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Pharmacists as Medical Providers
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Advancing Pharmacists' Role on the Healthcare Team

Our healthcare system is undergoing drastic changes. Pharmacists are the most underutilized healthcare provider. Rethinking the way pharmacists are utilized and aligning quality based compensation incentives is the way to improve management of chronic disease and reduce costly ER visits and hospitalizations.

What do pharmacists and pharmacy technicians do?

Scope of Contemporary Pharmacy Practice: Roles, Responsibilities, and Functions of Pharmacists and Pharmacy Technicians 2009
This paper provides an introduction to the education and training pharmacist and pharmacy technicians receive as well as mandatory and voluntary credentials available to pharmacists. Also provided, is a spectrum of profession roles, responsibilities and services in regards to the scope of pharmacy practice and patient care. Summary

What is the value of the care provided by pharmacists?

Exploring Pharmacists’ Role in a Changing Healthcare Environment 
May 2014, Prepared by Avalere Health.
Pharmacists’ focused training in drug therapy positions them well for unique contributions to the management of patient health, especially within evolving payment and delivery models that explicitly focus on quality and efficiency. This analysis by Avalere Health set out to investigate the ways that pharmacist services are improving care, and how these services are aligned with the changing healthcare environment.

Forbes Magazine recognized the unmet need that pharmacists can address in an article published June 2014. The article stated that, “MTM has the potential to alleviate some glaring problems in America’s health care system.” CMS estimates hospital re-admissions cost the program $17.5 billion a year, many due to the adverse effects of medication therapies. One study, referenced in the Forbes article, showed that people who received MTM services from a pharmacist were three times more likely to remain out of the hospital after 60 days. The Forbes article demonstrates the ever growing support for pharmacists as a valued member of the healthcare team.

Improving Patient and Health System Outcomes through Advanced Pharmacy Practice, A Report to the U.S. Surgeon General 2011
From the Office of the Chief Pharmacist for the U.S. Public Health Service
An evidence-based report demonstrating improved patient and health system outcomes through pharmacist delivered patient care services. This report summarizes a substantial amount of published literature from peer-reviewed journals validating the need for pharmacists to be recognized as healthcare providers and be compensated. Report Summary Letter of Support from the Surgeon General Letters of Support from Physicians

Pharmacist as Medical Providers
Passage of Landmark Legislation: ESSB 5557
After decades of fighting for recognition as care providers, we finally have a victory to celebrate! As you may have heard, ESSB 5557 has passed with 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 of its kind in the country to increase patient access to medical care from pharmacists practicing within their scope of practice.  
We are proud that Washington State pharmacists continue to lead the way in providing innovative, quality care to patients.

Understanding the Bill
For decades, pharmacists in Washington State have been recognized as healthcare providers in state laws and have had a scope of practice allowing for the provision of patient care including prescribing through collaborative drug therapy agreements, monitoring and managing medications therapy, and ordering and interpreting lab orders within policy and procedures. This has allowed pharmacists in Washington state to integrate 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 to 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 WA SB 5557, pharmacists in Washington have a tremendous opportunity – we can bill for services. It’s a law we have fought for decades to achieve and requires health plans to include pharmacists in their provider networks. 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 
Washington Bill Tracker for ESSB 5557


January 1, 2016: Health plans that have delegated credentialing agreements with provider organizations are required to include pharmacists in their participating provider networks and pay medical claims for covered services within the pharmacists scope of practice.

January 1, 2017: Health plans are required to have an "adequate" number of pharmacists in their participating provider networks and pay medical claims for covered services within the pharmacists scope of practice. 

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

WSPA Pharmacists as Providers Implementation Workgroups

In order to assist our members with the knowledge and tools necessary to implement this legislation in their practice, the WSPA has created four Implementation workgroups.

Contracting, Credentialing and Privileging: Determine best practices and tools for credentialing and privileging pharmacists. 

Billing, Coding, and Documentation: Determine best practices to ensure pharmacists meet billing and documentation standards, and provider tools to facilitate the billing of services through contracts with health plans.

Outcomes and Research: Determine the metrics to measure and report quality and outcomes of using pharmacists to provider patient care.

Infrastructure: IT and Communications: Identify technology gaps and solutions in pharmacy practices to ensure interoperability, billing and payment, practice management, and documentation. 

If you are interested in participating in the Implementation Workgroups, contact Jenny Arnold for more information.

Click Here to Get Started

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