The Mounting Case for Pharmacist Provider Status
Staffing shortages and greater access to pharmacies have generated bipartisan support in Washington, D.C.
pharmacist as provider

The combination of the worsening shortage of primary care physicians (PCPs) and the valuable contributions of pharmacists during the COVID-19 pandemic have bolstered the societal case for pharmacist provider status.

According to the Health Resources & Services Administration (HRSA), there is a current shortage of 17,500 PCPs, and a study commissioned by the Association of American Medical Colleges concluded that the U.S. could experience a shortage of up to 48,000 PCPs by 2034. Moreover, the PCP shortage is even worse based on geographic distribution. Just as there are so-called “food deserts”—areas that have limited access to affordable and nutritious food—there are “PCP deserts”—places where there is one or fewer PCP for every 3,500 people, as defined by HRSA. A staggering 102 million Americans—31% of the total U.S. population—live in primary care Healthcare Professional Shortage Areas (HPSAs), and 65% of these HPSAs are in rural areas.

The Public Health Emergency (PHE) enacted by the federal government in response to the COVID-19 pandemic enabled pharmacists to provide essential services, including testing, vaccination, and treatment initiation. According to The Future of Pharmacy Care Coalition, during the pandemic pharmacists provided 350 million interventions to approximately 150 million people, in large measure due to the excellent accessibility of pharmacies—nine in 10 Americans live within five miles of a pharmacy—and the fact that patients visit their community pharmacist twice as frequently as they visit PCPs.

These two factors have generated greater bipartisan support in Washington, D.C. for pharmacist provider status, with two different legislative approaches emerging. 

One approach is to mandate Medicare reimbursement of pharmacists for a narrow range of services but broadly in terms of geography. H.R. 1770, the Equitable Community Access to Pharmacist Services Act, expands Medicare to permanently include services provided by a pharmacist, including incidental services and supplies, related to testing, vaccines, and treatment for COVID-19, influenza, and certain other illnesses. As of Jan. 10, the bill had 96 cosponsors (49 Republicans, 47 Democrats), and S. 2477 is an identical bill in the Senate that has 14 cosponsors (8 Democrats, 6 Republicans).

The other approach is to mandate Medicare reimbursement of pharmacists for a broad range of services, but only in geographic areas that are underserved by PCPs. S. 1491, the Pharmacy and Medically Underserved Areas Enhancement Act, which has been brought before Congress a number of times in the past, as of Jan. 10 had 12 cosponsors (seven Democrats, four Republicans, and one Independent). As evidence of the bipartisan appeal of the bill, Sen. Tom Cotton (R-Ark.), one of the most conservative senators, and Sen. Raphael Warnock (D-Ga.), one of the most liberal senators, are among its cosponsors. The bill provides for Medicare coverage and payment at the lesser of 80% of the actual charge or 85% of the Physician Fee Schedule amount for certain pharmacist services that are furnished by a pharmacist in a HPSA and would otherwise be covered under Medicare if furnished by a physician.

The former approach as proposed by H.R. 1770/S. 2477 has garnered the most advocacy support, with backing by The Future of Pharmacy Care Coalition, whose members include the leading pharmacist and pharmacy associations, the nation’s three largest drug wholesalers, several of the largest retail pharmacy chains, and 30 hospitals and health systems.

While there was a paucity of legislation passed by Congress in 2023 and partisanship will almost assuredly continue in 2024, an election year, the aforementioned verities of the worsening PCP shortage and the value demonstrated by pharmacists during the PHE offer hope that pharmacist provider status legislation could ultimately be passed as part of a large end-of-year federal spending package.

About the author: Ken Perez, healthcare marketing, strategy and policy consultant and former Vice President of Healthcare Policy and Government Affairs for Omnicell, Inc.