Workshop 3 Medication Access and Adherence: New Partnership Opportunities for Pharmacists #XUDisparitiesCollabs
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Accreditation UAN: 0024-0000-14-008-L04-P Participation in this activity earns 1.25 contact hours. To receive credit, participants must complete an evaluation form at the conclusion of this session. #XUDisparitiesCollabs
At the completion of this activity, participants will be able to: • Describe partnership opportunities for pharmacists as a result of the implementation if the Affordable Care Act; • Discuss innovative strategies used to broaden the scope of pharmacy practice; • Discuss strategies that pharmacists have used to create interprofessional partnerships (including the patient) and create new models of care; and • Examine the current external and internal factors impacting pharmacists receiving provider status for reimbursement. • Discuss methods used to evaluate and document patient outcomes #XUDisparitiesCollabs
Sharon Youmans, PharmD, MPH OPENING REMARKS #XUDisparitiesCollabs
Sarah McBane, PharmD, CDE, BCPS, FCCP SPEAKER #XUDisparitiesCollabs
The Impact of Current Pharmacy Legislation: California SB 493 Sarah McBane, PharmD, CDE, BCPS, FCCP Health Sciences Associate Clinical Professor
Objectives • Describe the strategy used in California to broaden the scope of pharmacy practice • Examine current factors impacting pharmacists’ reimbursement for their services
WHY NOW?
Healthcare Provider Workforce Gap in California • 2014: nearly 5 million additional Californians with healthcare coverage • Only 16 of 58 counties have sufficient primary care doctors
Development of SB 493 August 2012 Nov 16, 2012 August September September February May 29, • 1 st Task • Early 2012 11, 2013 12, 2013 21, 2013 2013 Planning Force Meeting SB 493 Passed Passed Passed Planning Assembly introduced Senate Senate Collaboration of 2 state pharmacy organizations (CPhA and CSHP) Identified a legislative champion
Development of SB 493 – Legislative Champion • "Pharmacists are vastly underutilized for the amount of training and education they receive“ - Senator Ed Hernandez (D)
Development of SB 493 Nov 2012 – Feb 2013 August September September February May 29, 2012 • Meetings 11, 2013 12, 2013 21, 2013 2013 • Conference calls SB 493 Passed Passed Passed • LOTS Planning Assembly introduced Senate Senate Content of legislation Expanding the scope of pharmacists
Development of SB 493 Feb 21, 2013 August September September February May 29, 2012 11, 2013 12, 2013 21, 2013 2013 • SB 493 introduced SB 493 Passed Passed Passed Planning Assembly introduced Senate Senate Placeholder bill Part of a legislative package
Development of SB 493 Feb 2013 – May 2013 August September September February May 29, 2012 • Meetings 11, 2013 12, 2013 21, 2013 2013 • Conference calls SB 493 Passed Passed Passed • LOTS Planning Assembly introduced Senate Senate Content of legislation Negotiation
Development of SB 493 – Legislative Champion • Examples of “gives” • Prescribe v furnish • Physical assessment v patient assessment • Psychoactive tobacco cessation therapies
Development of SB 493 August September September February May 29, May 29, 2013 Sept 11, 2013 2012 11, 2013 12, 2013 21, 2013 2013 • Passed • Passed SB 493 Passed Passed Passed Planning Senate Assembly Assembly introduced Senate Senate
Development of SB 493 August 2012 • Early Planning August September February May 29, 2012 12, 2013 21, 2013 2013 Nov 16, 2012 • 1 st Task Force Meeting SB 493 Passed Passed Passed Planning Assembly introduced Senate Senate Feb 21, 2013 • SB 493 Introduced May 29 2013 • Passed Senate Sept 11, 2013 • Passed Assembly
Development of SB 493 August September September February May 29, May 29, 2013 Sept 11, 2013 2012 11, 2013 12, 2013 21, 2013 2013 • Passed • Passed SB 493 Passed Passed Passed Planning Senate Assembly Assembly introduced Senate Senate
Oc October er 1, 1, 2013 13
WHAT’S IN SB 493?
SB 493 • Allows pharmacists to furnish prescription: • Travel medicines • Self-administered hormonal contraceptives • Smoking cessation products • Allows pharmacists to order and interpret tests • Allows pharmacists to initiate and administer ACIP- recommended vaccines (age 3 and over) • Declares pharmacists as health care providers • Establishes Advanced Practice Pharmacists
Advanced Practice Pharmacists • Perform patient assessments • Order and interpret drug therapy–related tests • Refer patients to other health care providers • Participate in the evaluation and management of diseases in collaboration with other health care providers • Initiate, adjust, or discontinue therapy
Advanced Practice Pharmacists • Actively licensed in California • Satisfy two of the following: • Earn certification in a clinically relevant area from a recognized organization • Have completed a residency focused on patient care • Have provided clinical services to patients for at least 1 year in collaborative practice or protocol
Advanced Practice Pharmacists • Broader scope of practice • No need for direct supervision • Order any test necessary to monitor drug therapy • Facilitate additional care through referrals
Advanced Practice Pharmacists • Expanded setting • Not limited to health care facilities • Clinics • Community settings
Recognition as Healthcare Providers • Facilitates reimbursement
Reimbursement in California • Experts in practice and reimbursement discussing implications of provider status (nothing in the legislation mandates $$$)
Reimbursement and Provider Status • 34 states have some recognition • Provider v practitioner • 28 states where pharmacists are reimbursed for non-dispensing services • 6 states without any formal provider recognition Weaver K. NASPA finds provider status is wide- spread, but not necessarily linked to payment. Pharmacy Today. February 2014.
Reimbursement and Provider Status • Lack of correlation • No Federal recognition • Many payers follow CMS/SSA precedent • Ongoing efforts of national organizations Weaver K. NASPA finds provider status is wide- spread, but not necessarily linked to payment. Pharmacy Today. February 2014.
Factors Impacting Reimbursement • Creativity of pharmacist • Marketing services • Willingness of payer • Regulatory opportunity • Insurance code • Other state codes • Medicaid recognition • Other payers
Presentation adapted from materials developed by: Sarah McBane, PharmD, CDE, BCPS, FCCP University of California, San Diego Daniel Robinson, PharmD, FASHP Dean College of Pharmacy, Western University of Health Sciences *with permission
Questions & Answers #XUDisparitiesCollabs
Closing Remarks #XUDisparitiesCollabs
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