Ohio hits provider status milestone with new law

The law sets the stage for direct relationships with payers

Ohio Gov. John Kasich has signed a new Ohio law that authorizes payment to pharmacists by the state’s Medicaid plan sponsors and other health plans. SB 265, which was introduced by Sen. Matt Dolan, is expected to become effective in April.

“What you have with this bill is a unanimous vote of an entire general assembly and the signing of a governor stating their endorsement that the pharmacist is a health care provider, and can and should be recognized by every other member of the health care team,” said Antonio Ciaccia, director of government and public affairs at the Ohio Pharmacists Association (OPA).

The new law is a green light for pharmacists to start working with payers in a more direct fashion, rather than a mandate for coverage. “From a legal standpoint, the law puts pharmacists on the same playing field as any other provider rendering a service, which means that they have the same rights and responsibilities as a doctor, a nurse, nurse practitioner, physician assistant, you name it,” Ciaccia said. “It enables a direct payer and provider relationship, so individual pharmacists can start working on a contractual basis with a payer.”

The next step is working with private-sector payers to develop credentialing programs to allow pharmacists to become an eligible provider within their networks.

“If payers are moving into a more managed care, population health-type model, pharmacists can and should be a major component of those models,” Ciaccia said. “Every member of the health care team, pharmacists included, ultimately need a seat at the table within these new care models.”

There is also work to be done with public payers.

“From an association perspective, we’re working with the Department of Medicaid and Medicaid managed care plans to start building access to billing codes that pharmacists weren’t previously authorized to use. Pharmacists have the scope to provide the services that are under those billing codes, but they’re currently not able to bill for those codes,” Ciaccia said. “We gave them the legal ability; now it’s to actually give them the functional ability in the market.”