Until a few months ago, pharmacists at Franklin Pharmacy in Warren, Ohio, would rattle off a familiar script when a customer arrived at the counter to pick up a prescription: here’s how to take your medicine; these are the side effects; do you have any questions? Most times, the answer was no.
Since June they have begun sitting down with patients who have chronic illnesses or have just been discharged from the hospital. They go over medications and make sure the patient is taking them as prescribed. They ask about stress, exercise routines, smoking and other health concerns—topics usually reserved for the primary-care doctor.
Danielle Hubbard, a pharmacist who has been with the 50-year-old pharmacy for two decades, said she’s helped patients quit smoking and put one on the right track after a hospital stay by consolidating his medications and throwing out old dosages he was mistakenly taking. George Graham, another pharmacist, said he’s caught medication errors and has recommended blood pressure machines and pulse oximeters for some patients.
Franklin Pharmacy is part of a UnitedHealthcare experiment in Ohio to put community pharmacists on the team of clinicians who care for a patient in hope of controlling chronic conditions and reducing hospital readmissions. The insurer is paying pharmacists to have these conversations, uncover any health and medication issues, and then do something about them.
“We tend to have better results in getting people care when we’re working with them within their communities,” said Michael Roaldi, who leads UnitedHealthcare’s Medicaid business in the state. “It occurred to us that pharmacies—community pharmacies and chain pharmacies—are literally thousands of examples of medical professionals in people’s communities that they regularly interact with that can be a conduit for receiving care.”
A number of other insurers in the state, including Centene-owned Buckeye Health Plan, CareSource, and Molina Healthcare, are rolling out similar pilots focused on Medicaid members in anticipation of new rules from the Ohio Department of Medicaid that would formally recognize pharmacists as healthcare providers and reimburse them for services that go beyond counting pills.
It’s a stark departure from the usual role of the pharmacist and positions Ohio as one of a few progressive states that will pay pharmacists as providers, in part to extend healthcare access to rural and underserved communities.
“We’re at the beginning of a care revolution here,” said Antonio Ciaccia, former director of government and public affairs at the Ohio Pharmacists Association who was recently named a senior adviser to the American Pharmacists Association. “Once the diagnosis is made and the patient is on established therapy, having the pharmacist act as a touchpoint to make sure the patient is adequately calibrated on the therapy plan and on progress to meet their goal—that is right in their wheelhouse.”
Pharmacists traditionally have been paid to dispense medications. Their services have evolved over the past two decades to include administering vaccines and immunizations, such as flu shots, and addressing other public health needs, like providing the opioid overdose reversal drug naloxone to high-risk patients. Pharmacists today are also commonly embedded in hospitals and physician offices, where they tailor drug therapy and address medication problems alongside other practitioners.
While there are a few mechanisms through which pharmacists can be paid for services beyond dispensing drugs and administering vaccinations, payment opportunities are limited, and that’s especially true for community pharmacists, said Anne Burns, vice president of professional affairs at the American Pharmacists Association.
A major reason is that Medicare Part B does not recognize pharmacists as healthcare providers, so pharmacists can’t bill the program for their services. Because other payers look to Medicare for guidance, CMS’ refusal to recognize pharmacists has dampened uptake of their services elsewhere, Burns said.
Pharmacists have long argued their extensive training, medication expertise and accessibility could be tapped to manage patients with chronic diseases, who drive the bulk of healthcare spending. Their inclusion on the care team could alleviate the effects of the physician shortage on patients, they say. According to the National Association of Chain Drug Stores, 9 in 10 Americans live within 5 miles of a pharmacy.
A wealth of evidence shows pharmacists have helped improve clinical outcomes for people with diabetes, hypertension, cardiovascular and respiratory diseases and other chronic illnesses. Some studies have also found that pharmacist interventions save healthcare costs. One review estimated that every $1 invested in clinical pharmacy services produced savings and other economic benefits of nearly $5.
Meanwhile, payment for dispensing has become tighter and tighter. Pharmacists are forced to fill prescriptions faster to stay afloat, leaving little time or incentive to counsel patients.
“You have this assembly line mentality,” Ciaccia said. “If you can start inserting new incentives into the pharmacy that press (pharmacists) to offer a higher standard of care, integrate new services into their system, and ultimately start grading them on how well the patients are doing … now all of a sudden you’ve stuck a wrench in the gears of this machine and are forcing the pharmacy to slow down and have skin in the game on how well the patient is.”
That pharmacy transformation is underway in Ohio. A law that took effect in April 2019 not only recognized pharmacists as healthcare providers but gave insurers the option to pay for higher-level pharmacist-provided services under the medical benefit. Pharmacists are usually reimbursed not by the insurer, but by the pharmacy benefit manager through the separate drug benefit, where incentives and goals differ.
Several other states, including Tennessee and Washington, have passed stricter laws that fostered payment for pharmacist services.