Payer/Processor Payment Rates and Methodologies Impacting Patient Safety (Resolution 121-3-25)
RESOLUTION NO: 121-3-25
TITLE: Payer/Processor Payment Rates and Methodologies Impacting Patient Safety
ACTION: PASS
WHEREAS, state boards of pharmacy are charged with protecting public health as it relates to patient safety, patient health, and patient services provided by pharmacists and pharmacies; and
WHEREAS, payer and/or processor payment rates and methodologies for pharmacy services have a direct and immediate impact on patient safety, pharmacy staffing, and patient access to care; and
WHEREAS, payer and/or processor payment rates and methodologies have contributed to pharmacy closures, resulting in the reduction, and in some cases elimination, of patient access to pharmacist care services – such rates and methodologies include, but are not limited to, inadequate reimbursement, or reimbursement under costs, which may inhibit pharmacies’ ability to provide safe patient care environments; and
WHEREAS, the United States Federal Trade Commission issued an Interim Staff Report in July 2024, finding that “between 2013 and 2022, about ten percent of independent retail pharmacies in rural America closed. Closures of local pharmacies affect not only small business owners and their employees, but also their patients. In some rural and medically underserved areas, local community pharmacies are the main healthcare option for Americans, who depend on them to get a flu shot, an EpiPen, or other lifesaving medicines”1; and
WHEREAS, unnecessary and burdensome prior authorization requirements increase the likelihood of prescription abandonment and patient care delays that could lead to significant adverse patient health outcomes, including increased mortality and morbidity; and
WHEREAS, participants in the 2023 joint summit titled “Implementing Solutions: Building a Sustainable, Healthy Pharmacy Workforce and Workplace,” convened by NABP, the American Pharmacists Association, and the American Society of Health-System Pharmacists, recommended the following from a multitude of action items for participating organizations and/or stakeholders:2
- educate the public, health-system executives, and payers on the value of pharmacy services with case studies and success stories in order to create sustainable collaboration with the care team and within organizations;
- leverage existing payment models and processes used for medical billing so that pharmacists are reimbursed for pharmacy services;
- work with state payers and commercial health plans to establish pharmacist credentialing pathways that leverage pharmacists’ impact on health care outcomes, as well as a compensation model that is outcome focused; and
- increase awareness on types of stressors (eg, eustress and distress), the stress continuum model (eg, ready, reacting, injured, ill), and strategies to manage short and long-term stress;
THEREFORE BE IT RESOLVED that NABP be unencumbered and free to cite where appropriate when payer and/or processor payment rates and methodologies act as factors contributing to workforce challenges, burnout rates, worsened mental health impacting patient safety, and increased stress in the workplace.
(Resolution passed at the 121st Annual Meeting in Fort Lauderdale, FL.)
1https://www.ftc.gov/reports/pharmacy-benefit-managers-report