Pharmacist groups drum up support for provider status legislation

Bill would amend Social Security Act

It’s not a priority for most of Congress, but pharmacist groups are trying their best to push "provider status" legislation to the forefront.

The Medicare Pharmacist Services Coverage Act (S. 974/H.R. 2799) was introduced in the U.S. Senate and the House of Representatives last year. The legislation amends the Social Security Act to include pharmacists on the list of health care professionals classified as health care providers, making pharmacists eligible to bill for the high-level patient care services they provide to Medicare beneficiaries. The legislation also promotes enhanced patient safety and will help contain rising health care costs by increasing patient access to the professional services of pharmacists, pharmacist groups say.

The Pharmacist Provider Coalition, a group working to educate members of Congress and the public about the role pharmacists play in the safe and effective use of medications, drafted the legislative language. The American Society of Health-System Pharmacists (ASHP) in Bethesda, MD, and American College of Clinical Pharmacy in Kansas City, MO, founded the coalition; the legislation is ASHP’s No. 1 agenda item, says Kathleen M. Cantwell, ASHP’s director of federal legislative affairs and government affairs counsel. The coalition’s core membership has since expanded to include the Academy of Managed Care Pharmacy in Alexandria, VA; the American Society of Consultant Pharmacists also in Alexandria; and the American Pharmaceutical Association in Washington, DC.

"Under the current Medicare system, pharmacists are only paid for providing patient care services that are incident to’ that of a physician’s service," says Henri R. Manasse Jr, PhD, ScD, ASHP executive vice president and CEO. "This means that pharmacists working in outpatient settings can only bill for a small number of services — limiting patient access to those services — and that care for high-risk patients is not covered."

Pharmacists’ medication management services also would be available to Medicare beneficiaries under the Medicare Drug and Service Coverage Act of 2002 (MEDS Act), prescription drug legislation also known as the Emerson-Ross bill. The MEDS Act, however, offers coverage as part of a comprehensive drug benefit, while the provider status legislation offers it as stand-alone coverage.

"If [patients] have a former employer that provides them with drug coverage under the MEDS Act, they wouldn’t necessarily have access to pharmacist services," Cantwell says. "Provider status gives it to everyone, no matter where they get their drug coverage."

The provider status legislation has been referred to the committees with congressional jurisdiction over Medicare. The Pharmacist Provider Coalition is now building support, such as trying to gain co-sponsors on the legislation, and hoping that the legislation will move at the end of this session, Cantwell says. "This is not a large enough issue in the eyes of Congress to move on its own." 

The coalition has been working both within and outside of pharmacy to gain support, she says. "We have made progress — it’s not a hard sell in pharmacy." The coalition has been working with a couple of the drug manufacturers. "They have a strong interest in pharmacist services because pharmacists help make the best use of their products."

Cantwell is encouraged by some of the support that the legislation has received. Recently, the Healthcare Distribution Management Association (HDMA) in Reston, VA, came on board. HDMA is the trade association that represents pharmaceutical and related health care product distributors throughout the Americas.

According to ASHP, Ronald J. Streck, HDMA President and CEO, wrote a letter in support of the legislation to the bill’s sponsor, Sen. Tim Johnson (D-SD). In the letter, Streck said, "coverage of pharmaceutical therapy management is one of the most important elements that should be included as Congress works to craft a comprehensive drug benefit for seniors."

How can pharmacists help?

Organizations in the Pharmacist Provider Coalition have a lot of resources available to lobby Congress in favor of the Medicare Pharmacist Services Coverage Act (H.R. 2799/ S.974). Legislators, however, pay extra attention to what their constituents have to say. That is why the American Society of Health-System Pharmacists (ASHP) in Bethesda, MD, and other members of the Pharmacist Provider Coalition are encouraging pharmacists to do the following:

• Write to members of Congress.

ASHP’s letter-writing campaign aims to make members of Congress aware that a problem exists with Medicare’s compensation methodologies for the patient care services of the pharmacist.

ASHP encourages pharmacists to write their members of Congress and explain what the patient care services of the pharmacist entail, the value the services add to drug therapy treatment, and the lack of compensation pharmacists receive for providing such services. The letters should explain the impact this has on patient care as well as on pharmacists’ ability to maintain this patient care service.

When writing the letter, pharmacists should not forget how little experience patients might have with the patient care services provided by pharmacists. In many cases, patients may only see pharmacists when they pick up prescriptions at their community pharmacy. This usually results only in a brief counseling session. Unless individuals have a more serious or chronic condition, their interaction with a pharmacist does not go beyond this low level of patient care.

If lawmakers and their advisors are not familiarized with the professional patient care services of the pharmacist, they will not understand the need for greater compensation. Every communication pharmacists have on this issue must begin by confirming that the individual truly understands the role of the pharmacist in drug therapy management.

In the initial letter, pharmacists should explain the problem, offer to be a resource, and request the member’s support for the Medicare Pharmacist Services Coverage Act (H.R. 2799/S.974). To find the names and addresses of members of Congress, go to ASHP also offers links to tips on writing an effective letter, to sample letters, and to examples of possible supporting documentation. For more information, see

• Be the voice of pharmacy.

ASHP encourages pharmacists to participate in local events where lawmakers are likely to be in attendance. Some of these local events include local political events, fundraisers and charity events, town hall meetings, and public forums. These events allow pharmacists to become more familiar with the individuals affecting policy and may provide an opportunity for them to share their views on pharmacy.

• Get friends, family, neighbors, co-workers, and patients involved in the campaign.

Pharmacists should increase the awareness of those around them of the problem facing pharmacy. Pharmacists’ friends, family, neighbors, co-workers, and patients know better than anyone the value of having access to pharmacist services, ASHP says. Pharmacists should talk to those around them about the issue and ask if they would be willing to write a letter to their senators and representatives about the care they have received.

• Conduct site visits.

Lawmakers and their advisors need to have a complete understanding of what the professional patient care services of the pharmacist encompass and the benefit these services add to drug therapy treatment. ASHP says it cannot overemphasize the importance of this understanding to its request for compensation for providing these services.

One of the most effective ways for pharmacists to educate lawmakers and their advisors about the patient care services of the pharmacist is to invite them into the health care facility so they can see for themselves what these services entail.

ASHP offers the following documents on its web site to help provide an effective site visit: tips for conducting an effective site visit, talking points, media advisory, provider status material, plus information about the bill itself.

"Site visits are probably the best way we can sell the services of pharmacists," says Kathleen M. Cantwell, ASHP’s director of federal legislative affairs and government affairs counsel. "We have had at last a dozen practice site visits set up by our members."

• Contact state chapters to get involved in local advocacy efforts.

ASHP’s state chapters play a key role in coordinating local grass-roots efforts. Pharmacists who are ASHP members can contact their ASHP-affiliated state chapter to learn how they can get involved.

• Become part of ASHP’s grass-roots system.

ASHP will indicate on its web site critical moments in the legislative process when pharmacists’ voices will have the most influence. In return, the society asks that pharmacists follow up on these opportunities to influence the lawmaking process.

Pharmacists should try and get involved, Cantwell says. "We can’t do it without you."