The California legislature is considering a bill covering comprehensive medication management services under Medi-Cal.
When California’s Senate Bill 493 was signed into law in 2013, it set the stage for provider status for pharmacists in the state. It also expanded the scope of practice for pharmacists to provide direct patient care in collaboration with the healthcare team, according to Jon Roth, CEO of the California Pharmacists Association.
At the time that SB 493 was being developed, Californiwas coming out of the great recession of 2008-2010, so any bill with a fiscal component would be vetoed by the governor, Roth was told.
“We really had to make a strategic decision,” Roth recalled during a recent town hall meeting, sponsored by Pharmacists Planning Service, Inc, in Baltimore. “We decided to go ahead with provider status and scope of practice expansion, but disassociate the payment at that time.”
A cost-saving measure
In mid February, Assembly Bill 2084 was introduced to the California legislature, providing comprehensive medication management services as a covered benefit under the Medi-Cal (Medicaid) program. So beneficiaries will be able to receive clinical services from a primary care physician or pharmacist, and that healthcare provider will be paid for direct patient care.
“We have taken [AB 2084] up as a cost-saving measure, and there are some dollars that the Medicaid program will have to put out to support pharmacists delivering this care. But the Medicaid program should enjoy a rich return on that investment,” Roth said.
With SB 493, the law allows all licensed pharmacists the authority to furnish nicotine replacement therapy (NRT), travel medications, and self-administered hormonal contraceptives under a statewide protocol adopted by the Board of Pharmacy.
In addition, pharmacists can administer immunizations to patients three years of age and older without a physician protocol, said Lisa Kroon, PharmD, chair of the Department of Clinical Pharmacy at the University of California, San Francisco (UCSF), who also spoke at the town hall meeting.
“The key to all of these authorities in SB 493 is communication with the physician,” Kroon said. “We are part of a team, and we have to make sure that they are communicating with the patient’s primary care provider.”
SB 493 also established additional authorities for pharmacists who obtain Advanced Practice Pharmacist (APP) status, which is a separate license for a pharmacist. Under the law, APPs can initiate, adjust, and discontinue drug therapy, working with the patient’s treating prescriber, as well as order and interpret drug-therapy tests in coordination with the primary care provider.
“SB 493 provides opportunities for community pharmacists to get more involved in patient care and comprehensive medication management,” said Kroon. “We want to see pharmacists using these authorities.”
Before the town hall meeting, Betty J. Dong, PharmD, FASHP, FCCP, AAHIVP, professor, Department of Clinical Pharmacy, UCSF, was honored as the 2016 PPSI/Stan Hartman Distinguished Person of the Year Award.
Dong was recognized for her commitment to the profession of pharmacy as an agent of change, said Rear
Admiral Pamela Schweitzer, PharmD, BCACP, who presented the award.