Ohio pharmacists gain ground with expanded CPAs

Ohio pharmacists will soon be able to offer direct patient care services under the expansion of collaborative practice agreements (CPAs) with physicians.

The bill

Last month, the Ohio House and Senate passed legislation that allows pharmacists practicing under CPAs with physicians to establish an agreement with multiple physicians to manage drug therapy for multiple patients, thus streamlining the CPA paperwork process.

In addition, under a CPA, pharmacists will be able to order laboratory tests for patients and then modify drug therapy on the basis of the test results.

The bill also gives pharmacists with or without a CPA the authority to dispense an emergency refill for patients who run out of life-sustaining medication.

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Antonio Ciaccia"Within the [collaborative practice] agreement, the doctor can empower the pharmacist to order blood and urine tests, analyze the results of those tests, and then make actual clinical decisions based upon the results of those tests," said Antonio Ciaccia, director of government and public affairs, Ohio Pharmacists Association (OPA), Columbus, Ohio. "Pharmacists can remove drugs, modify drugs, and add entirely new drugs from the drug therapy regimen."

Team effort

It took approximately seven years for the legislation to garner enough support for passage, with the help of the OPA, the Ohio Society of Health System Pharmacists, and the Ohio State Medical Association, said Ciaccia.

The key supporters of the Senate version of the bill (S. 141) were Sen. Dave Burke, a pharmacist and pharmacy owner from Marysville, Ohio, who developed much of the initial language of the bill, and Sen. Gayle Manning who favored the emergency dispensing and emergency refill provision within the legislation.

Rep. Nathan Manning, son of Gayle Manning, and Rep. Stephen Huffman, a physician, produced the House version of the bill (H.B. 188).

"This bill is a game-changer for all pharmacy practice settings. The opportunities for pharmacists to offer more hands-on services as vital members of the healthcare team have never been greater. Doctors, health plans, plan sponsors, and patients can all benefit from the expanded powers granted to pharmacists in this bill," said OPA Executive Director Ernest Boyd, in a statement posted at the OPA website.

Reimbursement

The legislation was signed into law on December 22 by Ohio's Governor John Kasich. Next it will be subject to promulgation of rules from the Ohio State Board of Pharmacy, which takes about 90 days, according to Allen Nichol, PharmD, COO and vice president of clinical operations at CeutiCare Inc.

Allen Nichol"After the rules have been promulgated, multiple things need to be worked out. The pharmacy benefit management company will have to be able to recognize pharmacists within their system, so that the claim can be adjudicated under the pharmacist's name," said Nichol, who has volunteered to be part of the board of pharmacy's rules committee for this legislation.

Provider recognition

In order to get paid for patient care services under the new law, pharmacists will need to be recognized as providers by insurance companies. Nichol initiated discussions with insurance companies recently about becoming a provider with the same statutory authority as a physician's assistant or nurse practitioner. A few insurance companies that he contacted were not aware that the law had passed.

"They said that this will take some time. They are not prepared, so I think it is going to take months [before pharmacists will be recognized as providers in Ohio under CPAs]," Nichol told Drug Topics.

Last May, Washington state passed legislation to enroll its pharmacists as network providers in all commercial healthcare insurance plans. The health insurance companies are mandated to pay for patient care services provided by pharmacists within the pharmacist's scope of practice, Nichol said.

"The payment piece [of the Ohio bill] will have to be negotiated, as opposed to what Washington state did, where they had to pass a separate law for that," he said.

"Eventually insurance companies [in Ohio] will have to come around," Nichol said. "If these [direct patient care] services [by pharmacists] are provided, ostensibly you would have fewer emergency department visits and fewer hospitalizations of patients who have chronic diseases."