You’ve no doubt heard
Do what you love, the money will follow.
Are you in love with serving your patients? How often are you fulfilled by doing what you love? Perhaps you find yourself pursuing compensation? Or, are you bogged down complying with regulatory practices and procedures?
Numerous groups representing pharmacy and pharmacists across the U.S. will continue to pursue a variety of wide-ranging legislation and regulatory efforts in the hopes of guaranteeing pharmacists access to additional practice opportunities and compensation for various pharmacist services in 2017. We offer a smattering of views – backwards & forwards – across America.
California Pharmacists Association
CPhA will continue to support pharmacists as they monitor activity touching: pharmacist provider status and reimbursement for clinical services, influence of health plans and PBMs on pharmacy practice, pricing transparency & MAC updates, Affordable Care Act / Health Care Reform, CURES (Controlled Substance Utilization Review and Evaluation System) & Prescription Drug Abuse, Workplace Regulations, mandatory mail order (versus “patient choice”), compounding, California State Budget and pharmacists’ professional liability.
In 2016 Governor Jerry Brown signed CPhA-sponsored AB 1114 into law. AB 1114 authorizes pharmacists to bill Medi-Cal for the service component of administering immunizations, furnishing hormonal contraceptives, naloxone, nicotine replacement therapy, and travel medicines, as well as smoking cessation counseling. In 2017, we’ll see more on the implementation of this legislation.
Since California pursuits often propagate to other states, we’re compelled to observe the Golden State actions, especially with the recent breakthrough in billing Medi-Cal.
Florida Pharmacy Association
In 2016, the FPA advocated to provide relief to pharmacies that are struggling with getting adequate supplies of pain medications to treat their patients; lobbied for changes to Florida laws that clarify enforcement and compliance with MAC pricing laws; considered changes to the pharmacy practice act to help pharmacists with patient health and wellness issues; continued efforts to support the national provider status initiatives; advocated for changes in Florida laws to allow pharmacists to dispense a 30 day supply of maintenance medications which previously allowed for a 3 day supply when the prescriber cannot be contacted.
Michigan Pharmacists Association
Biosimilars, compounding regulations and patient access, emergency preparedness, prescription drug abuse, promotion and support of a culture of safety, reimbursement and sustainability, pharmacy practice innovation – the MPA will be active in this Great Lake state.
Ohio Pharmacists Association
Another strong, representative association to monitor – OPA is
- delivering another session of APhA’s Delivering Medication Therapy Management Services certificate training program;
- asking their membership for feedback on the proposed Ohio Department of Medicaid dispensing fee model;
- reporting the passage of “med sync” legislation to allow patients with prescriptions for chronic diseases or conditions (including, but not limited to, heart disease, cholesterol, COPD, high blood pressure, etc.) to permissively participate in a process with their physician and pharmacist to align their medications to be refilled on the same day.
Washington State Pharmacy Association
In August 2016, our colleague Jeff Rochon, CEO of WSPA, posted
With Jan 1, 2017 just around the corner, pharmacists in all practice settings will soon be eligible to bill for patient services as medical claims. In 2016, certain health-system pharmacists have already started billing for their services and are getting paid! … If you provide a covered medical service, you will be able to bill insurance for compensation. In order to bill medical claims, individual pharmacists must enroll in provider networks like other healthcare providers.
WSPA has created a Contracting and Credentialing Resource Center available to their membership and supports payment to individual pharmacists. We look forward to hearing more from this progressive state.
American Pharmacists Association
APhA posts information on house of delegates policy topics regularly. For 2017 the three primary areas are:
- Patient Access to Pharmacist-Prescribed Medications
- Pharmacist Role within Value-Based Payment Models
- Pharmacy Performance Networks
Two of these topics include funding or pay for services.
National Community Pharmacists Association
Topics of interest to NCPA include: expansion of opioid overutilization edit requirements to all plans, specialty drug cost threshold increases, CMS allowance of a new “non-preferred” drug tier, plan sponsors that can designate drugs for a partial extended supply fill for new patients, MTM changes to participate in the Enhanced MTM Model that begins in 2017, establishing mail order protocols for urgent need fills to prevent gaps in therapy, changes to the 2017 Star Ratings and Beyond, access to Preferred Cost-Sharing Pharmacies (PCSPs). You’ll note many of these NCPA topics also reflect service and pricing.
American Society of Health-System Pharmacists
ASHP focus, and forecast, is aiming for the highest quality care at the lowest cost. We see reduced overall costs by bringing pharmacists into the overall healthcare picture. Details about the ASHP Forecast are available at hw.ashpfoundation.org/pharmacyforecastttp://ww and http://www.ajhp.org/content/early/2016/11/18/sp170001.
A large majority (84%) of Forecast Panelists (FPs) predicted that within the next five years, at least 75% of health systems will have formal programs aimed at achieving the highest quality at the lowest cost for specific patient populations.
Colorado – Value Pharmacists
In our home state, Val’s involvement in the legislative process included developing strategies, tactics and tools to gain consensus of stakeholders along with crafting amendment language in alignment with points of agreement of stakeholders leading to passage of the Veterinary Access Compounded Pharmaceutical Drugs; developing a Continuity of Care fact sheet in support of the Patient Choice in Pharmacy bill (which has national application); supporting a Veterinary Pharmaceuticals bill which was signed into law; and serving as an implementation consultant on the Collaborative Pharmacy Practice Agreements legislation. More information can be found through our projects page on our website. Yet again, patient access and services were at the forefront in 2016. As rules are implemented in 2017, our current efforts include monitoring the promulgation of the recently passed CDTM legislation.
2017 View
All of our examples illustrate themes affecting patient service and pharmacist compensation. These will continue into, and probably well beyond, 2017. Meanwhile, maybe you’ll find your specific niche reflected in one of these models to support your practice. Get ready for a Happy New Year!