AB 317 (Weber) Pharmacist Service Coverage
In 2013, pharmacists were granted the designation of “provider” in California law. SB 493 (Ch. 469, 2013) officially declared pharmacists are healthcare providers who have the authority to provide specific health care services. Given the increased reliance on the pharmacists’ activities on the healthcare team to optimize pharmaceutical therapies for patients, the state recognized the pharmacist’s role to improve health outcomes, particularly in communities with health care provider shortages.
With healthcare increasingly focused on prevention and disease management, SB 493 explicitly states the pharmacists’ play a key role in assisting patients in getting and staying healthy.
Additionally, the bill granted pharmacists the authority to independently initiate and provide:
Hormonal contraception
Travel Medications
Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies
Furnish nicotine replacement products
Disease management results in better healthcare outcomes, resulting in decreased hospital admissions.
The bill also established the “Advanced Practice Pharmacist (APP)” licensure category. With specified requirements, APPs are authorized to do the following:
Perform patient assessments
Order and interpret drug-therapy related tests
Refer patients to other health care providers
Participate in the evaluation or management of diseases and health conditions in collaboration with other health care providers
Initiate, adjust or discontinue drug therapy pursuant to the authority established in current law for pharmacists to perform certain procedures in a licensed health care facility
Pharmacists have the statutory authority to help physicians manage patients’ chronic illnesses and provide preventive care however; health insurance companies have not yet recognized them as providers therefore they are limited in their utilization due to the inability to bill for the patient care they provide.
Since passage of SB 493, pharmacists have also been granted additional authorities including independently initiating and providing lifesaving HIV prevention medications, administering all FDA approved and ACIP recommended vaccinations. Additionally, they have been granted the authority to perform the following CLIA waived tests: SARS-CoV-2 or other respiratory illness, condition or disease; Mononucleosis; Sexually transmitted infection; Strep throat; Anemia; Cardiovascular health; Conjunctivitis; Urinary tract infection; Liver and kidney function or infection; Thyroid function; Substance use disorder; and, Diabetes.
One of the central tenets of pharmacist’s new authorities is collaboration, not fragmentation.
As California faces healthcare provider shortages, pharmacists are well trained and positioned to relieve the strain on the system. According to recent reports, “Mid-range forecasts indicate the state would need about 4,700 additional primary care clinicians in 2025 and about 4,100 additional primary care clinicians in 2030 to meet demand.”
INTENT OF LEGISLATION
This bill removes a major barrier for pharmacists to bill commercial health plans for patient care services authorized by law. Pharmacists must be allowed to enroll in commercial health plan provider networks and bill for covered patient care services within the pharmacist’s scope of practice. Commercial health insurance carriers must recognize pharmacists in the same way as other providers such as physicians, nurse practitioners, and physician assistants. To continue to discriminate against pharmacists is detrimental to patients and contributing to access issues.
By treating pharmacists as healthcare providers, the bill will enable pharmacists to provide and bill for patient care services within their scope of practice. This will increase access to care while relieving strains on the healthcare system.
In 2013, pharmacists were granted the designation of “provider” in California law. SB 493 (Ch. 469, 2013) officially declared pharmacists are healthcare providers who have the authority to provide specific health care services. Given the increased reliance on the pharmacists’ activities on the healthcare team to optimize pharmaceutical therapies for patients, the state recognized the pharmacist’s role to improve health outcomes, particularly in communities with health care provider shortages.
With healthcare increasingly focused on prevention and disease management, SB 493 explicitly states the pharmacists’ play a key role in assisting patients in getting and staying healthy.
Additionally, the bill granted pharmacists the authority to independently initiate and provide:
Hormonal contraception
Travel medications
Order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies
Furnish nicotine replacement products.
The bill also established the “Advanced Practice Pharmacist (APP)” licensure category. With specified requirements, APPs are authorized to do the following:
Perform patient assessments
Order and interpret drug-therapy related tests
Refer patients to other health care providers
Participate in the evaluation or management of diseases and health conditions in collaboration with other health care providers
Initiate, adjust or discontinue drug therapy pursuant to the authority established in current law for pharmacists to perform certain procedures in a licensed health care facility
Since passage of SB 493, pharmacists have also been granted additional authorities including independently initiating and providing lifesaving HIV prevention medications, administering all FDA approved and ACIP recommended vaccinations. Additionally, they have been granted the authority to perform the following CLIA waived tests: SARS-CoV-2 or other respiratory illness, condition or disease; Mononucleosis; Sexually transmitted infection; Strep throat; Anemia; Cardiovascular health; Conjunctivitis; Urinary tract infection; Liver and kidney function or infection; Thyroid function; Substance use disorder; and, Diabetes.
One of the central tenets of pharmacist’s new authorities is collaboration, not fragmentation.
As California faces healthcare provider shortages, pharmacists are well trained and positioned to relieve the strain on the system. According to recent reports, “Mid-range forecasts indicate the state would need about 4,700 additional primary care clinicians in 2025 and about 4,100 additional primary care clinicians in 2030 to meet demand.”
Disease management results in better healthcare outcomes, resulting in decreased hospital admissions.
INTENT OF LEGISLATION
This bill removes a major barrier for pharmacists to bill commercial health plans for patient care services authorized by law. Pharmacists must be allowed to enroll in commercial health plan provider networks and bill for covered patient care services within the pharmacist’s scope of practice. Commercial health insurance carriers must recognize pharmacists in the same way as other providers such as physicians, nurse practitioners, and physician assistants. To continue to discriminate against pharmacists is detrimental to patients and contributing to access issues.
By treating pharmacists as healthcare providers, the bill will enable pharmacists to provide and bill for patient care services within their scope of practice. This will increase access to care while relieving strains on the healthcare system.
