North Dakota: Broad scope in testing capabilities
Although North Dakota pharmacists lack the prescribing authority that pharmacists in some other states enjoy, the state allows a broad range of testing, and pharmacists have begun to make progress in terms of gaining reimbursement for more of the services that they provide.
“Most states have a pretty good scope of practice,” said Mike Schwab, executive vice president of the North Dakota Pharmacists’ Association. “It’s just a matter of getting your payers to allow you to provide some of those services.”
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The association has had a strong working relationship with North Dakota Medicaid, he said, which has facilitated reimbursement from that agency for many of the services pharmacists in the state can provide. For many services, pharmacists in the state can bill as a healthcare provider just like physicians.
Currently, the association is working on broadening the medical codes that North Dakota pharmacists can bill for, beyond things such as continuous glucose monitoring, immunization and smoking cessation, Schwab said. The industry is seeking to be able to bill for some Chronic Care Management (CCM) and Evaluation and Management (E&M) codes, for example, as well as Transitions of Care Management (TCM) codes.
While the industry has made some traction in its efforts with Medicaid, it is also focusing on driving adoption among the state’s largest private insurers.
“If we can’t work together and chart our course together, and allow the carriers to have input and say in what they would like to see, well then we’ll probably have to go to our legislature to say, ‘We need to make them do this now,’” Schwab said.
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The role that pharmacists played during the pandemic, providing testing and administering vaccines, may be helping the state in its efforts, Schwab said. “I think what the pandemic showed us is that individuals really do put a value on accessibility and convenience, and of course your local pharmacies are the most accessible and oftentimes the most convenient.”
It also helps that North Dakota is a relatively rural state with a low ratio of doctors to patients, which leaves many communities with pharmacists as the only healthcare providers in the area, Schwab said.
Scope of practice
- Pharmacists in North Dakota can prescribe and dispense naloxone and smoking cessation products, and can also perform a range of tests, including drug screening, genomic, bone mass and bone density, vitamin D, thyroid-stimulating hormone testing, HIV, mono, flu testing, strep throat testing, salivary pepsin testing, respiratory syncytial virus testing, and various cholesterol and triglyceride tests;
- Pharmacists also can enter collaborative practice agreements with physicians or nurse practitioners that could provide the authority to prescribe and dispense; and
- North Dakota is one of the few states that allows pharmacists to provide medication management therapy for reimbursement under the state’s Medicaid program.