Avalere study identifies 3 ways to broaden reimbursements

A new analysis by Avalere Health is examining the ways that pharmacists might be able to see broader reimbursement for the services they provide. The research, funded by the National Association of Chain Drug Store, identified three factors that can be changed to improve reimbursements for pharmacists who are increasingly asked to provide improved outcomes among patients. 

 

“While opportunities for pharmacists to provide direct patient care services emerge, options for obtaining reimbursement for these services continue to be limited for community pharmacists,” the study said. 

 

One of the biggest barriers to reimbursement the study identifies is the pharmacist’s lack of provider status under Medicare Part B. Though several states have formally recognized pharmacists as providers, the lack of recognition at a federal level limits reimbursement for pharmacists providing certain services. A federal recognition, the study says, might put in place a reference for payers to establish reimbursement policies. 

 

Additionally, the analysis highlights a lack of communication between different systems, which can limit the pharmacist’s ability to access a patient’s records and coordinate care with physicians. The study highlights past instances where improved communication has improved outcomes as a result of coordinated interventions. 

 

“If clinical information and care strategies are siloed from one another, this creates a missed opportunity to inform the delivery of care to patients that integrates different practitioners in a coordinated fashion,” the study said. 

 

Finally, the study urges more evidence to show the value of such pharmacist-provided services as immunizations, medication therapy management, chronic condition management and wellness screenings — especially in terms of the money these services will save payers, which are increasingly looking to curb costs. 

 

To remedy the challenges facing pharmacists, the analysis calls for the establishment of a federal recognition of pharmacists as providers under Medicar Part D, standardization of methods for billing for services across state and federal programs and an increased coordination between pharmacists and medical benefit through improved exchange of information between different parts of a patient’s care team. 

 

“With a greater focus on improving the value of care, the opportunities for pharmacists to provide a variety of direct patient care services will continue to evolve as incentives for reimbursement of these services are established,” the study said.