Payment trends for pharmacist services gaining steam

If current trends continue, Michael Murphy, PharmD, said all payers will come to recognize pharmacists as healthcare providers by the end of the decade. 

Dr. Murphy, the American Pharmacists Association's adviser for state government affairs, said there has been "an explosion" of health plans increasing coverage for pharmacists' services. In a June 26 blog post, he said momentum is building among commercial plans and state Medicaid fee-for-service and managed care plans. 

"Pharmacists are being enrolled as providers in much the same way that health plans enroll physicians, nurse practitioners and physician assistants," Dr. Murphy said. "Pharmacists are also billing for their services in similar ways as other providers. Often, pharmacists submit the same billing codes that other healthcare providers submit for a comparable visit."

Across the U.S., a growing number of pharmacists are working in collaborative agreements with other healthcare professionals in multiple settings, including community pharmacies and ambulatory care clinics. 

APhA is "working to expand programs in every state so every service a pharmacist can provide, ranging from medication management services to conducting health screenings and administering immunizations, is covered and paid for by health plans and other payers," Dr. Murphy said.

Other than increasing reimbursement rates and coverage, he said the organization is dedicated to reforming exploitative PBM practices, increasing the viability of drug reimbursement, and aligning pharmacists' scope of practice with their education and training. 

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