We hear a lot about provider status and pharmacists being reimbursed for clinical services.
Ambulatory care pharmacists are already being reimbursed for services such as anticoagulation, behavioral health, and oncology. Some pharmacists are billing for office visits. Often, getting reimbursed involves getting creative, forming collaborative practice agreements with physician offices, offering enhanced services such as medication consultations or managing prior authorizations.
After completing his community pharmacy rotation, Michael Higbee, PharmD, pharmacy manager and clinical specialist at Buhl Drug in Buhl, Idaho, saw the potential in providing reimbursable clinical services to the community.
Soon after he graduated pharmacy school, Higbee opened Buhl Drug. “From the start, I focused on MTM services, employer health programs, and physician outreach.” Over the last 9 years, Higbee has built a fee-for-service patient care pharmacy.
Through marketing his MTM services, he receives patient referrals from local providers who pay cash for clinical services. Higbee goes out into the community to provide on-site flu shot clinics for various clubs, businesses, schools, and municipalities, billing directly for those services.
Building on those relationships, he offers smoking cessation treatment and weight loss clinics, charging the employer $ 40 per employee who enrolls.
Several years ago, Higbee wrote a collaborative practice agreement with a local physician so he could prescribe smoking cessation therapies. Since then, laws have changed in Idaho and pharmacists are allowed to prescribe for a host of conditions. Because they cannot currently bill insurance for these services, they charge a competitive cash price in line with insurance copays.
“Patients are usually happy to pay the small service fee because they can get quick service instead of waiting days to get into an available doctor,” Higbee said.
Higbee, who has been recognized for outstanding outcomes and was a regional McKesson Healthmart Pharmacy of the Year winner, also regularly prescribes naloxone (Narcan) to patients on opioids, without charging for that service.
“I personally feel so much more fulfilled with my career when I am an active participant in my patient’s health care team. Pharmacists learn and train to provide these services, but all too often are stuck just trying to keep their head above water in understaffed pharmacies. There is nothing better than making a real difference for my patients.”