Expanding pharmacists’ scope of practice improves health outcomes
When healthcare systems mobilized to combat the pandemic, the federal government temporarily expanded pharmacists’ scope of practice, to include things like testing for COVID-19 and administering vaccines, so that they could be better utilized in the fight against COVID-19.
Pharmacists’ contribution during the pandemic was so successful that by the end of 2022, over 178 bills had been proposed across 36 states wanting to permanently expand pharmacists’ scope of practice.
Most of these bills want to allow pharmacists to administer vaccines and test, diagnose, and prescribe medication for common conditions like influenza, strep throat, and urinary tract infection. But some argue that’s only a fraction of what pharmacists could do to improve patient care.
Tara Pfund, product manager at AssureCare, a tech company that provides technological solutions for pharmacists, sat down with DHI to discuss the evolution of pharmacists’ scope of practice – namely, from that of a retail seller that dispenses medication to one of a clinician who is an integral part of patient care.
“[Physicians will say] I have this patient newly diagnosed with high blood pressure. I’m going to start them on this medication, and they start coming to your pharmacy for the in-between visits, where you work on making sure that medications are optimized, making sure they understand diet and exercise and even just what general education or what high blood pressure means, and how to manage it and how to check your own blood pressure at home, and what to do if it’s too high,” Pfund says, outlining how physicians are utilizing pharmacists to improve health outcomes.
Expanding pharmacists’ scope of practice has positive impact in value-based care models
Studies show that integrating pharmacists into patient care can have a tremendous impact on health outcomes when they are involved in patient care, including improving medication adherence and outcomes in chronic conditions as well as preventing hospitalizations – which is why pharmacists’ expanded scope of care is often seen in value-based care models.
In a value-based care model, “everybody’s being incentivized to make the outcome be right, versus just the patient encounter,” Pfund says.
In other words, when healthcare providers are compensated based on health outcomes of the patient, integrating pharmacists as part of the healthcare team is a no-brainer.
But there are a few more obstacles to overcome before pharmacists can be fully integrated into patient care roles. To begin with, to properly coordinate care with physicians, pharmacists need the technological infrastructure to record and share clinical data, as well as bill for compensation.
“Pharmacy businesses are unique if they’re doing clinical programs, because they’re submitting two types of claims out of the same brick and mortar. I’m sending you prescription claims. And now medical claims. Nobody else really kind of does that,” Pfund explains.
While many private insurance companies cover pharmacy clinic services, the CMS doesn’t currently recognize pharmacists as healthcare providers, which means Medicare and Medicaid patients are only able to access pharmacy patient care services by paying the cash cost.
“We’re not nationally recognized as a federal health care provider by CMS, which is a huge limiting factor, because Medicare is probably the primary population for most pharmacies out there. They can do all this work to develop these programs, but 40% of their business are ineligible for these programs. That’s a huge, huge barrier to successful implementation, “ Pfund explains.
AMA opposes expanding pharmacists’ scope of practice
The AMA has been adamantly fighting against expanding pharmacists’ scope of practice for decades, including the Equitable Community Access to Pharmacist Services Act (H.R. 7213) that would allow pharmacy services, like testing for COVID-19, flu, and strep throat, to be covered by Medicare.
“Pharmacists play an important role as medication experts on the healthcare team, but they’re not trained like a physician. They don’t attend medical school and they don’t attain the clinical judgment to perform medical exams or diagnose patients.” Kimberly Horvath, JD, and senior attorney with AMA’s Advocacy Resource Center said in an interview..
The AMA claims that by covering services provided by a pharmacist would “lead to fragmented care and worsen the quality of patient care,” in a letter to Representatives behind the bill.
Pfund claims it’s a turf war, “If they’re going to come see you then they wouldn’t come see me…And so if you eliminate that barrier of getting into school because you get the vaccines you need from the pharmacy, then they’re not getting the necessary appointments.”
The AMA’s stance weakened significantly when the FDA allowed pharmacists’ the ability to prescribe Pfizer’s antiviral treatment Paxlovid to treat COVID-19.
The American Pharmacists Association celebrated the decision. “Opening the door for pharmacists as prescribers will open the door to equitable access at pharmacies in communities across the country.,” said APhA’s interim executive vice president and CEO, Ilisa Bernstein, PharmD.
Despite challenges, a study from Columbia University Mailman School of Public Health estimates that by 2030, the majority of pharmacists will move from retail into patient care.