the pandemic in March 2020, pharmacies remained open to fill medications and were then called upon again in January 2021 to administer Covid-19 tests.
Now, Dr. Fauci from the CDC and the rest of the country is relying upon pharmacists to administer vaccines to the general public to stop this pandemic that has resulted in more than 460,000 deaths.
Yet, our country’s largest healthcare insurance provider, the Centers for Medicare and Medicaid (CMS) have remained unwilling to recognize these heroes for their actions.
CMS announced again as recently as November 2020 that pharmacists are not considered non-physician Qualified Healthcare Professionals (QHP)s under federal law.
Yet they are allowed to practice as a “clinical staff” member under the supervision of a physician or QHP.
What Types of Professionals are Considered QHPs?
Physician’s assistants, advanced nurse practitioners, clinical nurse specialists and nurse midwives are the only non-physician professionals recognized by CMS as a non-physician QHP.
To compare the training of a pharmacist who must be in possession of a doctorate degree in pharmacology in order to obtain a license in the United States, to the level of training required for a clinical nurse specialist, for example, leaves the pharmacist feeling very over-trained and under-utilized.
One pharmacist, practicing with an advanced nurse practitioner in Ohio, a state that just passed a bill to recognize pharmacists as providers under Ohio state Medicaid, shared, “[CMS] can afford to pay physicians for visits completed by the team… which could even be a substitute for a visit where they might have seen the provider, so [recognizing the pharmacist as a QHP] may not even be [associated with] an increased cost [to CMS].”
Another colleague of mine, working in collaboration with a private practice physician in Florida noted, “My provider seems to think it will not be a problem to have her see patients with me [in a covisit model as is currently the CMS recommended model], but I do not think it will be feasible as both of our schedules are completely booked as is. It will also create more stress for her as patients will no doubt bring up acute issues that they are not actually scheduled to be seen for [in the pharmacist-physician covisit model].”
The covisit model would not work in the following scenarios because:
- The cost associated with a covisit model would actually be more expensive
- The goal of the pharmacist is to focus on specific medication-related issues
The easiest solution that would solve these problems as well as elevate the pharmacist to be able to truly have an impact on patient outcomes is to pass legislation allowing pharmacists to become recognized as non-physician QHPs.
In fact, there’s legislation proposing that change in many states currently, but not federally.
When Will Pharmacists Gain Federal Provider Status?
Pharmacists have been fully leveraged in Covid-19 relief efforts, showing how essential we are.
In August 2020, pharmacists were authorized to administer childhood vaccines during the pandemic to children aged 3-18. In September, pharmacists were given the authority to administer Covid-19 vaccines.
This was done because, in times of emergency, it only made sense to leverage pharmacists in the capacity in which they were trained. We are the most accessible provider.
Still, we are often taken for granted and overlooked, especially by health insurers.
This oversight not only hurts pharmacists and their ability to bill for services, it hurts the healthcare system as a whole. A healthcare system that recognizes pharmacists as providers can operate more efficiently and in better service to patients.
With their specific skill sets and education, pharmacists can be leveraged in preventative care, medication management, acute screening for population health, as well as in vaccination efforts.
This frees up time for physicians and nurses, providers more focused and specialized care for patients, and can result in favorable reimbursement rates as a healthcare facility based on good performance.
Giving pharmacists provider status at the state and federal levels makes sense for everyone involved.
What Can We Do?
As pharmacists are called upon to serve our country, let’s make sure the National news media hears the voices of all of us!
We are hundreds of thousands of pharmacists in thousands of pharmacy networks around the country. We must be appropriately recognized for contributions to not only this important battle within the COVID-19 pandemic, but also for the contribution to the overall health of millions of Americans every single day.
How can you make sure that happens?
Tell your representatives that you want your pharmacist to be formally recognized as a healthcare provider under the Centers for Medicare & Medicaid Services (CMS). Link to this CNN article to cite the reasons we should get provider status!.
There are pharmacists working 14-hour days to serve population health, and I know they would feel a lot more appreciated with a formal acknowledgement of provider status!
About Blair Green Thielemier, PharmD
Blair Green Thielemier, PharmD, is an MTM consultant pharmacist specializing in pharmacy billing models. She consults on and produces e-learning programs for state and national organizations, pharmacy wholesalers, payers, technology start-ups. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com. She speaks internationally about trends in leveraging pharmacists to improve value-based care.