Provider Status is Expanding – Don’t Get Left Behind!

Provider status has been a key objective in the pharmacy industry for years. Pharmacists are trained for long-term management of chronic care diseases and are eager to utilize their expertise to meet the needs of population health initiatives.

With so much focus on COVID-19, many pharmacists may not realize how quickly state legislatures and payers have broadened their coverage for pharmacist clinical services over the past year.  As awareness of the broad impact that pharmacists are making in rural and urban communities has increased, both changing regulations and new payer opportunities have enabled pharmacists to expand their scope of practice and improve access to clinical services.

The Clinical Services Landscape

Below is a map that outlines some of the key clinical services allowed by pharmacist in each state.

Now here’s the both the good and bad news: this map will be outdated almost immediately. States are adding new services and expanding provider status at a rapid pace.

Hormonal Contraceptive Prescribing

Not long ago, hormonal contraceptive counseling was limited to a few northwestern states.

Today, hormonal contraceptive counseling and prescriptive authority are allowed by pharmacists in 18 states. In Oregon, one of the first states to allow pharmacists to prescribe hormonal contraceptives, 10% of all hormonal contraceptive prescriptions now originate from a pharmacist.

Check out this great resource that dives more deeply into issues around hormonal contraceptive prescribing, and how pharmacy can improve access to this service.

Contraceptive access remains challenging in the US, with more than 19 million women with low incomes living in contraceptive deserts, counties in which there is not reasonable access to a health center offering the full range of contraceptive methods. Given this landscape, and ongoing federal policy challenges, interest in allowing pharmacists to prescribe hormonal contraception is likely to continue gaining traction in states.

Tobacco Cessation, MTM, DSME and More

Tobacco cessation counseling and prescribing is allowed in over 26 states. Most states are also allowing self-identified MTM opportunities, Diabetes Self-Management Education (DSME), point of care testing for COVID-19, cholesterol, A1C, flu and strep.

Getting Paid for These New Services

One of the most common challenges with new clinical services is how to get paid. Experienced medical intermediaries like OmniSYS can serve as your advocate with payers and assist your team with payer strategies. Several commercial payers have limited pharmacist access to their networks because pharmacists didn’t have an EHR like other medical professionals.

OmniSYS’s pharmacy EHR gives you the best of both worlds. You can process medical claims for clinical services in the same manner as PBM claims, benefit from real-time eligibility and clinically document encounters based on protocol-specific templates. With these capabilities plus an advocate working with payers on your behalf, you can secure expanded services on your fee schedules and spend your time focused on internal processes to effectively make the most of these new opportunities.

Don’t Get Left Behind

The past year has been transformational for the world of retail pharmacy. Like the H1N1 flu pandemic in 2009, today’s pandemic has proven that we as a nation need to continue to expand the number of providers and access points for care. And once again, the government and commercial payers are looking to community pharmacists to fill that role.

The traditional business model of drug dispensing is changing, supplemented by the new model of medical services. This is an important time for pharmacies to find their seat at the table and take advantage of this expanding opportunity. Don’t get left behind.

Shelley Hansell, SVP, Client Relations 

Shelley HansellShelley serves as senior vice president of client relations, responsible for building client partnerships and implementing products and services that mutually grow businesses. With nearly 15 years of domain experience, Shelley is well respected in the pharmacy industry for her revenue cycle management expertise as well as her ability to drive operational improvements aligned with medical billing policies.

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