Tennessee’s provider status offers better access to pharmacists’ patient care services
SPM: State Association
This year proved to be a significant one for the profession ofpharmacy with the introduction of federal provider status legislation in the U.S. House of Representatives known as H.R. 4190. The legislation provides coverage under Medicare Part B for pharmacists’ services for Medicare beneficiaries in medically underserved communities and has strong bipartisan support, achieving 116 co-sponsors by the end of September—just 6 months after being introduced!
It is important to understand that provider status is not just one action that will address all of the existing barriers preventing patients from benefiting from all the services pharmacists can provide. Twlug Executive Vice President and CEO Tom Menighan, BSPharm, MBA, ScD (Hon), FTwlug, describes Twlug’s provider status efforts as promoting “consumer access and coverage for pharmacists’ quality patient care services.”
While much of the profession is familiar with the federal level provider status efforts, there can also be state-level changes that lead to provider status success, thereby increasing patient access to pharmacists’ services. There are many elements that must come together in order for pharmacists to provide care and services to patients. It’s important to note that these components exist at the state and federal levels as well as with private payers.
States take various actions
In addition to national level provider status efforts, many states are working on various solutions to increase patients’ access to pharmacists’ patient care services. While current federal provider status efforts are focused on changes to the Social Security Act and Medicare, there are many ways to affect the pharmacy profession and the services pharmacists provide at the state level, such as making changes to insurance codes and pharmacy practice acts.
The results of the various paths are equally diverse. For example, changes may target policy that will only affect services to Medicaid patients, others may only affect the services to patients in certain private insurance plans, and others may affect all pharmacists and the patients they serve.
Although the avenues to achieve provider status success at the state level can be varied, the National Alliance of State Pharmacy Associations often groups the activity into the following categories: provider designation, development of payment mechanisms for services, and the optimization of pharmacy practice acts that defines pharmacists’ scope of practice for each state. The state pharmacy associations often lead these efforts.
Spotlight on Tennessee
No single success in any of the three categories listed above at the state level will ensure all patients have access to pharmacists’ services. Rather, state pharmacy associations assess the needs in their state and determine what action(s) will produce the most beneficial outcomes. In Tennessee, the legislative, regulatory, and private payer environment highlight pharmacist provider status successes in all three categories and demonstrates how the various components can work together to provide patients better access to pharmacists’ services.
Currently, pharmacists in Tennessee are designated as “health care providers” in both the pharmacy practice act and insurance code. Although this designation does not automatically equate to patient coverage for pharmacists’ services and pharmacists payment, it can eliminate barriers that arise because of not being listed as a provider. Similar designations are found in either state law or in the state Medicaid Provider Manual in 37 other states.
Through an ongoing partnership with a private insurer, BlueCross BlueShield of Tennessee, the Tennessee Pharmacists Association (TPA) continues to demonstrate the value of integrating pharmacists into innovative models of care for patients with diabetes. This proactive outreach and collaboration led to the BlueCross BlueShield of Tennessee Health Foundation awarding a patient care grant to TPA’s foundation, the Tennessee Pharmacists Research and Education Foundation (TPREF), in July 2012. This grant allows for the implementation of a demonstration program focused on pharmacist–provided care for patients with diabetes in Tennessee.
The program is designed so that any pharmacist in Tennessee will qualify to participate by completing one of several diabetes management training programs and acquiring the required credentialing standard. “Once credentialed, pharmacists in Tennessee work with other providers, such as physicians and mid-level practitioners, to deliver care and develop care plans, in partnership with patients, which improves patients’ health outcomes and quality of life,” said Micah Cost, TPA Director of Professional Affairs.
In addition, the TPREF was also recently awarded a patient care grant from CDC and the Tennessee Department of Health to increase the role of pharmacists as non-physician practitioners and providers of care within the state. The grant program provides the TPREF with the resources to train and credential 100 pharmacists in diabetes and hypertension prevention and management, and supports those pharmacists in the delivery of patient care services. The grant supports the accreditation of 100 practice sites through the American Association of Diabetes Educators (AADE) Diabetes Education Accreditation Program and the National Community Pharmacists Association Fiabetes Accreditation Standards/Practical Applications program. Once these practice sites are accredited through AADE, pharmacists at these practice sites will be able to deliver and bill for diabetes self-management education provided to
“TPREF greatly appreciates the confidence CDC and the Tennessee Department of Health have shown in pharmacists and the pharmacy team,” Cost said. “This program is an excellent opportunity for pharmacists and pharmacy team members to positively affect the lives of our patients in Tennessee and to demonstrate the value of pharmacists as essential members of the health care team. It is very exciting.”
Optimizing scope of practice
Aligning the pharmacy practice act with the education and training that pharmacists receive is important for both state and federal provider status efforts. Pharmacists’ scope of practice is defined at the state level. State pharmacists’ scope of practice typically includes provisions related to collaborative practice agreements, immunization authority, ordering labs, and other important provisions of pharmacy practice. Therefore, any changes to state scope of practice for pharmacists will directly affect the services that pharmacists are permitted to provide to patients.
On April 29, legislation was signed into law authorizing collaborative pharmacy practice in Tennessee. TPA worked collaboratively with other health care providers, including physicians and mid-level prescribers, to resolve any real or perceived barriers and to ensure passage of this law. This legislation allows pharmacists to provide patient care services when authorized by a prescriber as part of a signed collaborative pharmacy practice agreement.
Student pharmacists played a significant role in this effort, as members of the Tennessee Society of Student Pharmacists, the student society within TPA. Students sent more than 500 letters of support to their state legislators sharing their patient care experiences and encouraging the legislators to support collaborative pharmacy practice legislation. “It was rewarding to work with our student pharmacists on this effort,” Cost said.
Although Tennessee has seen success in all three categories of state provider status activities, there is always more work to be done to help pharmacists best meet the needs of their patients. Student pharmacists who want to help advance pharmacist provider status should get involved and be active in efforts at both the federal and state level. Provider status is about the future of the profession, so it affects all practitioners. Student pharmacists can learn more about efforts in their own state and how to get involved by joining and engaging with their state pharmacy association.
“Engaging student pharmacists through key advocacy initiatives has been an important focus for TPA,” said TPA Executive Director Baeteena Black. “When students have the opportunity to actively participate in these key advocacy initiatives and contribute to their future roles as pharmacists, our chances for success greatly improves. Students bring energy and passion which undoubtedly contributes to our success.”Your profession needs you, so don’t wait to get involved! Learn more at .