Provider status is very necessary for pharmacists (and I will argue with AMA later on this)
James Lott, CEO of Script Health in Chicago, strongly favors the Pharmacy and Medically Underserved Areas Enhancement Act, the bill that would provide pharmacists expanded reimbursement as he outlined many ways they are already providing care to millions in America.
Last week, at MedCity News’s INVEST conference in Chicago, James Lott, CEO of Script Health, a healthtech company, was loud and clear when asked what would be on his policy wishlist if he had a magic wand: provider status for pharmacists.
The term is controversial and confusing but basically means that pharmacists should win reimbursement for the types of services they are offering.
In fact, a bill with bipartisan support has been introduced that would allow pharmacists in underserved areas to bill Medicare Part B for services within a pharmacists’ state scope of practice. The care would also have to be delivered to Medicare Part B beneficiaries who live in underserved areas to be eligible for reimbursement. If it became law, pharmacists would receive payment at at 85% of the physician fee schedule, according to the American Society of Health-System Pharmacists.
This is especially notable given rural healthcare already burdened by financial strain has faced even greater challenges and many facilities have simply shut down. In this. “medical desert” are pharmacists who are trying to pick up the slack and be the trusted source in the community.
Lott, a public policy expert and a doctor of pharmacy, rattled off a litany of ways pharmacists have actually delivered vital care during the pandemic from administering vaccines to providing tests.
“Most recent data shows that pharmacists administered over 235 million Covid vaccines nationwide. They administered over 100 million Covid tests,” Lott said to the INVEST audience on Wednesday. “And I would argue that if pharmacists were not able to vaccinate patients across the U.S., many of us would still be waiting in line for our first dose,”
He added that because pharmacists aren’t providers and because pharmacy benefits are separate and distinct from medical benefits, pharmacists have had to jump through hoops to provide this service.
“Pharmacists reimbursements for these services are completely different,” Lott explained. “A lot of them are designated by pharmacy benefit managers, and it’s causing a lot of problems.”
Lott’s company, Script Health is trying to bridge this gap.
“We’re seeing some pharmacies want to partner with us because we have access to physician partners who can provide agreements with these pharmacies and then oversee their clinical services like vaccine programs,” he said. “But if you’re in a small town in rural America and let’s say you’re in a medical desert, there’s no doctors within 50 miles.”
That’s where the federal legislation that the pharmacy community is pushing comes into play.
“So provider status is very necessary for pharmacists. I am optimistic, partially. My wish list is partially on the way because … there’s a bill that will be up for the House of Representatives so pharmacists can do testing and treating for things like strep throat flu, covet, et cetera, and bill under Medicare Part B,” he said. “So we are in a step in the right direction, but we still have a long way to go. And if any of my friends from the AMA [American Medical Association] are here, we can argue about this later.”
One doesn’t even have to imagine that this argument will be heated.
The American Medical Association has staunchly opposed moves to provider more responsibility to pharmacies. The latest came on March 4:
President Joe Biden’s “test-to-treat Covid-19 plan” would allow pharmacy-based clinics would be able to test people and prescribe antivirals immediately should they test positive. This would presumably be convenient for people who could get tested and get their prescription filled at the same location. However, the AMA, sensing perhaps an encroachment on primary care delivery, unequivocally stated: This approach, though well intentioned in that it attempted to increase access to care for patients without a primary care physician, oversimplifies challenging prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions.
In other words, pharmacists simply don’t possess the medical wherewithal to be able to provide this service to patients on their own. However, the problem appears to be a supply-demand issue. Most people live close to a pharmacy and in rural areas, a pharmacist is likely to be first in a patient’s care team than a doctor.
“[In these rural areas] the only provider or non provider is the pharmacist. That’s where your care is going to come from. Whether or not you have access to vaccines or Covid test or other things is going to ride or die on that pharmacist,” Lott continued. “And if that pharmacist doesn’t have a relationship with a physician because of many state laws and federal laws, they can’t offer their entire town of two, three, four, 5000 people vaccines. [People] have to drive 50 miles to do that, and that’s problematic.”
Compare that to this other statistic: roughly 9-out-of-10 Americans live within five miles of a community pharmacy, according to research from the National Association of Chain Drug Stores. That is one of the reasons Lott wants pharmacists to have the ability to deliver a bit more care like testing on site, checking blood pressure and so on.
“If you can democratize care in the physical realm, it would look like something like allowing pharmacists to do a little bit more,” he said. “And trust me again, to my friends at the AMA, pharmacists don’t want your job. They just want to be able to help their patients with minor things, get them healthy, and then kind of triage them to where they’re supposed to be.”
Lott was joined on the INVEST panel by moderator Cristal Gary, chief advocacy officer of, Amita Health and A.J. Loiacono, CEO of Capital Rx, an upstart pharmacy benefit manager, whose own comments on drug pricing will become fodder for a different post.