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On Friday, January 17, CPNP joined 7 other national pharmacy associations and over 70 state pharmacy associations in submitting a joint letter to CMS in response to their request, under Executive Order (EO) #13890, for additional input and recommendations regarding elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license. These comments were also submitted to SAMHSA and HHS. Collectively, the signing organizations represent over 300,000 pharmacists, student pharmacists, residents, and pharmacy technicians in all settings.

See letter for full comprehensive comments

Submitting organizations provided a number of opportunities where CMS could provide regulatory relief to alleviate regulatory burdens under Medicare that are more stringent than applicable state scope of practice laws. The letter notes how a growing number of states1 and private payers are providing enrollees beneficial pharmacist-provided patient-care services in a variety of practice settings and yet, current federal regulations severely limit the ability of pharmacists to practice at the top of their license and training.

In the letter, CPNP and this collective set of organizations request that CMS include the following changes in agency regulations, programs, and policies to implement the charges outlined in the EO:

  1. General Recommendations
    1. Use inclusive provider language in rulemakings, programs, and policies to ensure pharmacist inclusion to support medication optimization and improve patient outcomes.
    2. Issue a Center for Medicaid & CHIP Services (“CMCS”) Information Bulletin where payers could utilize pharmacists to better address needs for patients.
    3. Attribute and promote significant contributions of pharmacists to health outcomes of Medicare beneficiaries.
    4. Expand service models utilizing pharmacist-provided patient care services using CMS Center for Medicare and Medicaid Innovation (“CMMI”) data, including in value-based payment models by employing CCMI’s waiver authority.
    5. Incorporate and/or test an alternative model at CMMI in rural and medically underserved areas/populations focusing on optimizing medication use and health outcomes as part of coordinated care delivery including pharmacists.
    6. Ensure pharmacists can engage in remote patient monitoring and other telehealth services.
       
  2. Specific Recommendations
    1. Implement a general supervision requirement vs. direct supervision for services delivered by highly trained pharmacists.
    2. Align Medicare service requirements with the most robust pharmacist state scopes of practice.
    3. Clarify physicians and other qualified practitioners can bill for “incident to” services provided to Medicare beneficiaries by pharmacists at levels higher than Evaluation and Management (“E/M”) code 99211.
    4. Address challenges for pharmacists and pharmacies to deliver diabetes self-management services (“DSMT”) and continuous glucose monitoring (“CGM”) services.
    5. Allow pharmacist initiated electronic prior authorization.
    6. Allow pharmacists to be Drug Addiction Treatment Act of 2000 (“DATA”)-waived providers by including as qualified practitioners.

1HRSA. Allied Health Workforce Projections, 2016-2030. Last Accessed, January 16, 2020, available at: https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/pharmacists-2016-2030.pdf

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