Policy Analysis: Pharmacy and Medically Underserved Areas Enhancement Act By Ryan Mills Overview of the Health Problems While the Affordable Care Act (ACA) provided health coverage for more Americans, it also increased the demand for health services. Despite the implementation of the ACA, over 20% of Americans do not have access to primary care physicians (PCPs) largely due to the fact that the current supply of PCPs does not meet the market’s demand, especially in rural areas. In the rural North Carolina county of Columbus, for example, the County Health Ranking report states that the ratio of PCPs to patients is 2,620:1. (1) According to Health Workforce Analysis conducted by Health Resources and Services Administration (HRSA), the projected shortage of PCPs will be 20,400 in 2020. (2) Of note, this is the national average and does not account for the disparity between rural and urban areas. The supply of PCPs in rural areas is forecasted to be well below the national average. Due to the aging of the baby boomer generation and the implementation of the ACA,
the demand for primary care services will sharply increase through 2020. The HRSA projects the demand for care will be far greater than the supply of PCPs and increased optimal use of non-physician providers can help mitigate the PCP shortage and bridge the gap in care for patients. Pharmacists are an integral part of the healthcare team, and when integrated, patients, providers, community, and healthcare systems all benefit. (3) Granting pharmacist’s provider status in medically underserved areas is one way of increasing access to care. H.R. 592 and S. 109 seeks to amend the Social Security Act in which Medicare would recognize pharmacists as healthcare providers enabling coverage for pharmacist-provided clinical services. Passage of H.R. 592 and S. 109 into law would mean pharmacy services consistent with state laws, provided to Medicare beneficiaries in medically underserved areas, and would be reimbursable under Medicare Part B. In North Carolina, pharmacists can administer most vac-
North Carolina Pharmacist
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cines designated by the CDC without a prescription. North Carolina pharmacists, with appropriate training and experience, can obtain their Clinical Pharmacist Practitioner (CPP) credential and enter into collaborative practice agreements with physicians, whereby the physician grants authority to the pharmacist to provide specific patient care services. Physician-pharmacist collaborative practice authority has been used in North Carolina since 1998 as a means to provide improved care for patients with conditions such as diabetes, hyperlipidemia, hypertension, hypothyroidism, osteoporosis, chronic pain and smoking cessation. (4)
Severity of the Health Problem Access to PCPs is vastly different in rural communities in comparison to urban areas. Rural communities across the U.S. face many contributing factors that create disparity in the delivery of healthcare. According to the National Rural Health Association report, living in remote areas correlates with poorer health due to social and economic factors such as educational shortcomings, health behaviors, and lack of access to care. Table 1 illustrates the disparity between urban and rural areas in the US. The increasing demand for healthcare services coupled with the vast difference in the percentage of physicians in rural compared to urban areas magnifies the importance of passing H.R. 592/S.109.
Volume 99 Number 3 Summer 2018
