When discussing solutions to the problem of primary care shortages, nurse practitioners and physician assistants are top of mind. A law that took effect the first of the year in California is putting the spotlight on another option: pharmacists.
California, like many other states, is trying to handle a growing shortage of primary care providers in the face of an influx of newly-insured residents and an expansion of the state’s Medicaid program. The new law expands the scope of pharmacists and demonstrates how they may increasingly become part of the provider care team in the future. It also may serve as a model for other states as pharmacists become more involved in collaborating with providers and other prescribers.
[See also: Physician shortage could affect 7 million due to ACA insurance coverage expansion]
Among its provisions, the law that Gov. Jerry Brown signed in October establishes an Advanced Practice Pharmacist license that enables pharmacists to perform patient assessments, order and analyze drug therapy tests and participate in the evaluation and management of diseases and health conditions in collaboration with other healthcare providers.
“Acknowledging pharmacists as providers will allow them to provide expanded services to their patients while filling a void that is absolutely critical to ensuring that Californians who will receive insurance through the Medi-Cal program have a place to access that care,” said Jon Roth, CEO of the California Pharmacists Association, in a press release.
A state-licensed pharmacist would have to complete certain advanced training and patient treatment experience, obtain Board of Pharmacy recognition, and meet two of three criteria: Obtain certification in a relevant practice area, such as ambulatory care or geriatric care; complete post-graduate residency with direct patient care experience; and provide clinical services in a collaborative practice with a physician, another advanced practice pharmacist or health system.
“There are so many patients who need help out there that we need to be working with all the other healthcare professionals, with everyone working to the top of their licenses,” said Marilyn Stebbins, PharmD, vice chair of clinical innovation and a faculty member in the University of California, San Francisco’s School of Pharmacy’s Department of Clinical Pharmacy, in an interview posted on the pharmacy school’s website.
"Traditionally, and still right now, community pharmacists have been seen as and paid for delivering a product,” she added. Now, pharmacists can be viewed as providing healthcare services as part of a team, using their medication management skills to improve patient care, and co-managing the patient with the primary provider.
“We believe we are part of the patient healthcare team, and the California expansion of the scope of practice provides more recognition of that and has highlighted what pharmacists can do,” Stacie Maass, senior vice president, Pharmacy Practice and Government Affairs, American Pharmacists Association told Healthcare Finance News.
While California’s new law is bringing attention to expanded practice for pharmacists, it is not the first or only such law, Maas noted. North Carolina and New Mexico have had advanced practices for over a decade, for example.
And pharmacists have had some opportunities to practice in collaborative ways. For instance, pharmacists have been practicing collaboratively and as an essential member of the healthcare team in federal pharmacy programs in the Department of Defense, the Veterans Health Administration and the U.S. Public Health Service, for decades.
Additionally, large retail pharmacies, like CVS Caremark, and their pharmacists have already been building relationships with health systems through exchanging electronic health information and messages about patients’ and tracking whether they have picked up or are adhering to their medications, said Troyen Brennan, MD, executive vice president and chief medical officer of CVS Caremark, while speaking at a recent conference.
“We don’t have claims data, but we have close relationships over time with local primary care programs and offices,” Brennan said. “And increasingly, we’re getting messages from providers and insurers of other things that they want us to do.”