Pharmacy Reimbursement and Patient Safety

Pharmacists have long fought for the provider status they deserve.

Local community pharmacies operate around a fundamental focus on personalized, attentive patient care. This expands past simply filling prescriptions to provide a larger scope of clinical services that enhance overall patient health outcomes. However, a lack of recognition and reimbursement for these critical services hinders the operation of pharmacies when they are needed most.

Without the financial incentives of reimbursement for patient-centered care, many chain pharmacies have been criticized for endangering patients while focusing on high-volume dispensing to increase profits. These chains need to be held accountable for the consequences of their poor staffing and flawed priorities. But the issue goes even deeper.

In order to shift this misaligned business structure and enable all pharmacies to operate around prioritizing patient outcomes, pharmacists need to be properly recognized for the scope of services they are trained to provide and the significant impact of these services.

Patient Safety Concerns

Unfortunately, it has become common to hear news surrounding how chaos at chain pharmacies is putting patients at risk. From mismatched doses to blatantly incorrect prescriptions, patients have become injured and even died from mistakes in dispensing their medications. Typically, most investigations into these situations are only focused on the pharmacists themselves and not the workplace conditions that led them to make mistakes in the first place. This makes it difficult to make any actual reform and get to the root of the issue.

Recently, the Ohio State Board of Pharmacy has begun investigating workplace issues in pharmacies when responding to concerns about safety. Four CVS Pharmacy locations were fined by the Board after multiple complaints coming in regarding the drugstore chain’s dangerously flawed operations.

These safety concerns are a threat to the public health, and pharmacists everywhere are urging more effective action towards restructuring payment mechanisms – enough is enough.

The Road To Change

The road to change has been a long and winding one. Many states have passed legislation regarding pharmacist provider status, but the implementation of the payment mechanisms and logistics is a complex task. H.R. 592 / S. 109, also known as The Pharmacy and Medically Underserved Areas Enhancement Act, was created to give Medicare Part B patients in underserved communities access to pharmacist-provided services and reimburse pharmacists for those services. This bill has yet to be passed into law, but it remains an important goal for the industry.

Recently, the pandemic has cast a spotlight on the underutilized resource that is pharmacies. On July 30, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) announced that health care providers – including pharmacists – can be paid for counseling patients at the time of COVID-19 testing. Another win for pharmacists comes from CareSource launching a pilot program that aims to reimburse pharmacists in Ohio for clinical services provided to Medicaid patients. Initiatives like these are important stepping stones for the utilization of pharmacists to their full potential.

But there are still roadblocks along the way. Recently, pharmacists have expressed concern over the lack of provider status mentioned in a new stimulus package. Pharmacies have the potential drastically expand COVID-19 testing and immunization, so there is an even greater push now for temporary pharmacist provider status in Medicare Part B. Pharmacist groups and organizations continue to fight for change and spread awareness in any way possible.

Act Now!

You can take action by participating in advocacy campaigns and asking congressional leadership to hear your voice. Follow both of these campaign links from the American Pharmacists Association (APhA) Action Center, and advocate for pharmacist provider status today!

COVID-19: Advocate for Provider Status

Pharmacists Providing Care

Ready to Take Your Pharmacy Further?
Request Software Demo