A recent article in the International Business Times outlines how pharmacists are pushing for a bigger role in health care. According to the article, Washington recently became the first state to recognize pharmacists as health care providers, and require that insurers reimburse them for consultations. Beginning next year pharmacists in Washington can bill insurers for appointments just like doctors and nurse practitioners.
The change was the result of a law known as Every Category of Health Care Providers. This regulation requires insurers to cover a provider in every type of medical specialty. In Washington State advocates convinced lawmakers that pharmacists are a type of health care provider. Numerous other states have similar laws that could potentially be used to grant pharmacists provider status.
There is some merit to the idea pharmacists can do more for patients than merely count pills. The Asheville Project found community pharmacists helped diabetic patients achieve better health metrics. The program reduced health care costs for diabetic patients (and their health plan) by nearly half. Some health advocates argue pharmacists are capable of providing contraceptive advice to women and dispensing birth control without a doctor’s prescription. There are probably many other chronic conditions pharmacists could manage in collaboration with doctors. Scott F. Giberson, US Assistant Surgeon General and chief professional officer of pharmacy at the US Public Health Service, calculates that every $1 spent on pharmacy consultations could save $4 in other health care spending.
However, when it comes to discussions of allowing pharmacists take on a bigger role in health care there are really two distinct issues: 1) what should be pharmacists’ scope of practice?; and 2) who’s going to pay them? Pharmacists are already allowed to counsel patients on medications; they are already allowed to charge patients willing to pay for their advice. Patients are free to spend their own money as they see fit. However, insurers and Medicare are not required to reimburse pharmacists for consultations.
A few years ago a chain pharmacy tried offering extended pharmacy consultations for $25. The effort failed because few patients were willing to part with $25 for just advice. A 15-year old article in Medscape analyzed “willingness to pay” (out-of-pocket) for a consultation with a pharmacist to reduce the risk of medication-related problems. Patients reported being willing to pay between $4.02 and $5.48 for the services. Patients were asked about their willingness to pay using a survey instrument; the data was not based on actual patients who willingly paid for the service. In all likelihood, the patients surveyed perceived the service as valuable to someone else (worth $4.02 to $5.48) but possibly not something they would personally pay for. A 2005 journal article in Research in Social & Administrative Pharmacy found (again through a survey) women were willing to pay an average of $40 for an initial 30-minute consultation about hormone replacement after menopause and $20 per half hour consultation for follow up consultations.
I suspect that many patients would willingly to pay for a pharmacist consultation if the pharmacist could approve a prescription that was both cheaper and more convenient than scheduling an appointment with their doctor. Of course the American Medical Association opposes expanding pharmacists’ scope of practice to include prescribing authority.
David Howard, a health economist at Emory University counters that all medical care need not be under the supervision of a doctor. He thinks pharmacists have the potential to lower costs and boost access to care. I was quoted near the end of the article cautioning that efforts to allow pharmacists to bill Medicare and health plans (like doctors, nurse practitioners do) needs to be coupled with a clear goal of improving access and reducing costs — not some intangible assertion that the health care system somehow benefits. For instance, would pharmacists bill for what they already do for free? Or could they only bill for distinct tasks (like diabetes care or prescribing a drug) that improves health outcomes and achieves better access to care at a lower cost?
Providing a flu shot for $20 is cheaper and more convenient than getting one at your doctor’s office. There are undoubtedly many other conditions pharmacists could manage. Diabetes is one example that has been studied. It may be valuable to compensate pharmacists who occasionally counsel seniors taking multiple medications; or for helping seniors better manage a chronic condition. However, it would not reduce health care spending if every prescription a senior picked up at the drugstore resulted in both a drug claim and a consultation charge to Medicare.
But wouldn’t that same person getting diabetic or hormonal consult from the pharmacist end up getting the same medical review when they goto their primary care physician, thereby duplicating services and costs? And this is coming from someone who beleives A PharmD can be a cog in the preventive medicine wheel but just don’t know how, in the macro economic view of the medical pie, this would be all that beneficial to the patient and society as a whole.
@Big Truck Joe
That’s the type of question I’m alluding to. There has to be a discrete role that has value before states do like Washington state and assign pharmacists the right to bill insurers. In the Ashville Project, pharmacists helped doctors by counseling/educating diabetic patients and checking them between doctor visits — information that was sent to their doctor. It’s not that I don’t respect pharmacists, rather my worry is that there will be more people billing third parties for things patients themselves (and their insures) may not think are worth paying for. In the Ashville Project, Ashville paid the pharmacists.
Currently, when I pick up a prescription the pharmacy tech asks if I want drug counseling. I do not want there to be a time when I’m automatically told about the drug and then presented a bill, when I could have Googled the drug for free. On the other hand, there are times when seniors are on 12 drugs and need drug counseling.
In Britain, druggist can dispense certain drugs without a prescription, but only after talking with the patient. A customer can ask about Zocor for high cholesterol. The druggist then checks the persons age, asks if they’ve checked their cholesterol, informs them about the need for periodic liver enzyme checks and sells them Zocor if conditions are met. However, the US does not have so-called “behind the counter” drugs as Britain and Canada do.