Whether you are speaking to a legislator, their aide or another interested party, invariably you will be asked if granting provider status will change your scope of practice. Federal provider status legislation, the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314), would not expand the types of services that pharmacists are permitted to provide. Eligible services would continue to be governed by state scope of practice laws and regulations. Specific legislation in your state may or may not include scope of practice changes.
To find out the current scope of practice in your state, go to your state’s pharmacy statutes and look in the definition section for “practice of pharmacy,” and any terms included in the definition of the practice of pharmacy. Terms may include pharmaceutical care, medication therapy management or collaborative agreements.
The next question you may hear is what is happening with scope of practice and collaborative practice in other states? After reading this blog, you will be able to say, “I’m glad you asked!”
Currently, 47 states and the District of Columbia allow for CDTM (Collaborative Drug Therapy Management) according to a new analysis by APhA and the National Alliance of State Pharmacy Associations. This count includes Tennessee, which does not have a CPA (Collaborative Practice Agreement) provision but does permit physician–pharmacist relationships. The District of Columbia, where CPA authorization went into effect in October 2012, is the most recent addition to the list.
CPA provisions vary greatly state to state regarding the extent of the pharmacists’ authorized services, limitations on practice sites and health conditions, authority to order lab tests, and requirements for pharmacist participation, based on the new analysis.
Thirty-three states plus the District of Columbia allow for pharmacist initiation of drug therapy; many allow for discontinuation; and nearly all allow for modification of drug therapy. CPA authority is restricted to certain practice sites in eight states, all of which exclude community pharmacies. Six states define in their legislation which specific disease states may be included in the CPA, and many more require that the agreement be disease-state specific for each patient. At this time, 31 states allow for pharmacists to order and interpret laboratory tests.
If I am asked to point to recent legislative successes for pharmacy, the three states that come to mind are Washington, Oregon and California.
On June 10th 2015, Oregon announced “with HB 2028, groups of doctors and pharmacists can now design and utilize collaborative agreements to increase access to pharmacist care and decrease costs for patients. The legislation also tasks the Oregon Health Authority, in consultation with the Oregon Board of Pharmacy, to establish statewide protocols for pharmacist delivery of services such as smoking cessation and travel health services.”
Oregon’s success followed the May 11, 2015 Washington state press release “Washington’s ESSB 5557 requires health insurance carriers to recognize pharmacists in the same way as other providers.”
California has been drafting rules implementing their provider status legislation, SB 493, that passed last year. SB 493 grants all pharmacists certain authorities in all practice settings that had previously been limited to inpatient settings or integrated systems. The bill also establishes a new “Advanced Practice Pharmacist” recognition. This recognition can be granted when specified experience and/or certification requirements are met.
Since federal legislation will permit compensation of eligible pharmacists services as determined by state laws and rules, many state pharmacy organizations have been introducing and promoting legislation expanding the current scope of practice in their respective states. If you are not sure if any provider status or scope of practice legislation has been introduced or planned in your state, contact your state pharmacy organization. The NASPA (National Alliance of State Pharmacy Associations) member directory lists state associations.