ASHP InterSections ASHP InterSections

February 21, 2020

New Mexico Legislation Expands Access to Pharmacist Care

Dear Colleagues,

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

A concerted and highly organized effort has resulted in a significant step forward for pharmacists and patients in New Mexico. Pharmaceutical Services Reimbursement Parity (House Bill 42), passed by the New Mexico Senate on February 20, will expand access to healthcare by enabling pharmacist clinicians and other pharmacists with prescriptive authority to be reimbursed for clinical services.

ASHP’s Government Relations team worked closely with the New Mexico Society of Health-System Pharmacists (NMSHP), the New Mexico Pharmacy Association, the UNM College of Pharmacy SSHP, and others to mobilize grassroots support urging Gov. Michelle Lujan Grisham and members of the New Mexico legislature to pass the bill.

This is a wonderful achievement for pharmacists and their patients in New Mexico. It also serves as a strong building block as we work toward achieving pharmacy provider status nationally. Supporting states in expanding access to pharmacist care is a key part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time.

Multiple studies have shown that pharmacist-provided clinical services expand access to care, improve chronic disease outcomes, and help decrease the cost of care with research estimating that every $1 invested in clinical services by pharmacists reduces overall healthcare costs by $4.[1] We are working hard to make sure that policymakers across the country recognize that value and the impact you bring to patient care.

I would like to express my thanks to all of the individuals and organizations that worked so hard to support the passage of the bill, including Keenan Ryan, NMSHP president, Dale Tinker, executive director of the New Mexico Pharmacists Association, and the students at UNM College of Pharmacy who worked to make sure every legislator in New Mexico understood the importance of this legislation.

We have great momentum on this critical issue and look forward to continuing our advocacy efforts on expanding access to pharmacist care in other states to help improve patient health for all.

Thank you for being a member of ASHP and for everything that you do for your patients and our profession.

Sincerely,

Paul

 

[1] Avalere. Exploring Pharmacists’ Role in a Changing Healthcare Environment. May 21, 2014, available at https://avalere.com/insights/exploring-pharmacists-role-in-a-changing-healthcare-environment

 

 

 

September 23, 2011

Creating an Anticoagulation Service in a Community Pharmacy

From left, Michah Hata, Pharm.D., and Roger S. Klotz, R.Ph., BCNSP, FASCP, FACA, FCPhA

THE MEDICAL LITERATURE is filled with examples of how anticoagulation services managed by pharmacists help reduce the number of anticoagulation-related emergency room visits and hospitalizations. This, in turn, results in significant cost savings1.

Typically, these types of clinics only occur within health systems or medical group practices. But as pharmacy faculty members, I and my colleague, Micah Hata, wondered if this collaborative practice model could be implemented in a community pharmacy.

Overcoming Challenges

So, we worked with a community pharmacist owner in Arcadia, Calif., to add patient care services to his pharmacy. The pharmacy has a private area that can be used as a treatment room to provide patient confidentiality.

We faced a number of major challenges with this project, including:

• Physicians’ resistance to a community pharmacist managing their patients’ warfarin therapy,

• Patient concern about the pharmacists’ capability to manage a therapy that posed significant risk, and

• Payers’ lack of familiarity with community pharmacists’ billing under the major medical plans for services as well as pharmacist-managed medication therapy.

The first task in implementing such a service was to find a licensed physician to medically approve our warfarin management protocol. The second step was to obtain an FDA “Clinical Laboratory Improvement Amendments Waived” testing laboratory certificate so that the pharmacy could officially be recognized as a licensed laboratory. Both tasks were completed by the end of June 2009.

We then faxed a letter along with our physician referral form to the offices of four doctors in our community. The letter detailed the services we would be providing. Within two weeks, the four physicians began to refer patients to our clinic.

Two years later, we have 25 physicians who regularly refer their patients to us. The interesting thing is that we have never marketed to any physicians other than the original four. Therefore, the network of referring physicians has been developed by word-of-mouth among physicians and patients.

A Success Story

Patients have easily accepted pharmacists as providers of direct patient care services, including anticoagulation services. In fact, they have all commented on how much they prefer the pharmacy-based services. We currently have 71 active patients who utilize our services, many of whom have been with us since our debut.

Success in obtaining reimbursement from the patient’s insurance company has been the major challenge. Pharmacists were not listed as approved providers in the original Medicare Act. As a result, we cannot bill Medicare via Palmetto, Medicare’s intermediary claims processor. On the other hand, if the patient has a PPO as either a primary or secondary payer to Medicare, then we can bill the private payer.

One major payer in California initially refused to accept our claims because it had never seen pharmacists bill the major medical plan. Over time, we worked with this payer and responded to every question. We circumvented its refusal to acknowledge pharmacists as providers by starting a group practice, which the payer was willing to accept as a provider in its network.

We were finally informed that we are now listed as a provider in the payer’s network and now receive reimbursement. There are a number of other payers we are billing and from whom we receive reimbursement. Medicare Part B continues to be a problem, and we plan to inform our patients that reimbursement from Medicare is not available.

The best outcome of this new venture is that none of our patients have had problems with adverse events that necessitated a trip to the ER or admission to the hospital as a result of their anticoagulation therapy. In fact, we are now also receiving referrals for the collaborative management of diabetes Type II patients as part of our medication therapy management approach.

It’s clear from our experience that pharmacist-managed direct patient care services can be implemented in a community pharmacy.

By Roger S. Klotz, R.Ph., BCNSP, FASCP, FACA, FCPhA,  and Micah Hata, Pharm.D. Both authors are assistant professors at Western University of Health Sciences, Pomona, Cal.

1 Comparison of “Two Different Models of Anticoagulation Management Services with Usual Medical Care,” Rudd, KM, Dier,  JG; Pharmacotherapy, April 2010; 30(4): 330–338.

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