Three minute read: Rather than spend all our time advocating before Congress and federal agencies, we should invest in telling our story in state capitals. After all, that’s where we get our authority to practice.
Organized pharmacy has been advocating for pharmacists to be officially recognized as Medicare providers for several years. During the 115th Congress, a majority of members of the US House of Representatives and Senate had signed onto proposed legislation to allow pharmacists to bill Medicare for services to beneficiaries under certain circumstances. Despite the apparent popularity of the idea, the legislation never received a committee hearing or markup.
In the United States, the practice of pharmacy is regulated at the state level. States determine what services each healthcare profession is allowed to perform, and states have sole determination over who is granted a license to practice.
Federal legislation introduced in the recent past recognized this and allowed pharmacists to provide services included in the scope of practice authorized by their state license.
Focusing on Congress may have been a strategic error in the fight over pharmacist professional recognition. For health professionals, the main arena is in state capitals. One of the more successful initiatives in expanding the scope of practice for pharmacists involved the creation of collaborative practice agreements (CPA). Most states have allowed pharmacists and prescribers to crate an agreement for pharmacists to engage in product selection, order lab tests, and provide therapy oversight.
The extent to which pharmacists have taken advantage of these opportunities is spotty, but let’s consider these arrangements to be a step toward independent prescribing authority, the holy grail of full scope of practice.
Getting to this point on CPAs took awhile but all the effort was directed by pharmacy organizations and was aimed at state legislatures or boards of pharmacy. Wouldn’t it be an advantage to gaining provider status if most states allowed pharmacists to perform at the highest level of their training?
While most of the public focus on healthcare advocacy takes place in Washington, DC (Congress) or in Baltimore (CMS), the states have acted on many healthcare policy issues, even during the pandemic. Unlike Washington, DC, not all states are driven by partisan gridlock.
Since state legislative districts are smaller than Congressional districts you have more influence in states than in the federal arena. While members of Congress have large staffs, state legislators have fewer people to follow all the issues on which they are asked to make policy decisions. Local experts in pharmacy (or in any profession) are able to provide expertise that’s not readily available to a legislator.
State legislators are much more accessible, as a rule, than are members of Congress. You have a better chance to personally inform and persuade state legislators than you do with a U.S. Congressman or Senator.
Finally, state legislatures typically resolve issues faster than their federal counterparts. Legislative sessions are shorter, and some legislatures don’t meet every year. They generally begin work in January and adjourn by early summer.
States often consider legislative issues for a few years. Finally, one state makes a move and suddenly several others follow. Consider marijuana legalization. The effort to decriminalize recreational marijuana use goes back more than 50 years but didn’t achieve much success until California passed legislation in 1996 to legalize medical marijuana. In 2014, Colorado allowed recreational marijuana use and now 48 states allow some form of legalized marijuana use, even though the federal government maintains a prohibition against the drug.
One state can start a chain reaction that signals to other states that an issue has finally come of age, and it is now safe to innovate. For our purposes that issue may be something as bold as independent prescribing authority or as incremental as expanding CPAs. Is there a state that has the right political climate that might serve as a national catalyst? There probably is.
Don’t Sit Still