Q&A: Pharmacist Duties Highlight Need for Provider Status Legislation

If signed into law, the Main Street Pharmacy Access Act will not arrive as the sweeping, all-encompassing provider-status bill some in the pharmacy profession had envisioned. Experts explain, however, that it may arrive as something more surgical: a focused, carefully scoped piece of legislation designed to move across the finish line.

As Chad Worz, PharmD, BCGP, FASCP, executive director and CEO of the American Society of Consultant Pharmacists (ASCP), explains, the bill's narrower focus on test-and-treat services for respiratory infections is not a weakness; it is the product of years of strategic refinement aimed at making pharmacist reimbursement under Medicare a practical and politically viable reality.

“If somebody’s more compliant because they’re getting their monthly antipsychotic shot at the pharmacy, that’s a good thing for population health, mental health, and our health care system,” he told Drug Topics®. “Those things are already happening, and so, the more sort of ubiquitous it becomes for pharmacists to step into those roles is what is going to show us what the future looks like.”

What makes the bill so significant, Worz explains, is its reimbursement provision.

Right now, a pharmacist can administer a vaccine and get paid. A conversation, however, about which vaccines a patient needs and why, goes uncompensated. That gap is exactly what the Main Street Pharmacy Access Act is designed to close.

According to Worz, as the vaccine landscape grows more complex and the profession continues expanding into mental health, chronic disease management, and preventive care, having that billing infrastructure in place could define what pharmacy looks like for the next generation to come.

And with pharmacists already doing many of the tasks they are looking to receive billing authority for, the signing of this legislation could transform the profession even further.

READ MORE: How the Main Street Pharmacy Access Act Advances Pharmacist Provider Status

Drug Topics: Of the bill’s provisions, which is most necessary to move the pharmacy profession forward?

Chad Worz: I don’t know that you’re capable of breaking the bill down any smaller. If you think about the history of bills that worked on provider status, they started out very wide. Pharmacists could provide all kinds of provider-type services. Then it became, because the way they calculate the cost is so expensive, maybe we just do it in rural areas. And then it became, let’s just try it in respiratory infections and test-and-treat. All that was designed to shrink the price tag on the bill. I don’t know that you can take it any further down into provisions.

What I would say is, ultimately, the provision that we’ve held throughout those different iterations of pharmacist provider capability is that reimbursement component. Right now, you don’t get paid to have a conversation with a patient about a vaccine; you only get paid if you actually deliver the vaccine to an individual. There is a component where it’s important to talk about the vaccine, do a plan of care on an individual and what vaccines they might need, and then deliver or not deliver those vaccines based on clinical or patient hesitancy.

Those service levels won’t exist if there’s not an ability for the pharmacist to bill for the medical component of that. I think the most important thing is a pharmacist being able to bill Medicare Part D for that test-and-treat and get those codes that are not dependent on product to get reimbursement.

Drug Topics: How does this bill support the ongoing paradigm shift of US pharmacy practice today—from industry technologies and innovations to new telehealth and clinical service models?

Chad Worz: I think people are always waiting for this big shift to happen, and all of a sudden, bam: We’re doing all these different things; a lot of the things that we’ve aspired to do for a while. If you take a step back and look, it’s happening. It’s happening in pieces, and it’s happening in certain settings of health care. When we get that big event, like a piece of legislation passing, it will feel like we went over a tipping point and you see it more frequently. But a lot of that work is being done.

Think about what’s ahead of us as a society from a health care perspective. We’re going through an awkward period with vaccines, where there’s some hesitancy and some concern and all kinds of noise. But I think all of us as pharmacists probably look back and remember that vaccines were sort of the nirvana of drug therapy. These are the things that really were gamechangers; stamped out polio, got rid of measles. I like to bring up chickenpox because I had chickenpox. Everybody my age, we lived through chickenpox, and I have kids, and they’ve never had chickenpox. That just gives you some sort of intuitive recognition that, hey, vaccines do work.

We’re developing all kinds of vaccines that can be significant as part of preventative health care. This kind of legislation for pharmacists sets them up to be the people that deliver that on the long-term side. We need to think about that because that is changing our profession and probably changing it in the ways that we would have aspired it to be changing. We’re an access point to good, preventative care. We’re not certainly limited to vaccines, but vaccines and that vaccine space is only going to get more sophisticated and more meaningful for US health care.

There are even pharmacists that are delivering long-acting psychoactive medications to patients, and they’re part of the treatment of mental health in this country. Again, that’s just sort of an offshoot of [how] pharmacists are successful, accessible, and able to deliver high-quality health care services that make a difference. If somebody’s more compliant because they’re getting their monthly antipsychotic shot at the pharmacy, that’s a good thing for population health, mental health, and our health care system. Those things are already happening, and so, the more sort of ubiquitous it becomes for pharmacists to step into those roles is what is going to show us what the future looks like. I think that’s really the position we’re sitting at right now.

READ MORE: Law and Regulations Resource Center