Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S.

Alina Cernasev,Vaiyapuri Subramaniam,Komal Patel,Meghana Aruru,Suzanne Clark,Natalie Dipietro Mager,Hoai-An Truong

doi:10.3390/pharmacy9010057

Abstract

This article describes the history and evolution of pharmacist-physician collaborative practice agreements (CPAs) in the United States with future directions to support pharmacists’ provider status as the profession continues to evolve from product-oriented to patient-centered care and population health. The pharmacy profession has a long history of dispensing and compounding, with the addition of clinical roles in the late 20th century. These clinical roles have continued to expand into diverse arenas such as communicable and non-communicable diseases, antimicrobial stewardship, emergency preparedness and response, public health education and health promotion, and critical and emergency care. Pharmacists continue to serve as integral members of interprofessional and interdisciplinary healthcare teams. In this context, CPAs allow pharmacists to expand their roles in patient care and may be considered as a step towards securing provider status. Moving beyond CPAs to a provider status would enable pharmacists to be reimbursed for cognitive services and promote integrated public health delivery models.

Highlights

Subsequent regulations, including the federal Omnibus Budget Reconciliation Act of 1990 (OBRA-90), addressed pharmacy services in federally funded and state-managed Medicaid programs [8]
The Centers for Medicare and Medicaid Services (CMS) recognized that proper drug use was in the best interest of Medicaid recipients, and that pharmacists could play a role in improving drug use through review of medications and prescription counseling
In the US, Pharm.D. programs are accredited by the Accreditation Council for Pharmacy Education (ACPE)

Summary

Empowering the Pharmacy Profession

CPAs are defined as “an agreement between one or more physicians and pharmacists wherein qualified pharmacists working within the context of a defined protocol are permitted to assume professional responsibility for a variety of functions, including patient assessment; ordering drug therapy—related laboratory tests; and selecting, initiating, monitoring, continuing and adjusting drug regimens” [12]. The pharmacist would callCthPeApshsyisginciiafyn twruitsht tihnetihr erepcroomfemsseinodnaatilojnusdagnedmtehnetpbheytwsiceiean twhoeuclodllbaeboabraletitnogmpahkyestihcioasne ancdhapnhgaesrmtharociusgt,heanpsurersecrciopntitoinnuchitayn-goef-.cHaroewfeovrepr,athtiiesnwtso,uelndhliakneclyedrepsualttieinnts-epvheryaslicpihaonn-pe hcaalrlsmaancdisdt irseculastsiioonnsshbieptws,eeanndthealplhoywsicfioarn eafnfdicpiehnatrmwaocirskt,fluolwtims.atMelyorleeaidminpgotrotalenstsldye, sCirPabAlespaaltlioewnt eparcCcaaPhcrAetitO)ttyhiwnoprconeoeueuoCgrlsdhfPAtpeboiesrtaphcacearbtromliedvteieitodoilnnaemyteosdraeoiktrxroeeiusctuthntetaopnivslcaieaeztii,meleathnbetedhtiliiecpctaiyharrtaoeiorof.mwnseanrlceeigcsstitkem(iddlelepsnpraceehsnncaddrniipngletgeivsouenaprsnoa.dngfiestllathtteheelaspwkrielaslnscdroipefxtittohennetfooortfhtthheeer patiCenotnwsihdileerththeye wfoaliltoawt itnhegpehxaarmmpaclye.: The change would be noted in the electronic health record that would be shared with the physician to refer to at the patient’s future visit. Per a recent report from APhA, pharmacists in all 50 states, as well as the District of Columbia, and Puerto Rico can administer immunizations [31,32] Pharmacists have embraced their roles as immunizers in their communities and contributed to expanded immunization rates [33,34]. The step would be to consider moving beyond CPAs to conferring provider status to pharmacists that would enable them to freely collaborate and work with physicians and other healthcare providers and be reimbursed for their services

Development of Public Health Pharmacy

Actions during COVID-19

Findings

Future Directions