Category: Professional Posters
Purpose: Decades of research has proven the value of pharmacists in improving health outcomes, lowering healthcare costs, and increasing access to care. However, the compensation pharmacists receive from insurers are based on an antiquated model of pharmacist-provided patient care that does not consider the ever-expanding scope of pharmacist-provided healthcare services. Therefore, pharmacists are either denied or do not receive equal compensation for the same services rendered by other heathcare providers resulting in compensation discrimination.
Methods: In July 2018, the Alaska Pharmacist Association sponsored the Sustainable Education & Training Model under Pharmacist-Provider Reimbursement demonstration project to identify and address factors contributing to compensation discrimination.
Results: For pharmacists to bill for healthcare services provided within their scope of practice, they must be credentialed as a "provider" by insurers. In Title 21 of Alaska Statute on Insurance Regulation, a provider is: "a person licensed ... to provide medical care services" (AS 21.07.250). Under AS 08.08, a licensed pharmacists is a "health care provider" and provider of "medical care services" (Alaska's Pharmacy Practice Act, Title 8). A "person with an active license under AS 08, or under the laws of the jurisdiction in which the person provides [medical care or health] services, [is an] Eligible Medicaid Provider ..." (7 AAC 105.200).
Conclusion: Based on Alaska statutes and regulations, pharmacists are medical providers and are therefore eligible for reimbursement for pharmacist-provided healthcare services through insurers at the same rate as other healthcare providers. Through the provision of equal compensation for healthcare services, insurers will contribute to the sustainability of the expanding scope of pharmacist-provided healthcare services to underserved patient populations.