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February 15, 2022

Medicare Beneficiaries in Underserved Areas and Pharmacist Provider Status

James Stevenson
Chief Clinical Officer, Omnicell

Since the beginning of COVID-19, healthcare employment has fallen by 524,000 jobs, resulting in a nationwide shortage of nurses, technicians, and more. A physician shortage is another looming issue.

For years, the United States has been predicting a physician shortage. A 2019 study commissioned by the Association of American Medical Colleges indicates that there will be approximately 139,000 physicians at the end of the decade. As a comparison, that's one-seventh of the current number of physicians. The shortage of primary care physicians (PCPs) is particularly concerning. Currently, the shortage is estimated at 15,000, and that number is expected to reach 55,000 by 2033. 

PCP deserts are areas where people have limited access to physician care – in some places, fewer than one PCP per 3,500 people.

We have seen inequities in healthcare access across the country highlighted by the COVID-19 pandemic. For essential services such as immunizations and diabetes care, people in underserved communities, which are often rural, must travel far from home. Even though local pharmacists already provide these services to commercially insured populations, Medicare Part B does not directly reimburse pharmacists.

To close this gap, Congress is considering bipartisan legislation known as the Pharmacy and Medically Underserved Areas Enhancement Act. This bill would allow pharmacists to be reimbursed as healthcare providers for treating Medicare beneficiaries in underserved areas. Provider status would enable pharmacists to provide services permitted by state pharmacy practice acts and in collaborative agreements with physicians.

If granted provider status, pharmacists in health systems and community pharmacies would have a significant financial incentive to devote more time to clinical and patient-oriented activities in outpatient and retail settings. As providers, the 250 to 300 retail clinics currently operating in medically underserved areas have a more significant opportunity for expansion and growth. Additionally, it will enhance the quality of patient care and employment satisfaction of pharmacists while fairly compensating them.

Research shows that pharmacists improve health outcomes and reduce health care costs significantly.

  • A pharmacist administers immunizations, measures blood pressure and cholesterol, performs foot checks for patients with diabetes, provides smoking cessation products, and screens for depression, among several other services. Pharmacists can also perform point-of-care testing for blood glucose, cholesterol, influenza, strep, COVID-19, and more.
  • By educating and counseling patients, pharmacists can help them to keep healthy while reducing the cost burden on payers. Using medications correctly, managing ineffective medications, and identifying more affordable options are a few benefits pharmacists can provide.

By making pharmacists providers, reimbursements would be aligned with the services pharmacists are trained to provide, and underserved patients would have better access to critical care.

Nearly 90 percent of the population lives within five miles of a pharmacy in the United States today, with approximately 60,000 pharmacies in total. Despite being easily accessible and ready to assist, pharmacies cannot sustainably treat patients without Medicare reimbursement.

I recently had the opportunity to talk with Scott Knoer, MS, PharmD, FASHP, Executive Vice President and Chief Executive Officer, American Pharmacists Association, and Snehal Doshi, PharmD, MBA, Senior Vice President, Ancillary and Support Services, Wellstar Health System, about this important legislation. You can watch our discussion in this recent Scottsdale Institute webinar on-demand to learn more about how pharmacist provider status can positively affect critical care needs for Medicare beneficiaries and underserved areas.

      The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.