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Landmark Legislation: Pharmacists as Providers
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Passage of Landmark Legislation: ESSB 5557

After decades of fighting for recognition as care providers, we finally have a victory to celebrate! Washington Bill ESSB 5557 had overwhelming bipartisan support from the legislature and Governor Jay Inslee (D) signed the bill into law on Monday, May 11th, 2015. Sponsored by Senator Linda Evans Parlette, this landmark law is the first in the country to increase patient access to medical care from pharmacists practicing within their scope of practice. 

Understanding the Bill
For decades, pharmacists in Washington State had been recognized as healthcare providers in state laws and since 1979 our scope of practice allowed for patient care including prescribing through collaborative practice agreements, monitoring and managing medications, and ordering and interpreting lab orders. Pharmacists in Washington have subsequently integrated into healthcare teams and provide valuable patient care. However, pharmacists had not yet been recognized by health insurance companies as providers and have been limited in their utilization due to the inability to bill for the patient care they provide. 

ESSB 5557 states that pharmacists are among the healthcare providers that must be represented in  health insurance provider networks and clarifies that PBM contracts with pharmacies does not meet this requirement. Simply stated, this legislation removes a major barrier for pharmacists to bill commercial health plans (not PBM's) for patient care services outside of dispensing medications. As of January 1, 2017, pharmacists in all practice settings can enroll in commercial health plan provider networks and bill for covered patient care services within the pharmacists scope of practice. The legislation requires commercial health insurance carriers recognize pharmacists in the same way as other providers such as physicians, nurse practitioners, and physician assistants.This legislation applies to commercial health plans providing individual, family, small group and large group coverage. The law does not apply to Medicare, Medicaid FFS and Self Insured plans.

With the passage of this legislation, pharmacists in Washington have been billing for patient care, and increasing access to care. By treating pharmacists equal to other healthcare providers, the law opens the door for pharmacists to provide and bill for patient care services within their scope of practice. This is the first provider-status victory of its kind in the country!

ESSB 5557 Bill Language

ESSB 5557 Legislative Deliverables from Advisory Workgroup

Over the summer of 2015, WSPA staff and members worked with other stakeholders on the ESSB 5557 Collaborative Advisory Workgroup directed by the Legislature and Office of the Insurance Commissioner to determine guidance directives for implementation of the legislation. On December 1st, 2015 the Workgroup completed their work. Below are the cover letter and three documents that were the conclusion of their work. 

Letter to the Insurance Commissioner
ESSB 5557 FAQ and Definitions

Pharmacist and Other Providers Expectations

Health Plan Policy Directives


Get Started Billing for Patient Care Services - WSPA Resources for billing for patient care services


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