As Health Care Providers, Pharmacists Must Advocate for What They Need and What Patients Deserve

The last year has included a number of legislative and regulatory advancements and wins for the pharmacy industry: The Centers for Medicare and Medicaid Services (CMS) finalized their Medicare Part D rule,¹ set to require Part D plans to include pharmacy price concessions (commonly referred to as direct and indirect remuneration (DIR) fees) in negotiated price at point of sale, and that is scheduled to take effect in 2024. The bipartisan Pharmacy Benefit Manager Transparency Act of 2022² was introduced by United States Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA). But perhaps most important for the future of the pharmacy profession was the introduction of the bipartisan HR 7213, the Equitable Community Access to Pharmacist Services Act.³

As founding members of the Future of Pharmacy Care Coalition, AmerisourceBergen and Good Neighbor Pharmacy have come together with peers across the industry, “working collaboratively to establish and craft new legislation to permanently recognize pharmacists as providers to be reimbursed through Medicare for clinical services related to COVID-19 and other respiratory illnesses,” explained Beth Mitchell, senior director of government affairs at AmerisourceBergen. “Having this bill introduced is a notable legislative development.”

HR 7213 was introduced on March 24, 2022 by United States Representatives Ron Kind (D-WI), David B. McKinley (R-WV), Earl L. “Buddy” Carter (R-GA), and Nanette Diaz Barragán (D-CA).^3,4 The goal of the bill is simple: to “ensure patients’ continued access to pandemic-related care services provided by pharmacists, including services to keep communities safe from COVID-19 and future public health crises.” To date, Mitchell said, there are more than 40 bipartisan Members of Congress who have cosponsored the bill. For those not yet engaged, Mitchell, AB’s public affairs group and the Future of Pharmacy Care Coalition are working to educate Members of Congress, federal agencies and the Administration to garner support for the legislation.

In addition to 42 bipartisan United States Representatives, HR 7213 is supported by organizations from the American Red Cross and the National Association of Black Nurses to the National Community Pharmacists Association, the National Association of Chain Drug Stores, the American Pharmacists Association, and state pharmacy groups. More than 80 organizations representing patients, seniors and rural Americans support HR 7213.

“As healthcare evolves, pharmacists are going to be an integral piece of providing clinical patient services,” Mitchell explained. “COVID-19 has shown pharmacists are accessible and more than capable of providing this level of clinical care to their communities.”

“With the flexibilities that the COVID-19 Public Health Emergency and the PREP Act declarations have afforded pharmacists, we [AmerisourceBergen and Good Neighbor Pharmacy] have pharmacy customers who are currently providing COVID-19 vaccines, tests, and treatment, such as monoclonal antibodies and antivirals used to treat COVID-19. Now, we’re also seeing some of our stores get tapped by their local healthcare jurisdictions to help roll out Monkeypox vaccines,” she added. “We’ve administered more than 6 million doses of COVID-19 vaccine shipped to nearly 1700 Good Neighbor Pharmacies across the country; without pharmacists, we would not be where we are in terms of the country’s response to this pandemic.”

Once the COVID-19 public health emergency ends and the PREP Act declarations ultimately expire, the flexibilities currently afforded to pharmacists are “at risk of going away,” Mitchell said. To avoid that, it’s crucial to have legislation introduced and enacted at the federal level ensuring that pharmacists are recognized as health care providers with the ability to provide critical clinical care and receive Medicare reimbursement for services related to testing, immunizations, and treatment for COVID-19, influenza, strep throat, and RSV.

One additional benefit of HR 7213? If enacted, the bill would also “give the Secretary of Health and Human Services the ability to, if a future public health emergency comes to fruition, call on pharmacists, again,” said Mitchell, enabling them to provide critical timely support.

“That’s what the bill is seeking to do,” said Mitchell. “Give pharmacists the permanent ability to provide clinical care services related to COVID-19 and other respiratory illnesses, and then to be reimbursed by Medicare for those services. All of that ultimately leads to improving health equity and making sure patients have access to care at their pharmacy in an effective and timely way.”

An Independent Focus

Although the COVID-19 pandemic brought to light the importance of health care providers across the practice spectrum, a bright light has been cast on independent pharmacists, a group that rolled up their collective sleeves and went above and beyond to continue caring for patients in their communities. This spotlight, Mitchell said, has led to a number of regulatory changes that have directly impacted the way independent pharmacists practice.

At the height of the pandemic, a slate of bipartisan Congressional COVID-19 response bills, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act,⁵ were passed and signed into law; these federal laws included significant provisions to make funding available at CMS to reimburse pharmacists for care provided. Put together with regulatory actions like the PREP Act and its subsequent amendments,⁶ independent pharmacists found themselves providing more care and services than ever before.

But, Mitchell said, “We need Congress to advance impactful bills such as HR 7213. I think a lot of people are having COVID-19 fatigue, including Members of Congress and key officials and federal agencies,” she explained. “Regardless of that, we must continue to advocate for long-needed and permanent changes, and remind lawmakers of the patient care that pharmacists continue to carry out in their communities.”

One way to encourage this Congressional action is by capitalizing on the momentum surrounding each legislative and regulatory victory.

“It’s important for citizens, pharmacists, pharmacy technicians, store managers, [and] patients…to be a part of the process and to be involved,” Mitchell explained. “I love what I do, because I get to be an advocate for our customers and for our company, but meaningful change happens when people and groups come together to advocate on a common issue of importance.”

For pharmacists and pharmacy technicians, that might look like inviting their member of Congress to visit their pharmacy, showing them in real time how independent pharmacists help their communities. Mitchell also encourages pharmacists to learn more about HR 7213 and to ask their Member of Congress to cosponsor the legislation; AmerisourceBergen’s Our Independent Voice platform is one available resource, she noted, which includes a Take Action page that facilitates pharmacists contacting their member of Congress.

Jennifer Shannon, PharmD, BCPS, owner of Lily’s Pharmacy in Johns Creek, Georgia and a member of the Good Neighbor Pharmacy network, never thought she’d be an advocate for anything. “When we opened our pharmacy, someone told me, ‘You’ll be at the table very quickly when your patients can’t access medicine,’” she said. Shannon took the stage during General Session at ThoughtSpot 2022 to discuss the future of pharmacy in the context of legislative advocacy work.

“Each of us building local relationships will ultimately help expand our scope [of practice],” Shannon said. “Federally, we are working on getting provider status. I really feel that working in your own communities – reaching out to our local and state legislators – will be the key to expanding our collective scope. It is incredibly important and will continue to help demonstrate what we’re doing [to lawmakers].”

Mitchell also underscored the urgency and importance of pharmacists achieving provider status and how that will improve health equity. “Once the current assortment of federal and state pandemic response flexibilities expire, the last thing anyone would want is for a patient to walk into a pharmacy and not be able to get the care they need from their pharmacist, such as a COVID-19 test,” she said. “That precedent has already been set, and that’s part of our message too. You can’t just turn the lights off.”

For her part, Shannon is optimistic about the potential passage of HR 7213 and looking forward to the ways its enactment will improve pharmacy practice for the better.

“There are a lot of things that were ‘if’s’ a few short years ago that became ‘now’s—our new reality” she explained. “It wasn’t too long ago that pharmacists couldn’t give vaccinations; it wasn’t too long ago that nobody knew what a PBM was.

“I always worry what would happen [to the people we take care of] if we weren’t here,” she added, “but I know we’ll be here because there are so many people advocating on our behalf, when some of us have trouble saying what we need or communicating what we do. We all have to work to share our voice and our story, and to not be afraid.”

To learn more about AmerisourceBergen’s commitment to advocacy on behalf of independent pharmacies across the United States, visit Our Independent Voice.

References

1. AmerisourceBergen commends the introduction of S. 1909 & H.R. 3554, the Pharmacy DIR Reform to Reduce Senior Drug Costs Act, in Congress. AmerisourceBergen. Published June 8, 2021. Accessed August 12, 2022. https://www.amerisourcebergen.com/newsroom/media-statements/amerisourcebergen-commends-the-introduction
2. Key U.S. Senators introduce PBM legislation requiring transparency and prohibiting deceptive practices. Our Independent Voice. Published May 27, 2022. Accessed August 12, 2022. https://www.ourindependentvoice.com/latest-updates/news-item/2022/05/27/key-u.s.-senators-introduce-pbm-legislation-requiring-transparency-and-prohibiting-deceptive-practices
3. H.R 7213 - Equitable Community Access to Pharmacist Services Act. 117th Congress (2021-2022). Accessed August 12, 2022. https://www.congress.gov/bill/117th-congress/house-bill/7213
4. Media statement and quotes on the Equitable Community Access to Pharmacist Services Act. AmerisourceBergen. Published March 25, 2022. Accessed August 12, 2022. https://www.amerisourcebergen.com/newsroom/media-statements/media-statement-and-quotes-on-the-introduction-of-hr-7213
5. S.3548 – CARES Act. 116th Congress (2019-2020). Accessed August 12, 2022. https://www.congress.gov/bill/116th-congress/senate-bill/3548/text
6. Seventh amendment to declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID-19. Public Health Emergency. Reviewed March 12, 2021. Accessed August 12, 2022. https://www.phe.gov/Preparedness/legal/prepact/Pages/PREP-Act-Guidance.aspx