Pharmacists Embrace Provider Status in Healthcare, but Hurdles Remain

There is a national push to grant pharmacists provider status and integrate pharmacy data for end-to-end optimized patient care. Pharmacists are valuable healthcare team members — highly educated, trained, and licensed to deliver many clinical services including immunizations, screenings, medication management, chronic disease management, and patient education. There is ample evidence of their positive impact on patient outcomes, care costs, and access to healthcare services.

Although nearly half of all U.S. states recognize pharmacists as healthcare providers (HCPs), their ability to provide and receive proper reimbursement for clinical services is limited by lack of federal recognition and reliable reimbursement models, along with interoperability challenges. By recognizing pharmacists as healthcare providers, particularly under Medicare Part B, and allowing them to exchange healthcare information with other members of the healthcare team, communities can begin to expand patient access to essential healthcare services while driving better outcomes overall.  

This article explores the promising potential for integrating pharmacy to connect the entire healthcare ecosystem. Expanding pharmacists’ role in healthcare delivery contributes to benefits for healthcare provider organizations, payers, physicians, pharmacies, and most important, the patient. 

Enhancing patient access to care

The traditional role of pharmacists as dispensers of medication has expanded with the recognition of pharmacists as healthcare providers in various states, through Medicare Part D, and with the critical role they played in delivering Covid-related services. Despite the challenges they face, many pharmacists are now engaged in direct patient care activities, immunization delivery, medication management, chronic disease management, and preventive care services. 

There are major benefits to integrating pharmacy into healthcare delivery models for patients, including convenience and improved access to care. It is estimated that 94% of Americans live within five miles of a pharmacy and visit their pharmacy two to twelve times more frequently than their primary care provider. This makes pharmacies a critical and convenient touchpoint, especially in rural areas that often lack adequate access to primary care providers (PCPs).

Integrating pharmacists into the healthcare ecosystem as fully provisioned members of the patient’s healthcare team brings timely care and health interventions to patients within their own communities. Pharmacists can also be tapped to bridge continuity of care gaps in the current healthcare delivery model. However, they must be able to access patient data that is actionable and timely, exchange information with providers and payers, and receive reimbursement for the services they provide. 

Optimized data sharing required

It is crucial that payers and providers share valuable insights with pharmacies, considering their frequent and direct interaction with patients. With access to comprehensive patient data, pharmacists can better identify gaps in care, proactively address needs, and optimize each patient interaction. 

Technology that uses health data to surface actionable clinical opportunities in workflows that make sense for pharmacies is also critical. Today, pharmacies across the nation are leveraging technology that is opening the way for them to engage in clinical services, giving them the ability to offer clinical interventions alongside medication dispensing at every patient touchpoint. Clinically integrated software that works with existing dispensing systems allows users to see not only what medications are ready for pick up, but also gaps in care, vaccine opportunities, and adherence issues they may be able to address. 

This type of integrated clinical platform helps pharmacies:

• Efficiently engage patients, document interactions, address care concerns, and communicate with providers. 
• Identify gaps in care for specific populations and address them onsite, such as patients diagnosed with diabetes and hypertension.
• Measure and support medication adherence, optimize medication regimens, and deliver counseling.
• Ensure immunization compliance.

Exchange of data with providers and payers to close the loop on pharmacy conversations and interventions ensures providers are updated and payers support pharmacists in their efforts to deliver care. 

Getting payers on board

Despite the evidence of their positive impact, pharmacists today lack the ability to reliably bill for clinical services as healthcare providers. It is important that payers provision pharmacists, include them in networks, and enable reimbursement through traditional billing models. Recognizing pharmacists’ provider status delivers valuable returns for members and elevates quality scores such as HEDIS and Stars over time. 

• Closed care gaps support quality reporting.
• Improved access to care increases member satisfaction.
• Preventive care and therapy optimization supports reduced costs and improved outcomes. 
• Frequent screening and monitoring reduce ER visits. 

Recognizing the role of pharmacies as a vital intervention point with patients and as an administrator of clinical services helps close costly gaps and address patient access needs. This initiative offers participating providers, payers, and patients an important advantage for cost savings and quality care. 

Photo: JohnnyGreig, Getty Images

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