Law gives state’s pharmacists compensated-provider status
If you ask the average person what a pharmacist does, you might hear “count pills,” or “dispense medication.” Even health insurers and other payers limit pharmacists' patient care to dispensing medication.
That’s about to change.
Under legislation signed into law today by Gov. Jay Inslee, Washington is the first state in the nation to require pharmacists to be included in health insurance provider networks. Pharmacists, as with nurse practitioners and physician assistants, will be compensated for the patient care they provide within their scope of practice.
“This change simply means that patients will have greater access to high quality care services,” said Don Downing, clinical professor in the University of Washington School of Pharmacy. He has advocated for this change for 15 years.
"Pharmacists don’t diagnose and don’t replace the doctor’s role in acute care. Pharmacists are a key part of the health team with highly specialized knowledge of medications and years of college and post-college training," he said.
Five percent of patients consume 50% of healthcare expenses, much of which comes from the costs of managing chronic illnesses such as diabetes, hypertension and congestive heart failure. Studies have shown that when a pharmacist is included in a healthcare team, the patient's outcome improves.
As with other states, Washington has had an influx of newly insured individuals. Clinics and medical groups have wanted to add pharmacists to their staff or include them in Accountable Care models, but could not afford to do so in the absence of this legislation. The new law also benefits rural and underserved communities that struggle with primary care providers who are in short supply and overburdened.
“This is a watershed moment for the profession of pharmacy and for the citizens of Washington state,” said Sean Sullivan, dean of UW’s School of Pharmacy.
UW Pharmacy faculty have established other practice standards that have won widespread acceptance, including collaborative agreements for pharmacists prescribing under limited authority, providing Plan B emergency contraception (nine states), and pharmacist-provided vaccinations (all 50 states).
An advisory group including the insurance commissioner, insurance providers, physicians, pharmacists, hospitals, community pharmacies, and others will work this summer to develop the state's policies for provider accreditation and implementation. The change begins in hospital systems and clinics in 2016 and goes into effect more broadly in 2017.
“Ideally, 20 years from now the pharmacist will be a fully integrated member of your healthcare team," Downing said. "Your pharmacist would refer you back to your physician regularly as appropriate, freeing physicians to do their best work, including acute care and diagnostics. As a patient, you will benefit from the full experience and specialized knowledge of your complete health team."