Provider status is fine and dandy, but pharmacists need to get paid

March 25, 2015

In the pharmacist's hierarchy of needs, which comes first? Provider status? Or getting paid for the work you're doing right now?

The debate taking place among Drug Topics readers online and in print has more angles than a hall of mirrors. And as in a hall of mirrors, some perspectives may disguise the obvious. The pharmacist who wrote the following wants to refocus attention on the bottom line.

The latest craze in the pharmacy world is provider status. From students to deans to pharmacy organizations, provider status is front and center and considered of the utmost importance.

See also: Provider status: Important to pharmacists, critical to patients

Why the urgency now? Why such a strong push to get this over and done with?

25 years of nothing doing

To put it bluntly, the profession of pharmacy is dying. The internet, cheap generics, FTC's ineptitude in keeping monopolies at bay, and legislation designed to sidestep pharmacists are just some of the reasons for the demise of the profession. The causes deserve a lengthy discussion beyond this article. Realizing that the profession may crumble, like an aging fortress, interested parties want to apply the patchwork of provider status.

See also: Is community pharmacy a dying profession?

From the APhA website: "Provider status: What pharmacists need to know now …. Pharmacists’ services have grown well beyond functions tied only to dispensing medications."

We were fed the same nonsense 25 years ago when I went to pharmacy school. We were told that we would become a part of the inner circle of the healthcare team. However, for 25 years, every single national organization did absolutely nothing to educate either the general public or the lawmakers about the importance of the role of the pharmacist.

 

Way to make a living

Provider status would let pharmacists bill Medicare Part B either individually or as a corporation. (I feel the word "accreditation" coming up.) Medicare Part B is notorious for nonpayment, audits, or payments below minimum wage.

See also: Below-cost reimbursements, Medicare drug plans concern community pharmacists

Case in point: The reimbursement for 100 lancets is $1.65 (not a typo) – 2% sequestration, whatever that means.  If you get lucky and actually get paid, hold your breath, because six months later, you can get a letter asking for money back, due to whatever excuse Medicare comes up with. Basically Medicare is a nightmare to deal with.

CVS Health is actually paying for MTMs now, without provider status. Thanks to the FTC, CVS was able to buy Caremark and the Mirixa platform, which sets up MTMs for pharmacists. My payment so far is $336 for 25 cases.

Those who think that's good reimbursement are kidding themselves. The number of phone calls and amount of work involved is ridiculous. Will provider status get pharmacists better reimbursement? CVS is the same company that pays us $1.85 for a month’s supply of furosemide. That includes all possible cognitive services required by the state board. $1.85 per month. Let that sink in.

Does anyone else hear crickets?

The bottom line is that reimbursement is controlled by a few third-party payers, and those few interests will pay whatever they feel like paying.

See also: Games insurers play

Relying on this method is the downfall of pharmacy -something not one single supporter of provider status wants to discuss - but reimbursement is the essence and the core of this debate.

When CVS Health pays 50 cents in dispensing fees, one has to stop and wonder, why didn't the university deans and national pharmacy organizations step in and say that this is not right? They had 25 years to step up and fix the problem, yet they chose to ignore the needs of pharmacy as a profession.

They have not demonstrated our usefulness and necessity. They have not shown that we are providing a service and not just simply selling pills in plastic bottles. They have not argued that our service is worth more than 50 cents a month.

 

So much for most trusted

For a second year, Sens. Amy Klobuchar (D-Minn.) and John McCain (R-Az.) have introduced a bill that would let Americans buy medication from Canada.

See also: Should Americans be able to buy cheaper drugs from Canada?

Last year Maine, with the assent of Janet Mills, Maine’s Attorney General, passed a law allowing residents to purchase prescription drugs through a broker from pharmacies licensed in Canada, the U.K., New Zealand, and Australia.

The perception of John McCain, Amy Klobuchar, and Janet Mills is that pharmacists are useless. The services we provide are not seen or felt. To them and millions of Americans we simply sell pills. Pills that they should be able get anywhere. 

Keep your eye on the ball

I challenge everyone who's pushing this nonsense of provider status to start a debate about reimbursement, which is the ultimate marker of survival of our profession.

Academia and the national organizations will never discuss it, because reality is not in their blood. They are more comfortable in the make-believe, dissociated world, which was sold to me 25 years ago and is still being sold to young graduates today.

Jose Lopez is the pen name of a pharmacist in Brooklyn, N.Y., who has spent 25 years practicing as a licensed pharmacist and more than 30 years working in retail pharmacy.