N e ws Governors’ association backs expanded primary care role for pharmacists


recent report from the National Governors Association (NGA) encourages states that want to increase their primary care capacity to remove barriers that prevent pharmacists from doing the work they are trained to do. Barriers identified in the report include “restrictive laws and regulations governing [collaborative practice agreements], lack of provider recognition in federal and state law governing compensation of pharmacists who provide direct patient care services, and limitations on

pharmacists’ ability to access health information systems.” The January 2015 report, “The Expanding Role of Pharmacists in a Transformed Health Care System,” is based on NGA’s analysis of outcomes research, case studies, policy reports, federal and state data, and other sources of information about pharmacy practice. According to the report, pharmacists are capable of providing “more intensive care” related to medication therapy management, health improvement and

New drugs and dosage forms Ferric pyrophosphate citrate solution (Triferic, Rockwell Medical): The iron concentrate, for addition to the bicarbonate concentrate used in preparing hemodialysis solution, is indicated for the replacement of iron to maintain the hemoglobin concentration in adults with hemodialysis-dependent chronic kidney disease. Meningococcal group B vaccine for injection (Bexsero, Novartis Vaccines): The vaccine is indicated for active immunization of persons 10–26 years of age for the prevention of invasive disease caused by Neisseria meningitidis serogroup B. Parathyroid hormone for injection (Natpara, NPS Pharmaceuticals): The recombinant hormone is indicated as an adjunct to calcium and vitamin D supplements to control hypocalcemia in patients with hypoparathyroidism. The drug is subject to FDA risk evaluation and mitigation strategy and Medication Guide requirements. Perindopril arginine and amlodipine tablets (Prestalia, Symplmed): The combination product is indicated for the treatment of hypertension to lower blood pressure in patients whose blood pressure is not adequately controlled on monotherapy and patients new

to antihypertensive therapy who likely will need multiple drugs to achieve their blood pressure goals. Phenylephrine hydrochloride ophthalmic solution (no brand name, Akorn): The α1-adrenergic-receptor agonist is indicated to dilate the pupil. Phoxillum renal replacement solution (no brand name, Gambro): The solution, containing calcium chloride, magnesium chloride, sodium chloride, potassium chloride, sodium bicarbonate, dextrose, lactic acid, and dibasic sodium phosphate, is indicated for use as a replacement solution during continuous renal replacement therapy (CRRT) to replace patients’ plasma volume removed by ultrafiltration and correct electrolyte and acid–base imbalances. The solution is also indicated for use as a replacement solution in cases of drug poisoning when CRRT is undertaken to remove dialyzable substances. Secukinumab injection (Cosentyx, Novartis Pharmaceuticals): The interleukin17A antagonist is indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. The drug is subject to FDA Medication Guide requirements.

wellness counseling, disease prevention services, and general primary care. To maximize pharmacists’ services, the report encourages states to declare that pharmacists are healthcare providers within the state insurance code, Medicaid, health information exchanges, and state employee health plans— and to encourage private insurers to also recognize pharmacists as healthcare providers. “I think there’s an increased understanding of the important role not only that pharmacists can play but have played. And so a paper like this helps, I think, promote the debate on allowing pharmacists to provide more services and make sure that they are reimbursed for them appropriately,” said NGA Executive Director Dan Crippen. David Chen, senior director of ASHP’s Section of Pharmacy Practice Managers, said data cited in the report help to demonstrate “the impact and frequency of medication use in the United States and the role effective medication management can have on supporting the health system’s quality and financial goals.” Chen encouraged pharmacy leaders to share NGA’s findings with their hospital’s senior executives and government affairs staff. The NGA report is part of a series that examines how states can better enlist the skills of nonphysician healthcare providers—specifically, nurse practitioners, physician assistants, dental hygienists, and pharmacists—to meet expected needs for primary care services. Crippen said the reports, which were funded through a grant from the Health Resources and Services Administration (HRSA), generally agree that the supply of primary care “could be supplemented Continued on page 338


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by allowing these professions to practice at the top of their licenses.” “Of the four [professions] that we’ve looked at, most states have some limitations on scope of practice for one or more of those professions. So there’s certainly a common cause, if you will,” Crippen noted. Primary care is a major focus of federal health reform efforts, including payment models that emphasize coordinated care and reimbursement on the basis of health outcomes instead of the volume of healthcare services provided. HRSA in 2013 stated that the demand for primary care services is poised to outstrip the national supply of primary care physicians in the United States. The shortfall—an estimated 20,400 physician full-time equivalents by 2020—is driven mainly by population growth and aging, according to the agency. Crippen said the retirement of baby boomers, including physicians in that age group, will strain the nation’s healthcare capacity. “We’re going to double the number of retirees from 40 million to 80 million over the course of the next 15 years,” he warned. He said the intent of the report series is to provide governors’ offices with evidence-based policy options to improve primary care capacity. “We’ve been talking to governors consistently over the last two or three years about all of the influence they have over healthcare,” Crippen said. State-level policies may affect the availability of physical components of healthcare, such as public hospital and nursing home beds, as well as services available to Medicaid enrollees. And state-funded universities exert some influence over their future work force by determining how many students to accept in healthcare-related programs. But Crippen said the scope-of-practice issues highlighted in the NGA reports represent a meaningful opportunity for governors’ offices to boost the availability of healthcare services.


“It’s a big piece that they can have an effect on more quickly than some of the others,” Crippen said. “In theory, at least, it can be accomplished much more quickly than the building of new facilities or training of new doctors.” He said some states are using the reports as the basis for assessing their healthcare work force and determining how best to meet immediate and future patient care needs. So far, just four states—California, Montana, New Mexico, and North Carolina—have laws that create an advanced pharmacy practice credential for pharmacists to expand their scope of practice through the use of collaborative practice agreements. Although state legislatures ultimately determine whether to develop and move forward with expanded scope-of-practice laws, governors’ offices can influence the process. “What the governors can do is put pressure on their state legislature to move forward,” explained Nicholas Gentile, ASHP’s director for state regulatory affairs. Gentile said governors’ offices work much like legislative offices in responding to constituents’ concerns. And he said governors’ offices are another venue

for pharmacists to promote the benefits of “expanded scopes of practice, broader collaborative drug therapy management rules and regulations,” and related issues. Crippen, who has led NGA since 2011, indicated that governors’ offices may not be aware that pharmacy training has evolved to support an expanded clinical role for the profession. He said he first heard the term medication therapy management just a few years ago, but he’s known for a decade about the role nurse practitioners play in providing direct patient care. “Unfortunately, pharmacists have too often been thought of, typically, [as being] in a store dispensing medication as opposed to being part of a care team,” Crippen said. Federal legislation that was introduced in the House and Senate in late January would grant healthcare provider status under Medicare to pharmacists caring for patients in medically underserved areas. ASHP and other members of the Patient Access to Pharmacists’ Care Coalition urge pharmacists to ask their congressional representatives to support the legislation. —Kate Traynor DOI 10.2146/news150015

California strengthens antimicrobial stewardship mandate for hospitals


California law that goes into effect this summer strengthens the state’s previous requirement for acute care hospitals to practice antimicrobial stewardship. Starting July 1, acute care hospitals in California must put into effect antimicrobial stewardship programs that follow federal and professional society guidelines and include a process to evaluate the judicious use of antimicrobials. The law speci-

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fies that the stewardship teams must be multidisciplinary and include “at least one physician or pharmacist” who has expertise and training in antimicrobial stewardship. California is the only state that has enacted legislation mandating antimicrobial stewardship for hospitals. The law, which was passed last September, supplements legislation from 2006 that mandates stewardship programs for California’s acute care

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Governors' association backs expanded primary care role for pharmacists.

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