What is SB 493?
California Governor Edmund G. Brown signed SB 493 into law on October 1, 2013, and it took effect on January 1, 2014. SB 493 recognizes pharmacists as health care providers and views them as a member of the health care team. California’s primary care provider shortage will only worsen in the upcoming years and SB 493 addresses this issue by authorizing pharmacists to expand their roles and provide health care services. This bill aims to empower pharmacists and improve patient access to health care. It will also create new reimbursement opportunities, as payers will recognize how important pharmacy services are in improving patient outcomes.
SB 493 authorizes pharmacists to:
Provide education, consultations, and training on drug therapies as well as disease management and prevention
Participate in multidisciplinary review of patient progress
Furnish hormonal contraceptives, medications not requiring diagnosis such as for travel, and prescription nicotine replacement products for smoking cessation
Independently initiate as well as administer immunizations and give prescribed medications by injection
Order and interpret tests to monitor and manage how effective or toxic drug therapies may be
SB 493 establishes an Advanced Practice Pharmacist (APP) category and authorizes them to:
Perform patient assessments
Order and interpret drug therapy-related tests
Refer patients to other health care providers
Initiate, adjust, or discontinue drug therapy as long as they notify the diagnosing prescriber
Collaborate with other health care providers to evaluate and manage diseases and health conditions
What Do Pharmacists Think of SB 493?
The following are opinions from community and hospital pharmacists:
Reggie Singh, Independent Pharmacy Owner and Pharmacist
“SB 493 is a pivotal moment in pharmacy history. It will open up a new career avenue to pharmacy profession. No longer will we be bound to the brick and mortar pharmacy, clinical hospital pharmacy, nuclear pharmacy, or specialty pharmacy setting only. Now we can work as a midlevel provider and bill for services. Pharmacy consulting was always unpaid, but this is the turning point that will change that and pave the way for billing for cognitive services. Being recognized as a provider is the first step in making this all come true.”
Janet Evans, Community Pharmacist Manager
“In theory, it sounds great and I wish as a retail pharmacist that I could believe that proper staffing would ever be reached so that these functions could be preformed with the appropriate amount of patient care. However, the reality is there will never be enough staffing to actually preform these functions. At times, I barely have enough time to fill all the scripts in front of me, give flu shots, and take a bathroom break.”
Chuck Mills, Hospital Pharmacist Director
“It would appear that the crafters of this bill are sensing the deficiency that we will have in practitioners and the urgent need we have to educate patients for prevention of disease rather than treating the disease after the fact. What we need are comprehensive skills and a training course for those pharmacists who want to pursue this type of patient interaction.”
Thien Nguyen, Hospital Pharmacist Director
“I think it is just a step to officially recognize the pharmacist’s role. Pharmacists have been working with physicians as a provider/prescriber for years so it will not change much of the reality of the pharmacist’s role, but now we are able to bill directly to Medicare instead of under a physician’s name. So nothing is new, just now we have a name to call it.”
Why is Provider Status Important?
The improvement of health outcomes is important in the health care system and proper use of medications is necessary to make this happen. In 2009, it cost the health care system $1.7 trillion to treat chronic conditions and almost $290 billion from inappropriate medication use. Pharmacists have the education and training in medications for prevention, treatment, and management of disease conditions and contribute greatly as part of the health care team.
US States that Recognize Pharmacists as Providers
According to the National Alliance of State Pharmacy Associations (NASPA) there are 34 states in the US that recognize pharmacists as providers and majority of them do so through their state law. However, in a couple of states, pharmacists are recognized in their Medicaid provider manual but not within state statute. In at least 28 states, state or private payers cover pharmacist patient care services. There are 15 states that pay for services through their Medicaid program and 6 states have a state employee MTM benefit. In at least 6 states, pharmacists are not recognized as providers, but they are compensated for targeted services.
Barriers to Provider Status
The following are some barriers that prevent the recognition of pharmacists as health care providers:
Congress is focused on issues related to the nation’s spending and other issues which adds difficulty to moving provider status legislation
Decision makers are focused on initiatives that save money instead of those that require new spending
Members of Congress often associate provider status with the “fee-for-service” payment model and instead, may engage in new delivery and payment models
There is a strong focus on minimizing health care costs and organizations must demonstrate the value of pharmacist patient care services on the health care system in order to achieve legislative success
Other health care providers who have provider status and bill Medicare may strongly oppose the pharmacy provider status initiative
The majority of health conditions are treated with prescription medications and pharmacists are experts when it comes to drugs. Not only does SB 493 designate pharmacists as a crucial member of the care team, but also attaining provider status helps improve patient access to pharmacy services and health care. Pharmacists will be able to consistently deliver patient care based on their education, training, and certification. Seeing how pharmacy services improve patient outcomes result in greater job satisfaction among pharmacists; Now they will be recognized for the value they bring to patients and the health care team.
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