Workshop 3 Medication Access and Adherence: New Partnership - - PowerPoint PPT Presentation

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Workshop 3

Medication Access and Adherence: New Partnership Opportunities for Pharmacists

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Accreditation

Participation in this activity earns 1.25 contact hours. To receive credit, participants must complete an evaluation form at the conclusion of this session.

UAN: 0024-0000-14-008-L04-P

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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

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OPENING REMARKS

Sharon Youmans, PharmD, MPH

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SPEAKER

Sarah McBane, PharmD, CDE, BCPS, FCCP

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

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

August 2012

• Early

Planning Nov 16, 2012

• 1st Task

Force Meeting

Collaboration of 2 state pharmacy

• rganizations (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

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

Nov 2012 – Feb 2013

• Meetings
• Conference calls
• LOTS

Content of legislation

Expanding the scope of pharmacists

Development of SB 493

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

Feb 21, 2013

• SB 493

introduced

Placeholder bill

Part of a legislative package

Development of SB 493

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

Feb 2013 – May 2013

• Meetings
• Conference calls
• LOTS

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

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

May 29, 2013

• Passed

Senate Sept 11, 2013

• Passed

Assembly

Development of SB 493

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

Passed Senate September 12, 2013

August 2012

• Early Planning

Nov 16, 2012

• 1st Task Force Meeting

Feb 21, 2013

• SB 493 Introduced

May 29 2013

• Passed Senate

Sept 11, 2013

• Passed Assembly

Development of SB 493

February 21, 2013 August 2012 May 29, 2013 Planning SB 493 introduced Passed Senate

Passed Assembly

September 11, 2013 Passed Senate September 12, 2013

May 29, 2013

• Passed

Senate Sept 11, 2013

• Passed

Assembly

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
• rganization
• 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

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Questions & Answers

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Closing Remarks