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The Commonwealth of Virginia is known for many things–being the birthplace of eight American presidents including the first, George Washington, along with battlefields that mark the end of two wars. It’s even known for its iconic 1960s marketing slogan, “Virginia is for Lovers,” and let’s not forget the cured country ham.

With the conclusion of this year’s legislative session, there’s one more thing Virginia will be known for: joining a handful of states in an effort to establish a comprehensive approach to addressing primary care provider shortages. This approach includes passing laws to expand pharmacists’ ability to provide clinical care services and receive reimbursement. These actions serve to strengthen pharmacists’ role as part of the patient care team. 

Policy experts John Beckner, R.Ph., Senior Director of Strategic Initiatives, National Community Pharmacists Association and Karen Winslow, Pharm.D., Interim Executive Director, Virginia Pharmacists Association, recently shared how these new laws will improve access to care for patients in the Commonwealth.

Virginia is for Closing Gaps in Primary Care Access

The growing shortage of primary care providers (PCPs), including physicians, nurse practitioners and physician assistants, is impacting patient access to care across the country, with only 1 PCP per 1,500 people in more than half of U.S. counties, according to Surescripts data. Virginia’s shortage is representative of the broader challenge, with 69 of its 134 counties facing a PCP shortage according to this analysis.

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Data Brief

How Are Care Teams Evolving to Fill Primary Care Gaps?

69 of Virginia's 134 counties & incorporated cities have a relative PCP shortage

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According to Beckner, “in a lot of these rural communities, pharmacies, but especially independent community pharmacies, are really the face of neighborhood healthcare. They may be the only provider. There may not even be a physician in the town and may be 20 or 30 miles away.”  

Virginia took deliberate action to address such gaps in care with legislation that was signed into law in March 2023. These efforts resulted in new policy and payment structures that allow pharmacists to better support patient care teams by providing accessible care services across the state and be paid for doing so.

Virginia passed legislation that expanded pharmacists’ authority and enabled reimbursement under the state’s Medicaid program.

  • Pharmacist Scope of Practice (SB 948 and HB 2274), signed into law March 22, 2023, expands the scope of practice for pharmacists, allowing them to test for diseases including streptococcus, influenza, urinary tract infections (UTIs), COVID-19 and other coronaviruses and treat patients 18 years of age or older. Virginia's Board of Pharmacy, in collaboration with the state’s Board of Medicine and Department of Health, will adopt statewide protocols to establish parameters for clinical pharmacy activities.
  • Medicaid Payment for Pharmacist Clinical Services (SB 1538), signed into law March 23, 2023, expands Virginia's Medicaid program to include payment for pharmacist clinical services, when the services provided are performed under the terms of a collaborative agreement or statewide protocol, and directs Virginia's Department of Medical Assistance Services to provide reimbursement for medical assistance services by a pharmacist, pharmacy technician, or pharmacy intern.

Beckner noted that timely access to care is critical. He said, “if you're diagnosed with flu, in order to have an antiviral be effective, it needs be started within 48 hours. In today's health care environment, there is a shortage of primary care physicians, and it can be difficult for folks to get an appointment. Pharmacists can help bridge that shortage gap.”

Beckner adds, “if somebody can come to a pharmacy—and pharmacists have been called the most accessible health care provider—then it certainly makes a lot of sense.”

Winslow echoed this sentiment, stating that, “especially in a rural areas…to be able to have another choice besides the Emergency Department or urgent care is just a great opportunity for patients because that's their choice.”

How community pharmacies are delivering care in rural Virginia. Link to: Bridging the Healthcare Gap in Rural Virginia—One Community Pharmacy at a Time

Virginia is for Care Team Collaboration

Virginia’s newly adopted policies are in line with a handful of states and represents a growing shift from the traditionally siloed system of care that limited pharmacists from practicing at the full scope of their education and training.

Winslow noted the disconnect between what pharmacists learn in school and are trained to do and what they do in practice. She says, “you learn all this great cutting-edge patient care when you're in [pharmacy] school and … I think there's that hunger to do a lot of these patient care testing programs out in the community.”

With insights that highlight how nine in ten Americans live within five miles of a pharmacy and 77% of patients agree that pharmacists are integral members of the care team, patients are becoming more comfortable accessing primary care services from their pharmacist.

Virginia’s new laws demonstrate the approach needed for pharmacists to provide this care and be reimbursed for the services they provide.

Winslow emphasized that Virginia’s test and treat bill garnered the support of all aspects of pharmacy practice, in addition to many stakeholders across the medical community.

“Patients see the utility of being able to go to your pharmacy and get tested for strep, UTI, COVID and flu and be able to leave with a treatment rather than having to then go to the doctor and then go back to the pharmacy,” said Winslow. “So I think that's huge for patients to receive care in a streamline fashion and goes hand in hand with being able to be a provider within Medicaid and therefore receive reimbursement for these kinds of services and help care for some of Virginia’s most vulnerable population.”

Virginia is for the Future of Patient Care

Pharmacists were on the same page when it came to adopting these new policies, but Beckner noted support from the medical community was critical to this legislation becoming law in Virginia.

Beckner emphasized that the pharmacist could provide care that would complement the care of a primary care doctor. He said, “the pharmacist can be a very important referral source to the medical community if that is indeed warranted.”

Existing technology that connects providers and allows the secure exchange of patient clinical information is another key component to care teams filling gaps and delivering quality care to patients.

“When you put the patient at the center of care, it just makes sense,” Beckner said. “This is really the future of pharmacy, and in a more global sense, the future of healthcare.”

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