Pharmacist Medical Providers: Post-SB 5557 Update Don Downing Clinical Professor, UW School of Pharmacy

Pre-SB 5557 Pharmacists could only bill for medications ▫Pharmacists could not bill for clinical services ▫Pharmacists were, however, providing clinical services  Prescribing prescription drugs  Managing: Anticoagulation services, diabetes, hypertension, lipid, pain, contraception, etc.  All without compensation ▫PBM-based billing: Not appropriate for clinical care ▫A strong disincentive to coordinate or reduce medication complexity even for those on 20 Rxs

Post-SB 5557 Pharmacists are being hired to fill in gaps where primary care physicians are unavailable Pharmacists are initiating services that health departments can no longer provide: ▫Chlamydia, gonorrhea, TB, HIV/AIDS, Hepatitis C, etc. screenings ▫Immunizations, STI treatment, incl. expedited partner therapy ▫Teen pregnancy prevention services Pharmacists now have financial incentives that are aligned with best medication practices

Washington State Pharmacy Association workgroups: On February 19, 2016, the Billings Workgroup met to continue its work on creating a Billing Guide and Documentation Guide to help pharmacists implement ESSB Earlier this year, the WSPA established workgroups to develop educational and training tools to help prepare pharmacists to take advantages of new opportunities as medical providers. The Billing Workgroup is developing two draft documents: ▫(1) a Billing Guide which includes billing codes and diagnosis codes that pharmacists may use when billing for medical services provided to patients; and ▫(2) a Documentation Guide to help pharmacists understand how to appropriately document outpatient and office visits services using complexity-based billing rather than time-based billing. In the next few months, the WSPA will be rolling out new training and education programs. For more information about the Billing Workgroup, please contact Vergil Cabasco at

Consequences… Almost 2000 pharmacists, physicians and others signed up, nation-wide, for Feb 2016 “Pharmacists as Medical Providers” webinar Some hospitals in WA have added pharmacists to their medical boards Tribes have hired pharmacists to fill their long- vacant medical provider positions Are pharmacists specialists or primary care?

Questions & Consequences… Medical referral vs patient self-referral Coordination of care / Non-duplication of care Conflict of Interest policy development Pharmacy School curricular changes Network adequacy Board specialty certification decisions ▫Access to Care ▫Quality of Care More to come… Thanks