Pharmacist Reimbursement for Test and Treat – Guest Writer Parsa Famili

My interest in discussing how pharmacists should be reimbursed for performing diagnostic tests, including rapid strep, influenza, and H. pylori tests, as well as the pharmacists ability to furnish medications to appropriately treat the patient based on the test results, stems from the passion I developed for advocating for these services with our state pharmacy association in February. As members of the Texas Pharmacy Association, student pharmacists, including myself, pharmacists, and corporate leaders across the state participated in the Virtual Pharmacy Legislative Day at the State Capitol, during which we encouraged passage of a bill that would allow pharmacists to be reimbursed to “test and treat.” Specifically, the legislation would permit pharmacists who have protocols with physicians to write prescriptions for medications based on whether the patients receive a positive result from a CLIA-waived test like the Strep or flu test. As a reminder to our readers, a CLIA-waived test is a simple laboratory test that does not have as much risk of leading to a result that is not correct. Pharmacists in the state of Texas cannot prescribe medications for patients who receive a positive test result from the individual tests that the pharmacists perform on the patients. We believe that the legislation that we advocated for would prevent delays in care and allow the patients to recover faster from their symptoms while decreasing the spread of contagious diseases like strep or the flu. We also believe that the legislation would increase the patients’ access to high-quality care, reduce the amount of money the health care system has to pay for patients’ potential health complications from the diseases, and improve overall health outcomes for the patients. By allowing pharmacists to prescribe medications to patients who receive a positive result from a CLIA-waived test, we believe that the legislation would allow the patients to receive the proper treatment in a timely manner for their diseases.

An issue bigger than one state

The legislation that is being advocated for in Texas can and should be a priority for pharmacists across the United States. Right now, pharmacists in at least 16 states across the nation can perform diagnostic tests for conditions such as strep and influenza. In the states of Idaho, Illinois, Michigan, Minnesota, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Tennessee, Utah, Vermont, Washington, and Wisconsin, pharmacists are permitted to prescribe medications to patients who test positive on a CLIA-waived diagnostic test pursuant to their collaborative practice agreement laws. Additionally, three states, Idaho, Kentucky, and Florida, have passed specific legislation that allows pharmacists to prescribe medications to treat strep, flu, and other non-chronic minor conditions upon receiving positive results from the diagnostic tests. Each of these states have different requirements, such as whether or not they use state-wide protocols or if it is through an agreement with a physician that these services can be provided. However, all result in the same increased access to pharmacists services and optimal care for patients. 

While it is wonderful that several states already allow pharmacists to have such authority, it is imperative that we push for legislation in the other 34 states and the District of Columbia to allow pharmacists to prescribe medications based on a positive diagnostic test result for acute and minor health conditions that a patient may have! That way, pharmacists can have even more power and direction to improve the health outcomes of patients and provide timely, accessible care to patients. In turn, pharmacists can play a vital role in minimizing the costs associated with the patients’ health conditions in the form of treatment for complications associated with untimely care and additional office or emergency room visits.

The impact of expanding access to test and treat

In the long-run, allowing pharmacists to prescribe medications to treat acute and minor conditions like the flu and strep would deepen the trust that pharmacists have with patients and other health care professionals. Pharmacists could also provide more information to patients about their medications and address any questions or concerns the patients may have. Because patients see pharmacists as approachable and non-judgmental in general, it would also be a boon in terms of providing more of a blame-free zone for the patients to discuss their health problems with regards to the minor and acute health conditions with the pharmacists. Having pharmacists integrated into this model would also provide an easy and accessible provider to follow-up with the patients to ensure appropriate treatment outcomes. Above all, pharmacists can improve the health outcomes of patients by alleviating the patients’ diseases effectively and efficiently.

Limitations to keep in mind

Some problems to keep in mind as we start to consider the idea of pharmacists providing “test and treat” services: the fact that patients generally still consider the physician as the one who primarily diagnoses their diseases, the fact that patients may not know that pharmacists can prescribe medications, and the fact that patients generally are unaware of the expanded role of a pharmacist. The end result is that the patients would feel less confident and comfortable about pharmacists prescribing medications to them. It is particularly important to consider these barriers as we continue to develop and implement these services. Going forward, it is crucial that pharmacists educate their patients about their roles in providing care and improving overall health outcomes while emphasizing that pharmacists have the expertise and training to prescribe the appropriate medications for the patients to treat their conditions. That way, patients can feel more confident and trust that the pharmacists can best manage their acute conditions in collaboration with other health care professionals.

Advocate for a positive future

The future for pharmacists in terms of prescribing medications for acute conditions like the flu or strep after obtaining results from diagnostic tests is bright. Pharmacists have the ability to shape health care for years to come if they gain the ability to conduct diagnostic tests and prescribe medications to patients based on the results of the tests. As we have seen during the pandemic, it is essential for pharmacists to be at the forefront of managing patients’ acute conditions. By doing so, the patients could avoid a trip to either their physician’s office or to the emergency department for a preventable situation. Pharmacists can already administer vaccines and conduct health screenings for other conditions like blood pressure or blood glucose checks. Pharmacists have the appropriate knowledge about medications and health conditions to make decisions that best manage the patients’ conditions. The legislation that we advocated for in Texas is just the beginning of a long road to prove to both health care professionals and patients that pharmacists can play a pivotal role in managing patients’ health instead of being health care professionals who just dispense medications.