It’s official: California pharmacists are healthcare providers. Legislation granting provider status to all pharmacists licensed in California took effect on January 1. The law gives new and independent powers to registered pharmacists, establishes a new category of Advanced Practice Pharmacists with extended practice authority, and creates requirements for pharmacists to qualify as AAPs.
“This change in California resonates at the national level to re-emphasize the importance of pharmacists in the provision of healthcare,” said pharmacist Stacie Maass, BS Pharm, JD, Senior Vice President of Pharmacy Practice and Government Affairs for the American Pharmacists Association.
No overnight changes
But don’t expect any overnight changes. The bill does not address reimbursement directly. It does not require commercial insurers, government programs, or other third-party payers to begin paying pharmacists for services they were not paid for in 2013.
“There will not be automatic J codes and billing of CMS [Centers for Medicare and Medicaid Services],” said R. Pete Vanderveen, RPh, PhD, BCPP, dean of the University of Southern California School of Pharmacy. “That kind of regulatory adjustment can take years.”
He continued, “This allows pharmacists and pharmacies to contract with accountable-care organizations, health systems, and third-party payers; provide services; and bill direct. This opens the door for pharmacists to provide the kinds of clinical services they are trained to provide and bill like any other provider.”
All California pharmacists may provide prescription hormonal contraception, nicotine replacement, and travel medications as recommended by the Centers for Disease Control and Prevention, and administer immunizations to patients three years and older on their own authority; and they may administer drugs and biologics by injection under a physician’s order. Pharmacists may also order tests related to management of patients’ medication regimens.
Advance Practice Pharmacists may perform patient assessments, refer patients to other providers as appropriate, and operate as collaborative drug-therapy-management specialists outside the hospital setting.
Health-system pharmacists have had the authority to manage drug therapy since the 1980s, often overseeing specialized clinics caring for patients with asthma, diabetes, hypertension, hypercholesterolemia, and other conditions. Community-based APPs can now play a similar role.
Access to care
“The first benefit is that millions of patients will now have broader access to care,” said Jon Roth, CAE, CEO of the California Pharmacists Association. “This legislation means patients now have community access to care readily and easily available.”
Improved access helped sway state legislators, Vanderveen said. Kern County, among the ten largest counties in the nation, has just four endocrinologists for a population of more than one million. None of the four accepted MediCal, the state Medicaid program, which shut thousands of patients with diabetes out of care. Community pharmacies are already gearing up to provide diabetes care for state-funded patients.
“This bill is the foot in the door that expands pharmacy practice,” Vanderveen said. “As the bill’s sponsor, State Senator Ed Hernandez, OD (D-24) said repeatedly, pharmacists are the most highly trained and underutilized health resource we have. Recognizing pharmacists as providers will help ease the primary-care provider shortage as we get millions of new patients under the Affordable Care Act.”
USC and other schools of pharmacy were key supporters of the legislation, Roth said. The bill was sponsored by Californians for Accessible Health Care, a coalition that includes CPhA, the California Society of Health-System Pharmacists, the California Association of Nurse Practitioners, and the California Optometric Association. After early amendments, the California Medical Association and other physician groups dropped their opposition.
“We approached CMA quietly and privately before this was introduced,” Roth said. “These dialogues began before Day 1. We all listened and were able to come to agree that this really is in the best interests of patients.”
The coalition is now working with the State Board of Pharmacy to implement the new law. Regulations have been in the drafting stage since Gov. Jerry Brown signed the bill into law last October; they could be implemented by the end of summer.