Top Ten Things Every Clinician Should Know About Payment for Pharmacists’ Patient Care Services

Authors:
E. Michael Murphy, PharmD, MBA

Reviewers:
Betsy Shilliday, PharmD, BCACP, CDECS
Stuart T Haines, PharmD, BCPS, BCACP

Citation (AMA style):

Murphy ME, Rodis JL, Mann HJ.  Three ways to advocate for the economic value of the pharmacist in health care.  Am J Pharm Assoc 2020; 60: E116-E124.

Introduction:

The term provider status means different things to different people in different settings. While provider status is sometimes used to describe pharmacists’ scope of practice or simply to recognize pharmacists as essential members of the healthcare team, it is a term used to advocate for payment for the patient care services pharmacists provide. Pharmacists are not included in a section of the Social Security Act (SSA) that lists healthcare providers that can bill for their services under Medicare Part B. And this results in several challenges when it comes to payment for pharmacists’ patient care services by both public and private health plans. While provider status at the federal level has not yet been realized, there has been a steady growth of payers and programs covering services provided by pharmacists in recent years.

Here are the top ten things every clinician should know about payment for pharmacists’ patient care services.