Stakeholder report 2021

Redefining the Role of Pharmacist as Provider

Phamacist speaks to customer behind window

For most consumers, the role of pharmacists in their health care is tightly regimented. They fill and explain prescriptions, answer questions and then accept payment. However, a new state law in Ohio is giving pharmacists much more latitude in the care of Medicaid members.

Now, pharmacists in Ohio – and five other states – can take a more proactive approach in helping members manage chronic illnesses. Transactional prescription drug conversations are being replaced with deeper, more holistic discussions about stress, exercise and healthy habits.

In a six-month pilot program launched in late 2020, CareSource connected doctors with their local pharmacists to first establish a list of criteria in which a doctor could delegate certain responsibilities, ranging from simple blood pressure checks to more substantial holistic conversations.

Then, the pilot program identified four clinical areas of focus:

  • smoking cessation
  • asthma
  • diabetes
  • naloxone therapy/opioid management

The benefit of paying pharmacists as providers will have a positive impact on CareSource operationally, providing a more affordable option to doctor’s office and hospital visits. At the same time, pharmacists will have the opportunity to extend their services and fully utilize their capabilities.

But, the true benefit will belong to our members in underserved communities. While rural hospitals and providers have been steadily on the decline, the National Association of Chain Drug Stores estimates that 9 in 10 Americans live within 5 miles of a pharmacy. This additional point of access will greatly open up their networks of care.

Through this ongoing trial program, CareSource is fully assuming the responsibility of paying the pharmacists, but as we anticipate the success of our endeavor and new rules soon from the Ohio Department of Medicaid, that investment will be paid off handsomely by the better health of our members and our organization.

“The pharmacy is underutilized by society. The reality is that pharmacists have more frequent contact with members than any other health provider. For somebody needing care, the pharmacist is a valuable partner—we just need to think bigger and get beyond the mindset that they can only fill prescriptions.”

– Steve Ringel, CareSource Ohio Market President

This program was highlighted in the September 2020 issue of Modern Healthcare.