Ohio Provider Status for Pharmacists

On January 4th, 2019, the Governor of Ohio signed into law SB 265, which gave pharmacists provider status in the state and allowed Ohio pharmacists to perform services and receive payment after successful credentialing. Ohio’s Medicaid and Managed Medicaid programs are in the initial phases of including pharmacists as providers.

In April, United Healthcare Community Plan of Ohio announced that it would begin working with two independent community pharmacies in Ohio to expand access to care and help improve health outcomes in Ohio. During the COVID-19 pandemic, United Healthcare utilized the expertise of pharmacists to focus on caring for patients transitioning out of hospitals, assisting patients with the management of their chronic diseases (e.g. High Blood Pressure, Diabetes, etc.), helping to prevent adverse events, and optimizing therapies. This program also enabled pharmacists to bill and receive reimbursement for providing services using existing CPT codes for evaluation and management, virtual check-ins, and transitional care management.

Ohio’s Centene managed care organization, through Buckeye Health Plan, launched a program in June 2020; during the initial phase, participating pharmacists worked with physicians at a health system and two federally qualified health centers.  Pharmacists served patients living with chronic conditions through monitoring and adjusting medication, demonstrating medical equipment use, ordering lab tests, and providing preventative care, including vaccinations.

CareSource, an Ohio Managed Medicaid plan, announced a provider status program focused on two independent community pharmacies near Dayton, Ohio: an independent pharmacy in a rural community, Camden Village Pharmacy, and an inner-city independent pharmacy, ZIKS Pharmacy. The pharmacists in this pilot program will focus on CareSource patients that have been identified as being at high-risk or in need of care for tobacco cessation, opioid management, diabetes, and/or asthma. The CareSource pharmacist provider status pilot will also be added to the Value-Based Reimbursement opportunity that was released by CareSource in January 2020. This will allow pharmacists the ability receive payment for increasing the quality of care of patients.

The Ohio Department of Medicaid announced they will create provider identification numbers for pharmacists in January 2021.  The Ohio Department of Medicaid has begun compensating pharmacists for conducting COVID-19 testing.

Ohio pharmacists will not be included as providers for Medicare plans until federal changes occur.  Commercial plans may choose to include pharmacists as providers but are not required.  Will we see other states following Ohio’s lead? Are you advocating for this type of change in your state?



Posted October 2020

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