Pharmacy Making Strides in Washington

By Laura Hanen, Government Affairs Representative, District Policy Group (Authored 9/11/2020)

CPNP continues to engage on a variety of fronts to advocate for legislation and regulations related to expanding pharmacist scope of practice to increasing access to treatment for mental health and substance use disorders. CPNP engages in advocacy on its own and in coalition.

Pharmacist Scope of Practice

CPNP is meeting weekly with fellow Joint Commission of Pharmacy Practitioners (JCPP) organizations as well as other pharmacy organizations to advocate with policymakers for emergency scope of practice expansion and to ensure payment for those services. This advocacy has achieved some incremental gains that, while a narrow expansion of pharmacy scope of practice, are an opportunity to get the foot in the door for direct reimbursement for pharmacists’ services under Medicare. This has also resulted in education of Hill offices on the role of pharmacists in patient care as well as shoring up our Congressional champions who support a much broader expansion in the scope of practice for pharmacists. 

• On April 12, HHS authorized licensed pharmacists to order and administer COVID-19 tests approved by the FDA. Unfortunately, CMS maintains they do not have the authority allow pharmacists to bill directly as they are not designated providers under Medicare Part B. Pharmacists can be reimbursed in enrolled as a laboratory or through an “incident to” arrangement with a physician. CPNP has been engaged in a months-long effort with pharmacy stakeholder organizations to gain Congressional support for legislation to allow CMS, during a public health emergency, to pay pharmacists directly for the provision of COVID-19 testing and vaccine for COVID-19 and seasonal influenza. Rep. Buddy Carter (R-GA) and Sen. Chuck Grassley (R-IA) are leading the effort.
• On August 19, HHS announced that the Secretary used his authority to amend the Public Readiness and Emergency Preparedness (PREP) Act to authorize state-licensed pharmacists to order and administer vaccines to individuals ages three through 18 years subject to several requirements. Childhood vaccination rates have dropped during the pandemic and HHS is seeking to provide parents with additional options for vaccinating their children during this time. The AMA immediately opposed the action. CPNP and coalition partners issued a statement lauding the announcement.
• On September 9, HHS announced the issuance of guidance under the PREP Act that authorizes state-licensed pharmacists to order and administer COVID-19 vaccinations to persons ages 3 or older, subject to certain requirements. The PREP Act additionally allows state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer COVID-19 vaccines. The policy preempts any state and local laws that prohibit or effectively prohibits those who satisfy the requirements from ordering or administering COVID-19 vaccines. The announcement was welcome news after many months of advocacy.

Access to Behavioral Health Care Through Telehealth

CPNP continues to support access to telehealth and telemental health services during the pandemic and beyond, particularly through its participation in the Mental Health Liaison Group, including a letter to CMS Administrator Seema Verma requesting an extension of telehealth flexibilities for a reasonable transition period following the conclusion of the COVID-19 public health emergency and a letter with 340 organizations urging House and Senate leadership to support specific permanent telehealth reform provisions. CPNP is also supporting legislation to strengthen access in rural and frontier areas of the country.

Funding for Workforce Training

CPNP recently participated in a meeting with the White House Office of Management and Budget (OMB) through the Health Professions and Nursing Education Coalition (HPNEC) to advocate for the Health Resources and Services Administration’s Title VI health professions programs in the President’s FY2022 budget to be released next year. The Title VI program includes Mental and Behavioral Health and Behavioral Health Workforce Education & Training.

Making the Case Through Comments

Over the summer, CPNP submitted comments to the Bipartisan Policy Center’s Behavioral Health Integration Task Force to inform policy recommendations to improve the integration of primary and behavioral health care to achieve better health outcomes. CPNP also provided comments to CMS on Interim Final Rule with Comment (IFC) that provide additional flexibilities to health providers to address the COVID-19 pandemic.

CPNP will be submitting comments to CMS on the 2021 Physician Fee schedule and Part B payment policies due October 5. CPNP will highlight the role of psychiatric pharmacists as a key member of the healthcare workforce and the reimbursement barriers that impede greater access and utilization of their services.

Behavioral Health Legislation Moving in the House

On September 9, the House Energy and Commerce Committee marked up a slate of behavioral health bills, including the “Effective Suicide Screening and Assessment in the Emergency Department Act (H.R. 4861) and the “Mental Health Services for Students Act” (H.R. 1109) both supported by CPNP.

Federal Funding for COVID-19

The COVID-19 pandemic response continues to be the central focus of health policy in Washington leading up to the November election. There have been four COVID-19 relief packages signed into law – Coronavirus Preparedness and Response Supplemental Appropriations Act ($8 billion), Families First Coronavirus Response Act ($192 billion), Coronavirus Aid, Relief, and Economic Security Act ($1.7 trillion), and Paycheck Protection Program and Health Care Enhancement Act ($483 billion).

Despite a number of attempts, another relief package has yet to be adopted. On May 15, the House passed the Health and Economic Recovery Omnibus Emergency Solutions Act (Heroes) Act (H.R. 6800), a $3 trillion COVID-19 relief bill. The Senate Republicans have introduced three different packages - Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act, and two versions of the Delivering Immediate Relief to America’s Families, Schools and Small Businesses Act - but has not been successful in passing them. The HEALS Act includes $450 million for behavioral health programs for which CPNP has advocated be included in the final package. Negotiations have stalled between the White House and the leaders of the House and Senate with business liability protections, state and local aid, and enhanced unemployment benefits being major sticking points. A resolution is looking unlikely until after the election.

Congress to Take Action to Fund Federal Programs

Congress has been unable to pass the twelve annual spending bills in time for the start of new fiscal year on October 1. This will require Congress to pass a continuing resolution (CR) to keep the government funded. The White House and the House Speaker have agreed to adopt a “clean” CR, meaning no additional legislation or unrelated provisions will be added. The CR will run at least until after the election, but the exact date has not been determined. One of the twelve bills, the Labor-Health and Human Services-Education bill, funds health professions training, services, and research to address mental health and substance use disorders.