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Sound Off: Pharmacists as Providers

Created July 25, 2012 by Chivas Owle

Editor’s Note: This is the second installment of SDN’s new opinion column, “Sound Off.” If you are interested in submitting a column for publication, please visit the SDN Help Center to send a message to our Editor in Chief.

Recently pharmacists have been branching out further and further from the traditional dispensing role and gaining more and more acceptance as healthcare providers. Pharmacists have proven time and time again that we can positively impact patient outcomes on a cost effective basis. In spite of our recent advancements though there is one major hurdle that prevents pharmacists from living up to our full potential as healthcare providers – reimbursement. Until pharmacists are recognized in legislature as healthcare providers our ability to serve our patients to our full potential will be hindered.

One petition to have pharmacists recognized as providers, found at…care-providers, has this to say:

“Despite overwhelming evidence of the positive impact pharmacists can have on patient health, pharmacists are not recognized as healthcare providers under the Social Security Act and, therefore, cannot be paid by Medicare for therapy management and patient consultation services. The Social Security Act does recognize other healthcare professionals such as dieticians, nurse practitioners, physician assistants, nurse midwives, and clinical social workers. By changing the compensation structure allowed under Medicare, we can ensure that patients have access to the medication expertise of pharmacists. Studies have shown that when a pharmacist is directly involved in patient care, patients have fewer adverse drug reactions, experience improved outcomes, and healthcare costs are reduced. The perils of adverse effects from taking multiple medications affect all age groups. According to a recent survey, just over half of all Americans take at least 2 medications each day and nearly one-third take 4 or more medications each day. For the Medicare population, medication use is even higher — nearly half of Americans aged 65 and older take at least 4 medications each day. This is a critical safety issue!!”

Not every pharmacist agrees that this is the best use of political capital however. Thomas Menigham, BS Pharm, MBA, ScD, FAPhA, in an article recently published in Drug Topics, has this to say concerning the push to have pharmacists recognized as providers: “Just recently, in an important meeting with House committee staff, we heard the concern that provider status may not be the right fight at this time because of moves away from the pay-for-service and towards payments based on outcomes. If there is one mistake we want to avoid on Capitol Hill, it’s shooting behind the duck as it flies away!” He goes on to clarify, ”That said, under current rules there are situations for which provider status would add much to pharmacists’ economic toolbox. Pharmacists working in physician offices would have new billing options, and our members who work in those situations tell us that would help greatly in expanding MTM services…Given the creativity of our pharmacists in helping to solve America’s growing drug problem, I have no doubt that provider status would be an incredibly important advance in patient care”.

Dave Walker, RPh, on his blog, has this to say: “Pharmacists have been using the ‘waiting for reimbursement’ argument for providing MTM or consulting services for years. We could continue to wait like the profession has in the past. OR we can step up and BE THE HEALTHCARE PROVIDER now and show that we can provide valuable services to patients, physician practices, medical home providers, and any other applicable areas of healthcare.”

The Pennsylvania Superior Court agrees that pharmacists should be recognized as providers. The Superior Court has ruled pharmacists are considered health care providers for purposes of the Medical Records Act, overturning an Allegheny County Common Pleas judge who likened pharmacists more to yoga instructors than medical providers who have concrete doctor-patient relationships. The issue at hand was whether someone getting a prescription filled in a retail pharmacy should be considered a patient or a customer. The Pleas judge ruled that a person receiving services from a psychologist would describe himself as a patient, but a person receiving services from a licensed yoga instructor would not. He said the latter is more akin to the relationship between someone prescribed medication and the pharmacist who provides it. The Superior Court disagreed. “We specifically note that, as part of their health care duties, pharmacists are authorized to administer injectable medications, biologicals and immunizations,” Judge Jacqueline O. Shogan said for the state court. “Thus, the practice of pharmacy is not limited to filling prescriptions.” He also added, “First of all, we fail to see any ambiguity in the term ‘patient’. It is commonly understood that a person for whom a medication has been prescribed by a licensed health care provider is a patient. … However, we would not consider it erroneous to deem such an individual a patient of the dispensing pharmacist … as well as the prescribing health care provider.”

“The language utilized in the Pennsylvania Code, as well as the Pharmacy Act, reflects that the pharmacist is a health care provider and that the recipient of the prescription medication is a patient,” Judge Shogan said. She said the requirements that pharmacists maintain and review profiles of patients, provide counseling and maintain confidentiality support the conclusion that the records are medical records of a patient. “A pharmacist is not merely an intermediary between a vendor and consumer,” Judge Shogan said. “Rather, as noted above, a pharmacist is required to utilize his or her professional education, training and judgment to provide health care to patients.”

Eric Durbin, RPh has this to say: “The first issue that should have been addressed is recognition of pharmacists as medical providers. If pharmacists receive provider status and are able to bill for services rendered, the entire medication therapy management MTM practice model will take off. There are innovative minds in the pharmacy world that will revolutionize healthcare, but we need to be sure that the bills will be paid at the end of the day. Changing the practice model today with the hopes of reimbursement tomorrow isn’t going to cut it. We need to become recognized providers now.”

I urge every pharmacist reading this article to sign the petition today, to forward the link to everyone you know who has an interest in seeing pharmacists gain the status we need to bill for our services, and to encourage those people to do the same. Only by standing together and being politically active will the field of pharmacy be able to grow in the 21st century. We need you to let our leaders in Washington know how much of an impact we can have on patient care – sign the petition, write a letter, contribute to a campaign, do whatever you can to make a difference. Only with sustained efforts can we hope to make lasting changes!

Have you signed it yet?

Sandra Lee. (2012, July 25) “The President of the United States: Recognize pharmacists as health care providers!!!”. Retrieved from:
Gina Passarella. (2012, July 25) “Court: Pharmacists are health care providers”. Retrieved from:…viders-629521/
Dave Walker. (2012, July 25) “Message to Pharmacists: Be the Healthcare Provider” Retrieved from:…care-provider/
Eric Durbin. (2012, July 25) “Pharmacists as providers?” Retrieved from:…providers.html
Menighan, Thomas. “Provider status not the only path to payment for clinical services.” Drug Topics. May 2012. Retrieved from:

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