Colorado bill would reimburse certain pharmacists’ services

HB 18-1112 awaits governor’s signature

The Colorado legislature has approved state legislation that would require insurers to reimburse pharmacists for services delivered in an area with a health professional shortage, if the plans cover the same services when delivered by a physician or advanced practice nurse. The bill, HB 18-1112, moves to the governor’s desk after its March 23 passage in the Colorado state Senate.

The legislation provides an opportunity for pharmacists to bill and get reimbursed for nondispensing services and expands access for patients in rural communities. Newly covered nondispensing services would include provision of contraception services, immunizations, and smoking cessation.

“Particularly in rural areas in our state—of which there are many—there’s oftentimes one or two primary care providers in a county. Patients often have to wait for periods of time to see their providers,” said Gina Moore, PharmD, MBA, assistant dean for clinical and professional affairs and associate professor of clinical pharmacy at University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. “In health professional shortage areas (HPSA), there are pharmacies and community pharmacies that are readily accessible to those patients for services that are within the pharmacist’s scope of practice.”

Moore added that “in the federally qualified health centers, which are also HPSA by facilities designation, we oftentimes have clinical pharmacists who are part of the health care team to provide patient care or chronic disease management per collaborative direct therapy protocol. So for those patients who have third-party insurance, we would also have the ability for pharmacists to bill for those services, as opposed to trying to be creative with incident-to or other types of billing that might be available to them currently.”

According to Moore, pharmacy advocates started with a narrow focus to gain the support of insurers. But, she said, “I still think it’s a tremendous opportunity for pharmacists, particularly in rural communities and federally qualified health centers, to really be able to demonstrate their value to the health care team.”

Moore believes that the legislation, if enacted, would not only expand access for HPSA patients, who may be forced to use mail-service pharmacy without being able to take advantage of pharmacists’ patient care services; it also could eventually lead to “a financial model that’s viable” for pharmacies that serve these patients. “Hopefully, additional sources of revenue will help them to achieve financial stability in their business so that they are able to provide those services to patients,” she said.

“Eventually we would love to see that expanded to more urban areas of our state. Hopefully, once insurance companies see the value in having the infrastructure set up within their system to recognize pharmacists as providers, it will be easier for them to add pharmacists to their network of providers,” Moore added.

The legislation also includes preliminary mechanisms for pharmacist credentialing within health care and with health plan insurers. “I think the goal is that pharmacists are recognized and enrolled in the network of providers so they have a clear-cut billing mechanism to provide those services,” Moore said.