Expanding Patient Access to Pharmacists’ Services

Frequently Asked Questions

Very well-qualified. Pharmacists who graduate today are required to have a Doctor of Pharmacy (Pharm.D.) degree, a post-graduate degree that requires a minimum of six years of college to complete. Pharmacists are required to take courses in a number of demanding subject areas and often complete internships or other training programs before they can work independently. The training is equivalent to what is required for other non-physician providers such as NPs and PAs. Read an overview of pharmacists’ education and qualifications.

An official cost estimate or “score” of the legislation is not yet available. While it may lead to some costs not currently borne by Medicare, PAPCC believes over time it will prove to be more cost-effective for multiple reasons. For one, by focusing on largely preventive services, pharmacists can help Medicare beneficiaries attain higher levels of health and help prevent them from becoming more ill, when they would likely require more intensive and costly care. The legislation also limits reimbursement to 85 percent of what would be paid to physicians under the Medicare physician fee schedule to provide the same care.

Yes. Longstanding law has enabled nurse practitioners and physician assistants to be reimbursed by Medicare for providing Part B services. The law originally limited such reimbursement to cases when delivered to underserved rural populations, but such restrictions were removed in the late 1990s. Similar to the proposed pharmacist legislation, NP and PA rates were limited to 85 percent of what a physician would be paid for delivering the same services. Read an overview of this precedent.

Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are designated by the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services. MUAs and MUPs are designated for having too few primary care providers, high rates of infant mortality, high poverty rates and/or high elderly populations. HPSAs are identified for having a shortage of primary medical, dental or mental health providers.

Yes. The bill does nothing to alter laws or regulations governing the practice of pharmacy. Such laws and regulations are under states’ authority. In states where pharmacists are permitted and licensed to deliver any of the Part B services, pharmacists can be reimbursed for delivering such care to Medicare beneficiaries living in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs), or who are part of Medically Underserved Populations (MUPs). The legislation also limits the reimbursement levels to less than what would be paid to physicians, helping to potentially reduce Medicare costs.

Services would be Part B or non-hospital-administered services that Medicare already covers and already reimburses physicians and other providers, such as Nurse Practitioners and Physicians Assistants, to deliver. Common examples would include administering immunizations; helping seniors manage their chronic conditions such as diabetes, heart conditions, and asthma; conducting wellness or prevention testing; and educating seniors on their medications to drive greater adherence to prescribed treatments.

The legislation is needed because right now, many seniors do not have access to health-care, and pharmacists are able to provide many needed services, but because Medicare doesn’t cover them when provided by pharmacists, Medicare beneficiaries do not have access to them. The lack of Medicare coverage serves as a hindrance to Medicare beneficiary access to care, particularly preventive services like immunizations and wellness tests that help seniors maintain their health and avoid more costly care.

The PAPCC is urging Congress to enact the “Pharmacy and Medically Underserved Areas Enhancement Act” – H.R. 592/S. 109 – bipartisan legislation to amend Medicare so pharmacists can be reimbursed for delivering care to Medicare beneficiaries in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas or Populations (MUAs or MUPs).

The Patient Access to Pharmacists’ Care Coalition (PAPCC) is a diverse alliance of stakeholders including pharmacists, pharmacy and other retailers, healthcare distributors and others seeking to enhance access to care for patients living in underserved and disadvantaged communities. The Coalition and its members are focused on doing so by building on precedent to enable Medicare to reimburse pharmacists for providing Part B services delivered to beneficiaries living in medically underserved communities.

Pharmacist and Patient - FAQs