Provider Status: Is Pharmacy Really Ready?

Provider Status: Is Pharmacy Really Ready?

If you are in any way socially conscious of the current direction of health-care then you should be fully aware of the looming opportunity for pharmacists to gain the coveted provider status. Now of course, every pharmacy enthusiast will look at the title of this article and say, “are you serious? Of course we are ready!” One must understand that with great power comes great responsibility. It almost seems blasphemous to mention to a pharmacy radical that perhaps we as a profession should hold off on the whole provider status thing and play it conservative for now. However, the statement does warrant some discussion. Are we really ready for what is to come with this responsibility?

For centuries now, several other professions have traversed the health field with opportunities to provide direct patient care and be labeled as “Providers”, but what exactly does this mean? Well, in technical terms, Pharmacists are not included in Medicare Part B list of providers which include physicians, physician’s assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives, and certified registered nurse anesthetists. Thus with no provider status recognition, there is no formal integration of pharmacy services in the health care including a lack of reimbursement process for the profession. Consequently, this limits Medicare beneficiaries access to pharmacy services and the potential to save nearly $290 billion dollars attributed to preventable health care expenses. Intuitively, it makes sense to include pharmacist as true providers, but again, are we ready?

The first thing to assess is the aptitude of the profession. For years, we have assumed the role of “pill pushers” which has put limitations on our self-perceived capabilities. A PharmD degree is certainly no joke and the amount of knowledge we inhale through the four years of training is more than enough to perform beyond the “pill pushing” role. Collectively, the profession has to have the mindset that they are true providers before even moving forward.  So now after pumping yourself up and believing you can do it, the next thing to determine is, well can you actually do it? The reality is we actually already are “providers”. In many settings, pharmacists are providing medication therapy management services, direct patient care in specialty areas (HIV, diabetes, hepatitis C, immunology), and pharmacotherapy consultative services.  However despite all of this, the omission of pharmacists as recognized providers in the healthcare system limits patient’s access to many of these services.

Now if we are to finally attain provider status, all eyes will be on us to provide. Without the sheets over our heads, pharmacy will now be under the microscope of the health care system to fulfill these responsibilities. The whole profession must have a unified mindset of a provider, not just a subset of individuals who care to utilize the bevy of knowledge they gained through their training. The entire profession must be ready to step away from the counter and actually assess a patient holistically to provide comprehensive care. Each individual in the profession must understand the critical role they play in a patient’s life as they formally integrate into the health care team. So as a current and future provider of this profession, are you ready?

Check out APHA’s site for more information and how you can get involved!


by: Bryan Sackey, PharmD, BCPS, AAHIVP. Dr. Sackey is the founder of PILs and a staff writer for The Package Insert.

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