Part 1: Medicare Part B Provider Status for Pharmacists

Expert Interview

Ken Perez, MBA, vice president of Healthcare Policy and Government Affairs at Omnicell, spoke with Drug Topics® about current provider status legislation circulating in the House and Senate.

In an interview with Drug Topics®, Ken Perez, MBA, vice president of Healthcare Policy and Government Affairs at Omnicell, explained the crucial points of Medicare Part B provider status for pharmacists, which would allow pharmacists in underserved communities to be reimbursed for certain primary care services that they already provide in commercially ensured populations.

Drug Topics: Can you tell me a little bit about your background?

Perez: Sure, I’m the vice president of Healthcare Policy and Government Affairs. I’ve been in clinical healthcare for over 20 years, and I’ve worked in a number of different firms, specifically in health care analytics firms, and I have a policy background also working in marketing and business development. But [I have] a particular interest, obviously, in pharmacy, medication management. I serve on the [American Society of Health-System Pharmacists] (ASHP) Foundation Board for a number of years. So, I’m really passionate about issues related to pharmacy medication adherence.

Drug Topics: Can you explain the crucial points of this legislation for Medicare Part B (H.R. 2759) (S.1362)?

Perez: Right, so it’s pharmacist provider status, that’s the basic idea. They’re almost identical. I think there’s only a 2- or 3-word difference. They’re bipartisan, voted in both the House and the Senate. The idea is that for medically underserved populations as of January 1, [2022], pharmacists would be to get reimbursed up to 85% of the physician fee schedule rate for certain primary care services that they already provide for today for commercially ensured populations and that’s basically the idea behind it. And it’s to address some significant challenges that we face as a society.

Drug Topics: Can you tell me how this legislation (H.R. 2759) (S.1362) would help address the worsening shortage of primary care physicians?

Perez: Yeah, that’s a very significant problem that’s not only a current problem. It’s estimated there are about 15,000 primary care physicians that we’re short of today and that’s projected to be 22,000 to 55,000 by 2030 so it has worsened, and it will continue to worsen and there’s almost nothing we can do in terms of just getting more medical school graduates to fill those roles.

As you know, there is a significant financial incentive for medical school graduates to go after specialties rather than primary care. Just as it provides pharmacists the opportunity to get primary care in outpatient settings. An outpatient clinic let’s say connects to a health center or a retail pharmacy clinic setting, and this will help provide more access to care. The main thing here is this is for medically underserved populations which are about 1200 of the nation’s 3100 counties. Over 44 million Americans live in these areas, and they don’t have as much access to primary care physicians and so pharmacists would help fill the void or gap that exists that is the basic idea.

Drug Topics: How is this legislation particularly meaningful in light of the COVID-19 pandemic, which highlighted the critical role pharmacists play in health care delivery?

Perez: There was a debate about whether pharmacists should be the ones to also administer these vaccines. In addition, of course, to physicians as well as nurses. Well, it really came down to, ‘Hey, all hands-on deck.’ We’ve got to get as many people as possible vaccinated and so pharmacists are in a unique position both in terms of their training and knowledge and expertise as well as their settings at retail pharmacies as well as outpatient facilities such as clinics. So, basically, Congress said, ‘Hey look, this is really, this is critical.’ The government has really supported that the ability, showed the value of pharmacists.

Pharmacists can administer vaccines; they’ve been doing it for years for flu and other shots. But this really was a critical time, and from an emotional standpoint and from a pandemic response standpoint, it highlighted the role of pharmacists. It certainty highlighted the role of pharmacists. And let me just say, I would have 1 point here, this is going to continue. We’re going to have booster shots; this is not going to end with this first round. We have more and more of this to come. What does that mean? That means that immunization’s whole area of vaccines is going to become a topic of continued discussion and we’re going to need health care professionals, typically pharmacist’s conjunction with physicians, to really provide the knowledge and the expertise for what’s needed going forward.

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