A simple change to state law could allow Ohio pharmacists to play a larger role in patient care.
Senate Bill 265, sponsored by state Sen. Matt Dolan, R-Chagrin Falls, gives pharmacists provider status in order for healthcare providers including Medicare and Medicaid to cover various patient services. The bill passed unanimously in both the Ohio Senate in late November and in the Ohio House last week and is awaiting the Senate’s concurrence of House amendments before being sent to the governor’s desk.
Antonio Ciaccia, director of government and public affairs for the Ohio Pharmacist’s Association, said healthcare providers currently divide coverage into two different categories: pharmacy benefits and medical benefits. While pharmacists can already bill insurance companies for pharmacy benefits such as immunizations like flu shots and dispensing medications, SB 265 would allow them to bill for medical benefits they are licensed to practice.
Sen. Dolan emphasized that the bill does not change the scope of practice for pharmacists but rather gives an opportunity to use the full extent of their training.
“It allows pharmacists to practice at the top of their license. They’re trained experts in the area of pharmaceutical medications, so let’s get them involved with the patients,” Sen. Dolan said. “It’s good for the patient and tremendous cost savings.”
Mr. Ciaccia said the change would allow pharmacists to become a part of an ever-increasing collaboration of team-based care in health systems that include doctors, nurses, anesthesiologists, chiropractors and other professionals using their specialties to give patients better care rather than dumping all responsibilities onto physicians.
“Everyone’s pushing team-based care and the problem is that they’re not utilizing or incentivized to utilize pharmacists for some of the things within their scope,” he said. “When the insurance code was written, the pharmacist was merely viewed as a dispenser. That has changed significantly over time as vocational training has evolved, but also more healthcare facilities are integrating more providers onto a care team.”
Sen. Dolan said there is a broad range of potential services opened up by the permissive bill, including pharmacist consultations with patients before medications are prescribed to discuss how it will interact with other medications and phone call follow-ups when patients have questions about medication side effects. Pharmacists can also consult with doctors and patients when opioids are prescribed to ensure patients are not overprescribed and recommend alternatives when appropriate, he said.
Sara Dugan, associate professor in the department of pharmacy practice at Northeast Ohio Medical University, said pharmacists could become a centralizing hub for patients who abuse opioids and have other medical conditions.
“Sometimes with that particular group of patients, there is a fragmenting of care. Opioid use gets treated and then mental health is treated by somebody else and physical healthcare, maybe they have high blood pressure, is treated by somebody else,” Dr. Dugan said. “Pharmacists would be able to assist with streamlining the medications, watching for any changes that happen and focus on transitioning off of opioids.”
Mr. Ciaccia said patients with conditions such as diabetes or hypertension could have lab tests and appointments at their local pharmacy to make sure they are taking the right dosage of their medication rather than having to make an appointment with their doctor.
“Why can’t they just go to the pharmacy to get the more tune-up type work done rather than health systems for all those things?” he said. “We see this as creating the ability for new innovative care models to grow.”
Sen. Dolan said while he was researching the issue, he visited Ohio pharmacy schools and learned that pharmacy students work closely with future doctors in medical school but then separate upon graduation.
“Now it’s a continuation of how young doctors and young pharmacists are being taught. Now it can be put to practice in the real world which will be better patient care and cost savings that allow trained people hopefully to be incentivized to stay in Ohio and practice their profession here,” he said.
Dr. Dugan said the bill would also give pharmacists “a more direct opportunity” to practice outside of the traditional community pharmacy or hospital setting, an emphasis of training at pharmacy schools.
“It could be in hospice sites, pediatric respite sites, any potential agreement with either health systems or a physician outpatient facility,” she said. “It really can expand access to care for patients across the state in so many more places.”
If the bill is signed into law, Ohio would become one of the leading states in the country when it comes to utilizing pharmacists to their full licensing, Dr. Dugan said.
“A couple other states allow pharmacists to practice more at the top of their license where they can improve access and provide care for a lot more patients, but most of the other states in the country are behind when it comes to this legislation,” she said. “So that really is encouraging for the patients who live here in Ohio.”