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By IHPL - July 13, 2023

Over 10 years ago, Governor Jerry Brown signed into law SB 493, a landmark piece of legislation that formally recognized California pharmacists as healthcare providers who have the authority to provide health care services.1 The passage of SB 493 recognized pharmacists as medication experts who provide consult, train and educate patients on disease management and prevention; it also expanded pharmacists’ authority to furnish hormonal contraception, nicotine replacement products, and travel medications along with the authority to order tests to manage a patient’s medication regimen. Since the passage of SB 493, the state legislature has granted additional authority to pharmacists, including the ability to independently initiate HIV medications for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)2 and collaborate with physicians to manage chronic diseases and reduce fragmentation in healthcare.

As the pandemic hit, the impact and value of pharmacists on public health and the healthcare system came into greater focus. Pharmacists administered approximately 45% of COVID-19 vaccines nationwide. Estimates indicate that pharmacist-led interventions averted millions of COVID-19 deaths and hospitalizations, relieving significant strain on the healthcare system and resulting in an estimated savings of $450 billion in health care costs.3 Despite the conferral of provider status through SB 493, their expanding scope of practice, and extraordinary COVID-19 healthcare efforts, pharmacists continued to administer quality health care services for which they were not renumerated.4,5

In January 2023, physician and Assembly Member Dr. Akilah Weber, representing California's 79th Assembly District, introduced AB 317, legislation that amends Section 1368.5 of the Health and Safety Code and Section 10125.1 of the Insurance Code.6 The proposed bill aims to improve healthcare access to patients by removing statutory barriers for pharmacists to bill commercial health plans for authorized patient care services. The proposed legislation stipulates that pharmacists must be allowed to enroll in commercial health plan provider networks to bill for covered patient care services within the pharmacists’ scope of practice. If ultimately approved, AB 317 will require commercial health insurance carriers to recognize pharmacists in a manner similar to that already afforded to nurse practitioners, physician assistants, and physicians. The bill also provides further recognition of the value pharmacists bring to healthcare, a system already taxed by a shortage of primary care physicians,7,8 particularly in rural communities, where community pharmacies have also closed due to unsustainable reimbursement models related to the drug supply chain. The reimbursement of services provided by pharmacists through AB 317 also opens up additional revenue opportunities for community pharmacists to maintain their practice and deliver quality health services to communities.

Author Bio:

Dr. Kyle Sousa

Kyle M. Sousa, PhD

Dr. Sousa is an Associate Professor and the Associate Dean of Academic Affairs at the School of Pharmacy. His research interests include program/policy evaluation and the role of bile acids following bariatric surgery.

References:

  1. California Senate Bill No 493 (SB 493): https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493

  2. California Senate Bill No 159 (SB 159): https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB159

  3. Grabenstein, JD. Essential Services: Quantifying the contribution of America’s pharmacists in COVID-19 clinical interventions. 2022. Journal of the American Pharmacists Association. 62(6):1929-1945

  4. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. Dec 2011. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service.

  5. Murphy EM, Rodis, JR, Mann HJ. Three ways to advocate for the economic value of the pharmacist in health care. 2020. Journal of the American Pharmacists Association. 60(6): 116-124

  6. California Assembly Bill No 317 (AB 317): https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB317

  7. Association of American Medical Colleges. 2021 UPDATE The Complexities of Physician Supply And Demand Projections From 2019 To 2034. Available at: https://www.aamc.org/media/54681/download

  8. Health Resources and Services Administration. Heath Workforce Shortage Areas. Timeframe: as of May 25, 2023. Available at: https://data.hrsa.gov/topics/health-workforce/shortage-areas