Pharmacy Evolution: The Quest for Provider Status

Traditionally, pharmacists served as community healthcare providers who prepared and prescribed medications. In light of the rapid transformations in healthcare during the 20th and 21st centuries, experts suggest that pharmacies should once again be viewed as affordable medical homes for patients. This perspective was shared during a presentation at Asembia’s AXS24 Summit in Las Vegas, where three panelists spoke with Specialty Pharmacy Continuum post-meeting.

Ashley Galla, PharmD, MBA, FASHP, BACP, CSP, vice president of clinical operations at Northwell Health’s Vivo Health Pharmacy in New Hyde Park, N.Y., highlighted that pharmacists are among the most accessible healthcare professionals. She referenced a 2022 analysis indicating that nearly 90% of Americans live within five miles of a community pharmacy (J Am Pharm Assoc 2022;62[6]:1816-1822.e2) and that patients visit community pharmacies 1.5 to two times more frequently than their doctors or other healthcare providers (J Manag Care Spec Pharm 2022;28[1]:85-90).

Despite this accessibility, the lack of reimbursement for pharmacist services remains a significant hurdle for the industry, the panelists noted. “We need to reach a turning point where enough payers are willing to compensate pharmacists for these services, especially since the Centers for Medicare & Medicaid Services has yet to officially recognize us as providers,” said Alexandra Broadus, PharmD, senior director of clinical pharmacy strategy at Walgreens. She also emphasized the need to raise consumer awareness about the healthcare services pharmacists can provide, citing the example of immunizations. “Not even 20 years ago, if someone went to a pharmacy for a flu shot, it was typically administered by a nurse.”

Dr. Galla concurred, stressing that without securing appropriate reimbursement for the valuable cognitive services they offer, the ability to expand their reach and maximize their impact will be limited. “We must show positive clinical outcomes and the resulting return on investment to achieve our goals,” she stated.

The Fragmented Landscape of State Regulations

The issue is compounded by the fact that pharmacists are regulated at the state level, as noted by John Colaizzi Jr., PharmD, FNJPhA, vice president of pharmacy practice at Walgreens. He explained that regulations vary widely between jurisdictions, with some states allowing pharmacists to administer medications and immunizations while others do not. “If you’re permitted to perform a task but can’t be compensated for it, that’s irrelevant,” Dr. Colaizzi said. “Conversely, if you can get paid for a task you’re not allowed to perform, that’s equally meaningless. You need both aspects to work in tandem.”

Nevertheless, some pharmacists are pioneering innovative care models while demonstrating their value. At Northwell, pharmacists engage in collaborative practice agreements, allowing them to manage patients clinically alongside physicians. Dr. Galla explained that pharmacists embedded in clinics can assist with the management of chronic conditions between patient visits. “This approach not only helps patients achieve their therapeutic goals more quickly but also allows providers to focus on more complex cases that require their expertise.”

To establish their value, pharmacies must not only track reductions in hemoglobin (Hb)A1c levels for diabetic patients but also illustrate how these improvements can prevent hospitalizations and lower overall healthcare costs, according to Dr. Galla. She has recently hired a researcher specializing in outcomes and economics to collect, analyze, and validate these metrics.

At Walgreens, pharmacists implemented a patented medication adherence program targeting patients with hypertension, hyperlipidemia, or type 2 diabetes. This initiative achieved adherence improvements of 5.7% to 7.5%, generating estimated savings of $122 per member annually for Medicare beneficiaries (J Manag Care Spec Pharm 2024;30[4]:345-351). Dr. Broadus’s team is also developing healthcare cost avoidance models to showcase the value of clinical management programs across both specialty and non-specialty domains. Areas of focus include enhancing access to HIV testing in collaboration with other organizations, as well as initiatives to boost colorectal cancer screenings and HbA1c testing in conjunction with health plans, aimed at improving metrics like Medicare star ratings.

Utilizing Incident-to Billing for Payments

As pharmacists have not yet achieved universal recognition as providers, some in ambulatory care are employing an incident-to billing strategy to receive compensation. This model allows for billing of services provided in conjunction with a physician, whether in the provider’s office or a patient’s home. However, Dr. Galla cautioned that this approach comes with stringent criteria and serious penalties for improper billing. She pointed out that New York has recently authorized pharmacists to dispense self-administered hormonal contraceptives and administer long-acting injectable medications for mental health and substance use disorders, although reimbursement does not account for the time pharmacists spend evaluating and managing patients.

Looking ahead at the future of specialty pharmacy, Dr. Colaizzi noted that there is a growing pipeline of provider-administered products, presenting another area where pharmacists could play a crucial role. “Getting patients to adhere to their oral medications is challenging enough, let alone requiring them to find a provider for administration of their treatments every week or month,” he said. “Pharmacies are now the primary source of immunizations in this country, and they share a similar vision for medication administration, which will facilitate the introduction of novel products to the market.”

At Mediserv Pharmacy, a local compounding pharmacy located in the Bronx, New York, we recognize the evolving role of pharmacists as essential healthcare providers. We strive to deliver personalized care and innovative solutions to our community. Our team is dedicated to ensuring that our patients have access to the medications and health services they need. As we embrace this transformation in pharmacy practice, we remain committed to enhancing the health and wellness of our customers through our comprehensive services.