Advocating for Independent Community Pharmacies on Federal and State Levels

This article was written in partnership with AmerisourceBergen and Good Neighbor Pharmacy.

Many of the challenges that independent pharmacies have faced for years have become even more apparent during the coronavirus disease 2019 (COVID-19) pandemic, highlighting the need for action in several legislative areas.

During ThoughtSpot 2020, Good Neighbor Pharmacy’s annual independent community pharmacy conference and trade show which is being held virtually this year, Bob Mauch, PharmD, RPh, Executive Vice President and Group President of AmerisourceBergen, and Beth Mitchell, Senior Director of Government Affairs for AmerisourceBergen, talked with Drug Topics® about the importance of advocacy during this time and the legislative priorities that independent pharmacists should keep an eye on for the future. 

The COVID-19 pandemic has highlighted areas of needed legislation that can benefit pharmacists, their businesses, and their patients. To keep their pharmacies viable during this time, pharmacists can continue to advocate on both federal and state levels to address specific issues that would affect them and their patients. Since March, AmerisourceBergen and Good Neighbor Pharmacy (GNP) have met with more than 300 federal and state legislators and staff through video and phone calls, continuing to make an impact on pharmacy policy priorities amid COVID-19.

Expanded Immunization Authority

The Department of Health and Human Services’ (HHS) just authorized pharmacists to order/administer COVID-19 vaccinations (once available) to persons age 3 and older. In August, HHS also authorized state-licensed pharmacists to order/administer all CDC recommended and FDA approved vaccines for children ages 3-18, aiming to ensure stronger vaccine access for children during the pandemic.HHS was able to authorize this under the Public Readiness and Emergency Preparedness Act and both measures ensure stronger vaccine access for individuals in the US. The authorizations also aim to preempt state and local laws that prohibit or effectively prohibits those who satisfy requirements from ordering or administering vaccines. 

“This news is a huge win, but we’re still pushing for more,” Mauch told Drug Topics®. “These actions are certainly good steps in the right direction and they show that the government is thinking about the important role that pharmacists and community pharmacy can play in the immunization process, but it should be much more broad, frankly to include empowering and reimbursing pharmacists for providing immunizations and other services to patients during and beyond COVID-19.”

In addition, several questions remain about how pharmacists will be reimbursed by payers for this service. Mauch noted that GNP and AmerisourceBergen will continue to work with manufacturers and pharmacy partners in several pharmacy trade associations and the American Disease Prevention Coalition to monitor these concerns. 

Mitchell noted that the HHS announcements are positive developments for both patients and pharmacists, but improvements are still needed. “We’ve got to do more,” she said. “We have to think about how we need as many access points for all vaccinations as possible. Pharmacists are so well positioned to do this.”

On the state level, more legislation is being passed to provide pharmacists the authority to administer FDA-authorized COVID-19 vaccines to eligible individuals, once a vaccine becomes available. Minnesota became the first state to pass this kind of legislation, with Minnesota Governor Tim Walz signing the comprehensive bill into law on May 27. Several states, such as New York and New Hampshire, are now following suit.

Mitchell noted that pharmacists should continue to encourage their own state legislatures in support of legislation to authorize and reimburse pharmacists to administer vaccines. 

Provider Status

According to Mauch, national leaders must recognize pharmacists as providers under Medicare Part B, not only to assist the response to COVID-19, but to support public health initiatives going forward.

Pharmacists’ ability to care for patients, either through administering immunizations or flu tests, varies by state, service, and payer type. Pharmacists are not currently recognized as providers in Medicare, and it is the hope that if Congress establishes pharmacists as providers in Medicare, other states and payers will follow.

In 2019, 147 state provider status-related bills were introduced in state legislatures aiming to expand the scope of pharmacy practice, payment for services and/or designation of pharmacists as providers in Medicaid and/or commercial plans. Last year, Idaho granted pharmacists prescriptive authority, representing a step in the right direction.

“It starts with the patient and making sure they are well cared for, and it moves back to the pharmacist, and the pharmacy, and them being able to bill Medicare for the services that they provide,” Mauch said in the interview. “With the need for millions of immunizations to be given rapidly once a COVID-19 vaccine becomes available, the role of pharmacists is going to become even more critical.” According to Mauch, provider status on a broad level that allows pharmacists to bill for these types of clinical services is necessary, both as we continue to manage the current pandemic and in the long term for chronic disease management.

Mitchell noted that although progress is being made on the issue, there is still much more that needs to be done through legislation and/or additional regulatory pathways. AmerisourceBergen and Good Neighbor Pharmacy are working with several pharmacy associations and allies to advocate for emergency-based pharmacist provider status in Medicare Part B.

“The legislation we’re working on now would require Medicare to recognize pharmacists as providers in Part B, and pharmacists would be reimbursed for services they provide during the pandemic,” such as a COVID-19 and flu tests and COVID-19 and flu vaccinations, Mitchell said.

According to Mitchell, pharmacists should stay engaged with their elected officials and state and national pharmacy associations to keep advocating for change.

Direct and Indirect Remuneration (DIR) Fee Reform

DIR fees are one of the biggest challenges facing community pharmacy right now, Mauch said. Currently, there is legislation in Congress that aims to eliminate DIR fees.

“While the pharmacist’s primary focus is on providing clinical services to their customers and their patients, they also have to have an economically viable business,” Mauch said. DIR fees can cause delays or uncertainty in payments, destabilizing the viability of the pharmacy, and patient access to medications.

“We’re continuing to educate our elected officials on the importance of this issue,” Mitchell said. “Some elected officials have concerns that if DIR fees were to be passed on at the point of sale, that Medicare beneficiaries would see changes in premiums.” 

However, patients currently struggle with the consequences of DIR fees and a lack of transparency in the industry. Mitchell cited a recent CoverMyMeds survey that found that 75% of patients received a prescription that cost more than they expected, indicating that these punitive fees are harming both pharmacies and patients.

“We’re really trying to help pharmacists and patients see some relief on this issue,” Mitchell added. “I think it’s so important now because we are living in the current pandemic and we want to make sure pharmacists don’t have additional pressures facing their business and their patients.”

Other Areas to Watch

Pharmacists should also watch for a future COVID-19 stimulus or response legislation in Congress, Mitchell said. Congress has passed several major pieces of legislation over the last several months that have been enacted and signed into law. “Many of those bills have been beneficial for small businesses, including independent pharmacies,” said Mitchell, including programs such as the Paycheck Protection Program and other small business loans.

In an effort to move advocacy efforts forward, AmerisourceBergen and GNP continue to partner with a number of industry coalitions, state pharmacy associations, and boards of pharmacy to advance key issues in the increasingly contested legislative environment. Pharmacists can also get involved at both the state and federal levels to help propel advocacy on issues that are important to them.

“I think the best organization we partner with to promote advocacy are our customers and pharmacists who really take the time to get engaged,” she said. “I think our customers and pharmacists have the most impactful voice on legislative issues they care about, especially since they are providers and leaders in their communities. Elected officials want to hear from their constituents, especially those who are providing care to their constituents.”