http://wnpr.org/post/california-women-can-soon-go-right-pharmacist-birth-control#stream/0
The way this law reads.. the legislator in California has given Pharmacists limited prescriptive authority without provider status.. since insurance/Medicaid is not obligated to pay Pharmacists for prescribing services. Of course, the state funded Medicaid program could be one of the largest beneficiaries of not having to pay for doctor’s office visit at least once a year to give a woman a Rx for birth control meds. I am sure that the pharmacy chains will embrace this new capacity for Pharmacists… their employed Pharmacists, I suspect, will not share their enthusiasm. Maybe they just “won’t be comfortable” in doing this ?? Note that Pharmacists are required to have special licensing and CE requirements.. another REVENUE STREAM for the state of CALIFORNIA.. a sure win-win for the state.
Think of how often you stop by Walgreens or CVS. You run in and grab some Band-Aids or restock your ibuprofen supply. Maybe you even get a flu shot on your way to work.
Soon, it will be that easy for women in California to get birth control, too. Under a new state law, women will be able to go to a pharmacy, get a prescription for contraceptive pills, the ring, or the patch, get it filled and walk out 15 minutes later.
“For a woman who can’t get in to see their doctor, the pharmacist will be able to furnish that for them now,” says Lisa Kroon, a professor at University of California, San Francisco’s school of pharmacy who oversees students who work at the Walgreens store on campus.
That pharmacy will be one of the first to take advantage of a new law in California allowing pharmacists to prescribe hormonal contraception. The law, SB 493, was passed in 2013. State health officials are now finalizing the regulations for the law to take effect. The California pharmacy board met Thursday to review them. The law is expected to be fully implemented later this year.
But the law goes beyond birth control pills. It also authorizes pharmacists to prescribe medications for smoking cessation and travel abroad. Pharmacists can administer routine vaccinations to children ages 3 and older. They can even order lab tests and adjust drug regimens for patients with diabetes, hypertension, or other conditions. Kroon says the idea is to make it easier on patients.
“Maybe a working parent can now come after work because the pharmacy is open later,” she says.
The law was passed amid growing concern about doctor shortages. As more baby boomers hit age 65, and millions of people get health coverage under the Affordable Care Act, there aren’t enough primary care doctors to go around.
Advocates says California is the first state to recognize that pharmacists can help fill the gap.
“The pharmacist is really an untapped resource,” Kroon says. “We are graduating students that are ready for this, but the laws just haven’t kept up with what the pharmacist training already is.”
But there’s a big drawback for pharmacists. Now they can perform all these services once reserved for the doctor’s office. But, they won’t get paid for the extra time it takes to provide them.
The law does not compel insurance companies or Medi-Cal, the state’s version of Medicaid, to reimburse these services, says Jon Roth, CEO of the California Pharmacists Association.
In the long run, Roth says the law could ultimately save money, because reimbursement rates for pharmacists will inevitably be lower than what doctors charge.
“We are working to try and identify where it makes sense to pay pharmacists as opposed to other more expensive providers in the health care delivery system,” he says.
Pharmacists’ growing power has some physicians bracing for a turf war. The California Medical Association opposed an early version of the law, citing patient safety concerns. It later withdrew its opposition after lawmakers added a special licensing procedure and continuing education requirement for pharmacists.
Still, some doctors are concerned that if women don’t come to the clinic for their birth control, they won’t get screened for cervical cancer or tested for sexually transmitted diseases.
“Family planning for women is often an access point to assessing other health issues,” says Amy Moy, vice president of public affairs for the California Family Health Council, an advocacy group that supports the law. “Women accessing birth control through the pharmacist would be faster and more convenient. But they will also not have the comprehensive care available in another health care setting.”
Studies of women living on the border of Texas and Mexico found that women who get their birth control over the counter in Mexican pharmacies are less likely to go to the doctor for other preventive care, compared with women who get contraception at clinics. But women at the clinics were also more likely to stop using their birth control, in part because of having to schedule a doctor’s visit to get it.
Moy’s group and other women’s advocates say the benefits of improving access to birth control and reducing unintended pregnancies are critical to women’s health and outweigh the potential risks.
Pharmacy professor Kroon says the plan is for pharmacists to communicate regularly with patients’ doctors. “We are not a lone ranger out there doing something,” she says.
If things go well with the pharmacists law, it could bode well for efforts to expand the scope of practice for other health care practioners. Sen. Ed Hernandez, who led the effort on the pharmacist law, has also proposed bills to increase authority for nurse practitioners and optometrists. Both are working their way through the legislature.
Other states are watching California to see how the pharmacist law plays out. Lawmakers in Oregon and in Congress are considering similar laws.
“They are all watching what happens in California,” Kroon says.
This story is part of a reporting partnership with NPR, KQED and Kaiser Health News.
Filed under: General Problems
I have always heard that it was questionable ethical for the prescriber to also dispense out of their office.. many – including pharmacists – have always questioned that practice and its ethics.. Now we are going down that same path and all of sudden there is no ethical conflict ? Of course, the PBM’s will be establishing more step therapy protocols.. so we may not really have a choice of what to prescribe.. Will be fall into the trap of the best outcome for the lowest price med… because of the lunacy of the PA process.. or will we try to best serve the pts and fight the PA process to help the pt realize the best outcome and in some incidents.. the best quality of life.. IMO.. there are a lot of healthcare setting where Pharmacists can be part of the a healthcare team.. I don’t see it happening in the community setting.. at least not the chain stores.. maybe the independents
Steve, I believe that it would take congressional approval for pharmacist to bill Medi-Cal, California’s version of Medicaid. That’s why there is such a push for provider status so pharmacists can bill Medicaid and Medicare.
I believe that California’s has done a wonderful thing, in allowing pharmacist to practice in baby-steps to the full extent of their training. In my opinion provider status, is the salvation to the pharmacist glut and it will provide better working conditions too.
Maybe I am a little less idealist about this issue.. I can remember when Wm Apple (Pres of APHA) was gung-ho about how Pharmacies moving from the “market up ” system for pricing for Rxs to a professional fee would make us more professionals.. just as the PBM’s came on the scene and they accepted the concept.. today.. 45 yrs later.. how is that “professionalism” working for us ?
Then there is the big push to use generics.. to save pts and the system money.. have you seen the price increase of generics over the last past few years and the shortage of certain meds ? That has worked out so well..
Then there was the fairytale about the expanded use of technicians, computers and automation would give us more time to help the pts.. today with RPH’s having to verify 30+ Rxs/hr.. how’s that spare time to help pts with their medication working out ?
Our next “professional savior” was MTM with Medicare Part D.. except the PDP decided who was eligible (<10 % of part D population ) and established reimbursement at a level that would barely cover labor costs.. another “missed golden ring” as this professional merry-go-round made another revolution.
Next was vaccinations.. would give us more professionalism.. and we let the MBA’s establish that we were going to do it on demand.. more like fast food.. than other healthcare professionals working by appts. We were going to bring vaccinations to “the masses”… yet the per-cent of the population that gets vaccinations – especially flu – has hardly budged ..and now the MBA’s have got us asking like the Carny at the sideshow hawking flu shots.. every time you answer the phone.. and any other chance you get.. to get you to meet your quota of shots.
Now we have bureaucrats telling Pharmacists that they have to provide a service for FREE.. remember the permit holder is the one billing for the BC’s .. they are the ones that has the contract with the third party.. BUT.. the Pharmacist is the provider of diagnostic services.. only after special training and paying the state for a special license … Of course, the new PharmD’s will come out ready for that special license and the chain pharmacies will repeat the issue with vaccinations.. get certified/licensed .. or find a new job.. When all is said and done.. why should the insurance companies pay for a service that the Pharmacists have been more than willing to provide FOR FREE.. just like Pharmacists have done for CENTURIES.. IMO.. the bureaucrats in California have cleared declared what our worth to society is.. it is so infinitesimally small.. that it is PRICELESS… Even a wait staff that gives you terrible service.. you are suppose to leave a tip of TWO CENTS …
Nice synopsis of the downward spiral of pharmacy practice over the last 50 years.
And your prediction of the future may prove to be more accurate than mine, but I really believe provider status would be a game changer for many pharmacists. Not for me. I’m too old. For the PharmDs who have had training in diagnostics, it will open a whole new areas of practice, and many with much better working conditions.
You may be correct that the Chains will make their staff get certified or else, but overall I believe vaccinations have been a boost to pharmacy’s professionalism. Sure I hate hawking vaccines while answering the phone and being a cashier, but being a vaccine provider has opened the door for pharmacists to provide more professional services, and I appreciate that my employer provided me the opportunity to become an immunizing pharmacist.
Provider status could enable us to bill Medicare and Medicaid as mid-level practitioners for these services. If Medicare and Medicaid permit this billing, then most other insurance providers would follow as Medicare and Medicaid set a floor for basic billable services in our complicated health care system.
Provider status would also reverse the deleterious effects of the Durham-Humphrey Amendment which established that legend drugs could only be dispensed pursuant to a prescription issued by an authorized provider.
When pharmacist can function as providers in almost all clinical settings, working conditions and job opportunities will improve immensely.
Great.
No chart notes or exam findings to share with their doctor. And communication between pharmacist and doctor, which has soured where I live, will get better somehow?
The pharmacists in my town will only communicate by phone, while I am
Busy with patients. No texting, no email, no 21st century amenities. No written word or accountability either.
If a poor woman becomes pregnant because she can’t afford to see a doctor, it will cost the state a lot more in the long run. Sure, we can tell men and women to stop having sex, but prohibition has never worked, for sex or drugs.
Maybe pharmacists can start selling Viagra over-the-counter too.