Provider Status is Expanding – Don’t Get Left Behind!
April 20, 2021Pharmacist provider status has been a key objective in the pharmacy industry for years. Pharmacists are trained for long-term management of chronic care diseases and are eager to utilize their expertise to meet the needs of population health initiatives.
With so much focus on COVID-19, many pharmacists may not realize how quickly state legislatures and payers have broadened their coverage for pharmacist clinical services over the past year. As awareness of the broad impact that pharmacists are making in rural and urban communities has increased, both changing regulations and new payer opportunities have enabled pharmacists to expand their scope of practice and improve access to clinical services.
The Clinical Services Landscape
Below is a map that outlines some of the key clinical services allowed by pharmacist in each state.
This map will be outdated almost immediately, which is both good and bad news. States are adding new services and expanding pharmacist provider status at a rapid pace.
Hormonal Contraceptive Prescribing
Not long ago, hormonal contraceptive counseling was limited to a few northwestern states.
Today, 18 states allow hormonal contraceptive counseling and prescriptive by pharmacists. In Oregon, one of the first states to allow pharmacists to prescribe hormonal contraceptives, 10% of all hormonal contraceptive prescriptions now originate from a pharmacist.
Check out this great resource that dives more deeply into issues around hormonal contraceptive prescribing, and how pharmacy can improve access to this service.
Contraceptive access remains challenging in the US, with more than 19 million women with low incomes living in contraceptive deserts, counties in which there is not reasonable access to a health center offering the full range of contraceptive methods. Given this landscape, and ongoing federal policy challenges, interest in allowing pharmacists to prescribe hormonal contraception is likely to continue gaining traction in states.
Tobacco Cessation, MTM, DSME and More
Over 26 states allow tobacco cessation counseling and prescribing. Also, most states are allowing self-identified MTM opportunities, Diabetes Self-Management Education (DSME), point of care testing for COVID-19, cholesterol, A1C, flu and strep.
Getting Paid for These New Services
How to ensure you get paid is one of the most common challenges with new clinical services. Experienced medical intermediaries like XiFin Pharmacy Solutions can serve as your advocate with payers and assist your team with payer strategies. Several commercial payers have limited pharmacist access to their networks because pharmacists didn’t have an EHR like other medical professionals.
XiFin Pharmacy Solutionss pharmacy EHR gives you the best of both worlds. You can process medical claims for clinical services in the same manner as PBM claims, benefit from real-time eligibility and clinically document encounters based on protocol-specific templates. With these capabilities plus an advocate working with payers on your behalf, you can secure expanded services on your fee schedules and spend your time focused on internal processes to effectively make the most of these new opportunities.
Don’t Get Left Behind
The past year has been transformational for the world of retail pharmacy. Like the H1N1 flu pandemic in 2009, today’s pandemic has proven that we as a nation need to continue to expand the number of providers and access points for care. And once again, the government and commercial payers are looking to community pharmacists to fill that role.
The traditional business model of drug dispensing is changing, supplemented by the new model of medical services. This is an important time for pharmacies to find their seat at the table and take advantage of this expanding opportunity for pharmacist provider status. Don’t get left behind.
Shelley Hansell
EVP Client Relations & RCM Product Management, XiFin Pharmacy Solutions
Formerly, Shelley served as the executive vice president of client relations, and revenue cycle product management, responsible for building client partnerships and implementing products and services that mutually grow businesses. With nearly 20 years of domain experience, Shelley is well respected in the pharmacy industry for her revenue cycle management expertise as well as her ability to drive operational improvements aligned with medical billing policies.