The Pennsylvania Pharmacists Association (PPA) and the Pennsylvania Pharmacists Care Network (PPCN), the Pennsylvania Society of Health System Pharmacists (PSHP), the Philadelphia Association of Retail Druggists (PARD) and the Pennsylvania Association of Chain Drug Stores (PACDS) and are pleased to announce that Pennsylvania Medicaid will allow pharmacists to enroll as a mid-level practitioner and be eligible to bill for services. This change, effective March 1, 2024, is a significant milestone for the practice of pharmacy in Pennsylvania!
In Pennsylvania, “provider-status” means being eligible for payment of services on parity with other healthcare providers within the existing scope of practice authorized by the Pharmacy Practice Act with amendments per Act 80 of 2020, and pursuant to PA Code 49 Chapter 27, the State Board of Pharmacy regulations. We would like to thank PA Medical Assistance for acknowledging licensed pharmacists’ scope of practice and the impact they can have on patient outcomes by seeking a state plan amendment from the Centers for Medicare & Medicaid Services (CMS) to add licensed pharmacist services to the Other Licensed Practitioner (OLP) benefit.
PA Medicaid is recognizing pharmacists as a health care provider, creating access for pharmacists to provide and bill PA Medicaid fee-for-service for rendered services. A full list of services will be available from PA Medicaid on February 10, 2024. Unlike traditional pharmacy billing, use of these billing codes will require enrollment with PA Medicaid, and with each of the seven Managed Care Organizations (MCOs) operating in Pennsylvania. Each MCO will also establish mechanisms to credential and contract with pharmacists. Pharmacists can provide services in all outpatient settings where they have the ability to bill medical claims (i.e. community pharmacies, ambulatory clinics, medical offices, etc.).
Pharmacists and employers are advised to look for the official announcement in the Medicaid Bulletin published on February 1, 2024, and available on the PPA website HERE and on the PSHP website HERE. The Department of Human Services will offer a 2-hour virtual training session for pharmacists who wish to enroll as billing providers in the PA Medical Assistance/Medicaid Program on February 15 at 10:00 a.m. The training will include instructions for creating a login on the provider enrollment portal, completing the provider application with a list of information required when applying, and submitting claims for FFS/ACCESS for billing. Pharmacists can register for the training on line HERE.
“PA Medicaid’s recognition of pharmacists as care providers comes at a critical time when patients are increasingly losing access to needed care in communities, notably those in rural and urban underserved areas where pharmacists are capable, accessible, and passionate about ensuring the health of our communities,” said Christopher Antypas, PharmD, President of the PPA Board of Directors. “This opportunity would not have been possible without Pennsylvania-based pharmacy organizations speaking clearly, with a unified voice. Your state pharmacy associations are unified in comprehensively advocating for the value of pharmacy care to all stakeholders including the legislature, state agencies, payors and patients. By taking a holistic approach to promoting the value of a pharmacist’s scope of practice, we are well on our way toward equitable and sustainable access to pharmacist services.”
About The Pennsylvania Pharmacists Association
Founded in 1878, the Pennsylvania Pharmacists Association is a professional membership organization of more than 2,300 pharmacists, pharmacy students, and pharmacy technicians across the Commonwealth of Pennsylvania, representing all facets of pharmacy practice. As the leading voice of pharmacy in Pennsylvania, it promotes the profession through advocacy, education, and communication to enhance patient care and public health.
About the Pennsylvania Pharmacists Care Network
The Pennsylvania Pharmacists Care Network (PPCN), a CPESN® USA network, is a clinically integrated network of over 200 community pharmacies in Pennsylvania that provide enhanced patient care services and work to advance community-based pharmacy practice. In collaboration with payors and providers, PPCN Pharmacists provide high quality medication management services to patients ensuring appropriate medication use and improved health outcomes. PPCN is a service of the Pennsylvania Pharmacists Association (PPA), the state’s leading voice for advocating for the profession of pharmacy and advancing the quality of patient care.
About the Pennsylvania Society of Health-System Pharmacists (PSHP.org)
PSHP’s members include pharmacists, pharmacy technicians and student pharmacists practicing in
hospitals and health systems. PSHP’s mission is to advance patient care by promoting excellence in health-system pharmacy practice. This is achieved through “caring, collaboration, education and advocacy” with our patients, other health professionals and our pharmacy colleagues. Our members practice in acute care and specialty hospitals, as well as in health system operated ambulatory care programs. The latter includes health system owned/operated community pharmacies, home infusion, infusion centers, specialty pharmacies, and clinical pharmacy programs where the pharmacists in medical practices provide patient care under collaborative practice agreements. PSHP is the Pennsylvania affiliate of the American Society of Health System Pharmacists.
About the Philadelphia Association of Retail Druggists
In 1898, a group of 20 pharmacy owners in Philadelphia joined forces to create the Philadelphia Association of Retail Druggists, or PARD. Today, we represent over 250 independently owned pharmacies across Pennsylvania, concentrated in Philadelphia and the surrounding counties. We have members as far north as Scranton, and as far west as Pittsburgh. PARD is an advocacy organization, dedicated to creating a landscape for Independent Pharmacy owners to help them survive and thrive. We have lobbyists and advisors on staff to help guide us through the political process in Philadelphia and Harrisburg to get favorable laws and regulations passed to help pharmacies and their patients. PARD also owns the Keystone Pharmacy Purchasing Alliance, a buying group dedicated to serving pharmacies with vendors delivering the best price and the best service.
About the Pennsylvania Association of Retail Druggists (PACDS)
PACDS represents 13 member companies who operate approximately 1,100 pharmacies in the Commonwealth. Our membership includes AHOLD/Giant Food Stores, ACME/Albertsons, Genoa Healthcare, Giant Eagle, Market 32/Price Chopper Supermarkets, Rite Aid, Tops Markets, Walgreens, Wal-Mart-Sam Stores, Wegmans Food Markets and Weis Markets.
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