June 13, 2021

Volume XI, Number 164

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June 11, 2021

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Fourth Time’s the Charm? How COVID-19 May Spur Congress to Pass Legislation Expanding Coverage for Pharmacist Services

On April 22, 2021, Reps. G.K. Butterfield (D-NC) and David McKinley (R-WV), along with 22 co-sponsors from both major parties, introduced H.R. 2759, “A Bill to amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services.” The bill—which marks Congress’s fourth attempt to enact the Pharmacy and Medically Underserved Areas Enhancement Act (PMUAEA)—would allow Medicare to directly reimburse pharmacists for delivering certain Medicare Part B services to Medicare beneficiaries living in medically underserved areas, or MUAs. In other words, by guaranteeing Medicare reimbursement to pharmacists who administer select primary care services to Medicare beneficiaries in regions with limited access to primary medical care, the PMUAEA aims to expand pharmacy services to seniors, providing them with easily accessible and consistent primary care services, and, in turn, more optimal health outcomes.

Despite its bipartisan support, the PMUAEA died in committee each of the three times it was previously introduced in the House (with its companion measure meeting the same fate in the Senate during the 115th Congress). Although surprising, hindsight suggests that when introduced in the past, the PMUAEA was not yet ripe for consideration.

But the tide seems to have turned since the last time the PMUAEA was brought before Congress. And now, as the country emerges from the waning months of a COVID-19 response that has relied heavily on the services of pharmacies and pharmacists to administer life-saving vaccinations, an opportune moment to pass the PMUAEA may have finally arrived. This post discusses how this significant change of circumstances may finally break the PMUAEA’s unlucky spell, making its fourth time through Congress its last time.

Changed Circumstances

Access to quality health care is widely understood to be a social determinant of health, or key factor affecting the health risks and outcomes of individual people. As such, on the one hand, those with greater access to health care often benefit from, among other things, routine preventive care, earlier detection of life-threatening health issues, and better management of chronic illnesses, invariably leading to better health outcomes. While on the other hand, those with limited access to health care, including individuals living in MUAs, are often ill-equipped to handle acute illnesses (e.g., flu, pneumonia), and unable to detect and manage severe or chronic illnesses (such as COVID-19, diabetes and depression), invariably leading to worse health outcomes.

As the COVID-19 pandemic exploded across the country, it shined a spotlight on, among other things, the health inequities facing individuals with limited access to care. In MUAs and rural regions of the country, hospitals are generally so few and far between that getting to them often requires significant travel time. Consequently, patients displaying COVID-19 symptoms often only make a trip to the hospital as a last resort, putting such hospitals—which are often already smaller, understaffed and limited on resources—in an unenviable position of rationing resources between patients that, on average, are older, poorer and already less healthy than Americans living in urban areas. Then, as nationwide vaccine rollouts began, hospitals in many of these regions were given either no access, or limited access, to COVID-19 vaccines, in part, because of the challenges that came with distributing the Pfizer vaccine at its initially prescribed low temperatures. Accordingly, such delays in receiving the vaccine, significant travel time to receive both doses of the vaccine, and the generally slow dissemination of information due to the lack of broadband services, exacerbated the pandemic in the country’s MUAs and rural regions.

However, not all MUA and rural regions are entirely alike. Despite grappling with similar circumstances in its 62 MUAs and other rural areas of the state, West Virginia emerged as the poster child for vaccine rollout and vaccination delivery. By forgoing the federal vaccination program, which it predicted would result in an uneven rollout that overlooked its rural regions, and instead partnering with a network of pharmacies and long-term care facilities within the state, West Virginia was able to deliver its second round of vaccines to all long-term care facilities by early February 2021.

The remarkable example set by West Virginia highlighted the capabilities and wide reach of local pharmacists and pharmacies, and provided a useful roadmap for expanding equitable access to vaccines across the nation, most notably in MUAs and rural regions of the country. It was an example that was surely considered by the Biden administration as it prepared to launch its Federal Retail Pharmacy Program for COVID-19 Vaccination (FRPP), a program that allows eligible Americans to receive the COVID-19 vaccine at local pharmacies through a public-private partnership with networks of national and independent pharmacies.

Moving Forward

With successful initiatives like West Virginia’s COVID-19 vaccine rollout and the FRPP showcasing how pharmacists can provide certain primary medical care services as effectively as physicians and other health care providers, Congress may be hard-pressed to table the PMUAEA this time around.

©1994-2021 Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. All Rights Reserved.National Law Review, Volume XI, Number 132
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About this Author

Associate

Hassan’s practice focuses on advising a broad range of clients across the health care industry—including health care systems, pharmacies, and private equity firms investing in health care companies—in complex industry transactions and compliance and regulatory matters.

Hassan leverages his prior experience as a “deal team” attorney representing private equity firms through various mergers and acquisitions, restructurings, and growth equity transactions to provide reasoned and pragmatic solutions to a wide range of client needs. 

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202.434.7375
Theresa Carnagie, Health Law Attorney, MIntz Levin Law Firm
Member

Theresa counsels health care clients on a variety of transactional, regulatory, and fraud and abuse matters.

Theresa focuses much of her practice on counseling health plans, pharmacy benefit managers, pharmacies, device manufacturers, and distributors on regulatory and compliance matters. Her practice extends to counseling on drug pricing and reimbursement issues, Medicare Advantage and Medicare Part D compliance, and the regulatory requirements under the Affordable Care Act and state health insurance exchanges. Theresa has extensive experience...

202-661-8710
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