Provider Status

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OPA is actively participating in implementation efforts of provider status programs across the state. On January 4, 2019, Governor John Kasich signed SB 265, which formally recognizes pharmacists as providers in Ohio. The legislation, sponsored by State Senator Matt Dolan, changed key provider definitions and insurance laws to catch up to the growing role of the pharmacist. SB 265 will help remove barriers that have prevented health plans, hospitals and healthcare teams from integrating and utilizing the expertise of the pharmacist.

This page is a central hub for information about the new law, as well as OPA's ongoing efforts to utilize it to elevate the role of the pharmacist, drive practice innovation, and improve patient access to pharmacist care in Ohio.

Updates

  • Four Managed Care Organizations have launched programs where they are reimbursing pharmacists for their patient care services, November 2020
    Since our last update in June, the Ohio Pharmacists Association has been hard at work to ensure provider status implementation continues so that you can look forward to expanding patient access to care under this new model. And, we have to tell you, things have been moving quickly and expanding rapidly. As of the writing of this update, four Managed Care Organizations (MCOs) have launched programs where they are reimbursing pharmacists for their patient care services! UnitedHealthcare (UHC) Community Plan of Ohio has continued their Pharmacy Care Extension program including two independent pharmacies. Buckeye Health Plan was quick to follow and launch in two Federally Qualified Health Centers (FQHCs) and one health-system. CareSource launched their program in two independent pharmacies and one health-system. Molina has approval to launch a program with 10, yes 10 independent pharmacies across Ohio.

  • CareSource launches pharmacist provider status pilot, August 2020
    In August, OPA and CareSource announced a six-month pilot program reimbursing pharmacists for clinical services provided to Medicaid patients in Ohio. The Pharmacist Provider Status Pilot program includes two sites near Dayton, Ohio: an independent pharmacy in a rural community, Camden Village Pharmacy, and an inner-city independent pharmacy, ZIKS Pharmacy. Pharmacists involved in the pilot have collaborative practice agreements with physicians, nurse practitioners, or physician assistants, and the pharmacists will focus on CareSource patients that they have identified as being at high-risk or in need of care for tobacco cessation, opioid management, diabetes, and/or asthma. The pharmacist provider status pilot adds to the Value-Based Reimbursement (VBR) opportunity, that CareSource released in January 2020. The VBR program is the first of its kind in the state and allows for pharmacies to achieve payment for increasing the quality of patient care outside of the traditional pharmacy benefits manager reimbursement model.

  • Buckeye Health Plan launches new program that expands pharmacist’s role in patient care, June 2020

    In June, OPA joined Buckeye Health Plan in announcing the launch of the first phase of a new program that expands the role of pharmacists in direct patient care to improve the health outcomes of people living with chronic diseases, especially for Ohio’s most vulnerable populations. Through the program – which seeks to utilize recent OPA-backed law changes in Ohio that elevate the role of the pharmacist – physicians and participating pharmacists will work closely with patients living with chronic conditions like diabetes, depression and cardiovascular disease. The pharmacists will provide consultation, monitor medication and adjust as needed, demonstrate medical equipment, order lab tests, and provide preventative care including vaccinations.

  • Provider Status Implementation Update, June 2020
    Early in April, UnitedHealthcare (UHC) Community Plan of Ohio announced the launch of their Pharmacy Care Extension program. This exciting development has directly resulted from the passage of Ohio’s SB 265 legislation, recognizing pharmacists as healthcare providers. In the first phase, the managed care organization has chosen two pharmacies in northeast Ohio to pioneer this program. UHC Medicaid patients will now be able to have extended opportunities to meet and consult with their pharmacist. Pharmacists will be reimbursed for the time spent managing chronic conditions, conducting transitions of care visits, and interprofessional consults with other healthcare providers. Services provided include adherence checks, medication reconciliations, new medication counseling, disease state management, and transitions of care management

  • Pharmacists tapped by UnitedHealthcare to expand access to care and help improve health outcomes in Ohio, April 2020
    In the first significant move to deploy pharmacists in new ways, UnitedHealthcare – the largest private payer of healthcare in the world – announced the launch of their new, first-of-its-kind Pharmacy Care Extension program, utilizing two independent pharmacies in northeast Ohio to expand patient access to care, relieve pressure on health systems, and help drive better health outcomes for Medicaid beneficiaries.

  • Provider status implementation update, February 2020
    Hello fellow pharmacists. I want to take this opportunity to update you on what is happening with pharmacist provider status in Ohio. For a quick recap, SB 265 was signed into law in January 2019, updating all Ohio Revised Code to include pharmacists as a provider any place that health care provider is listed. Having this change in the law is the first step; the next step is to actually get payors to recognize pharmacists as providers within their networks to reimburse for clinical services.

  • OPA launches new pharmacy practice transformation initiative, November 2019
    OPA has announced the launch of a new initiative aimed at expanding patient access to pharmacist services across the state. The effort seeks to utilize the new state "provider status" law that aims to better integrate pharmacists onto healthcare teams to improve patient outcomes. OPA and lawmakers have made great strides in evolving the role of pharmacists in recent years, but the previous legal barriers in the insurance code prevented many institutions from deploying pharmacists in more elevated, clinical roles that reflect their extensive education and training. While several states across the country have passed similar “provider status” laws for pharmacists, in most instances, uptake in the market has typically fallen short. To be sure that this same fate does not occur in Ohio, OPA has partnered with Ohio’s colleges of pharmacy, added resources, and hired several new staff members to work with pharmacies, health insurance plans, and state Medicaid officials to begin integrating pharmacists into the care delivery system.

Program Launch Reactions | Pharmacist Provider Status Log | Episode 2

Meet the Pharmacies | Pharmacist Provider Status Log | Episode 1

Launching: The Provider Status Log 

Introduction to Ohio Provider Status

Media

Pharmacists in Ohio managing care as providers — and getting paid for it too - Modern Healthcare, 9/26/2020

Medicaid managed care plans start paying Ohio pharmacists as providers - Pharmacy Today, 9/1/2020

Ohio pharmacists enlisted to provide new health-care services - Columbus Dispatch, 8/11/2020

CareSource launches pilot reimbursement program for pharmacists - Dayton Business Journal, 8/6/2020

Pilot to pay Dayton pharmacists for more types of care - Dayton Daily News, 8/5/2020

CareSource launches pharmacist provider status pilot - CareSource, 8/4/2020

Records: Ohio Medicaid leaders showed little enthusiasm to support coronavirus testing at pharmacies - Ohio Capital Journal, 8/4/2020

Efforts to expand Ohio COVID testing to community pharmacies stalls - Columbus Dispatch, 7/30/2020

Ohio Medicaid starts paying pharmacists for COVID-19 testing & pilots focus on direct care from pharmacists - BMD, 7/2/2020

Ohio Medicaid begins laying out plans for coronavirus testing at pharmacies - Ohio Capital Journal, 7/1/2020

Medicaid pilots focus on direct care from pharmacists - Hannah News, 6/30/2020

Medicaid begins to pay smaller pharmacies for coronavirus testing - Columbus Dispatch, 6/29/2020

Despite promises, Medicaid still not paying pharmacists to test for coronavirus - Ohio Capital Journal, 6/29/2020

Program expanding role of pharmacists launches in Cincinnati - Cincinnati Business Courier, 6/25/2020

State hasn’t acted, but Medicaid care companies move to pay pharmacists for medical services - Ohio Capital Journal, 6/24/2020

After months of questions, Ohio Medicaid to start paying pharmacists for coronavirus testing - Ohio Capital Journal, 6/15/2020

Ohio’s community pharmacies can now offer COVID-19 tests - Columbus Dispatch, 6/15/2020

Amid other challenges, Medicaid department conducting massive overhaul - Ohio Capital Journal, 6/11/2020

Senate president, other lawmakers demand Ohio pharmacists be paid for coronavirus testing - Columbus Dispatch, 6/5/2020

Ohio Medicaid undermines governor’s plan to expand coronavirus testing to local pharmacies - Columbus Dispatch, 6/4/2020

Governor says pharmacists should test for COVID-19, but Ohio Medicaid won’t clear the way for them to be paid - Ohio Capital Journal, 6/1/2020

Ohio pharmacists one step closer to performing COVID-19 testing - WEWS 5 Cleveland, 5/28/2020

Column: Pharmacists can meet patients’ needs, unburden system - Columbus Dispatch, 4/30/2020

UnitedHealthcare working to re-make care model at Ohio’s community pharmacies amid coronavirus - Columbus Dispatch, 4/13/2020

Pharmacists called to do more as Ohio hospitals need more staff to battle coronavirus - WSYX 6 Columbus, 3/30/2020

Details emerge in CareSource pharmacy network change - Dayton Daily News, 11/14/2019

How Pharmacist Provider Status Is Crucial in Fighting the Opioid Epidemic - Drug Topics, 4/19/2019

April Marks Start of Provider Status for Ohio Pharmacists - American Society of Health-System Pharmacists, 3/19/2019

Ohio hits provider status milestone with new law - American Pharmacists Association, 1/15/2019

Resources

  • NPI Application Guide
  • Ohio Pharmacy Services Survey 
    OPA is gathering information to build a snapshot of services pharmacists provide across the state. Relevant information may be shared to health plans or state officials as OPA discusses provider status implementation. Start engaging with provider status by participating in the Ohio Pharmacy Services Survey.
  • OPA Provider Status Background Information
    OPA has created this presentation to help assist you with community outreach or education of pharmacists on provider status. The presentation is here to help you present on background information regarding provider status.