Inaugural Legislative Event Celebrates SB493 and the Future of Pharmacy

The passage of SB493 in the California Legislature and its signing into law by Gov. Jerry Brown late last year was cause for celebration at UCSF recently.

Pharmacy students, faculty and distinguished guests gathered on February 27 for the Inaugural 2014 Pharmacy Legislative Roundtable and Banquet to celebrate the passage of the landmark healthcare legislative reform, which grants pharmacists healthcare provider status and aims to equalize the healthcare professional role of pharmacists in patient-centered medical teams. 

The event was made possible by the combined effort of five pharmacy student organizations led by second-year pharmacy student Ronika Kalpage, co-chair and Student Section Executive Committee representative for California Health System Pharmacists (CSHP).  Among the groups were the Academy of Managed Care Pharmacy (AMCP), American Pharmacists Association–Academy of Student Pharmacists (APhA-ASP), California Pharmacists Association (CPhA), CSHP and the National Community Pharmacists Association (NCPA).  Students from surrounding pharmacy schools in Northern California were also invited to attend. 

School of Pharmacy Dean B. Joseph Guglielmo provided opening remarks.  He spoke of the need for pharmacists with an “ability to communicate, talk to patients, problem solve, complete physical assessments, manage disease states and create opportunity for healthcare in an era where access is terrible.”

Addressing a Shortage in Healthcare Providers

California currently faces an increasing shortage in healthcare providers due to the advent of the Affordable Care Act (ACA). In 2014 approximately 7 million Californians are expected to purchase health insurance for the first time, according to the CPhA and CSHP. 

In addressing the shortage, Dean Guglielmo stated, “Our profession is beautifully poised to fill that gap in healthcare providers.”

Dawn Benton, CEO of CSHP, provided insight into how pharmacists and legislators worked for the passage of SB 493.  In 2011, CPhA and CSHP joined forces to create the Joint Provider Status Task Force to draft the initial language of SB 493.  Sen. Ed Hernandez (D-West Covina) became a key advocate and proposed to bring forward a packaged bill comprising a coalition of practitioners (optometrists, nurse practitioners, physician assistants and pharmacists) in the hope that the bill would carry more weight in the State Capitol. 

The simultaneous implementation of the ACA and the shortage of primacy care providers worked in favor of the bill’s passage.  Members of CSHP and CPhA invited legislators to witness the benefit of their practice within the community, and within a year after the bill was introduced, Governor Jerry Brown signed it into law on October 1, 2013 as Chapter 469.

Jon Roth, CEO of CPhA, remarked on specific changes that the bill brings to the scope of practice of a pharmacist.  He recognized that pharmacists are highly educated and trained clinicians who now have expanded authority to provide basic care services to patients in an effort to provide accessible, cost-efficient, quality care for patients. 

Pharmacists’ Expanded Role

In addition to granting pharmacists health-care provider status, SB493 authorizes pharmacists to initiate prescriptions for nicotine replacement products, hormonal contraceptives, and travel medicines.  Pharmacists can administer vaccinations independently and both order and interpret tests used to monitor and manage therapies. 

The legislation also defines the concept of an Advanced Practice Pharmacist (APP), who is a licensed pharmacist recognized by the Board of Pharmacy to perform patient assessments, order and interpret drug-therapy related tests, refer patients to other health-care providers, participate in evaluating and managing diseases and health conditions, and initiate, adjust, or discontinue therapy in collaboration with a patient’s primary care provider.

The legislative event allowed students to participate in roundtable discussions with faculty members from the School of Pharmacy and invited guests about the implementation of SB493 into pharmacy practice.  SB493 mandates pharmacists to complete two of three requirements in order to qualify for APP status: certification in a relevant area of practice, completion of a residency and/or at least one year of experience with 50 percent of that time spent in clinical care. 

APP Training at UCSF

Dr. Lisa Kroon, professor and chair of the Department of Clinical Pharmacy, shared UCSF’s progress towards establishing a training program to satisfy the first prong: APP certification.  The University is creating a disease agnostic training program that will culminate in a clinical examination to be taken in the 4th year by students who wish to become certified as advanced practice pharmacists.  This training program will prepare students with a generalized skill set to order laboratory tests and to initiate or adjust treatment plans for the management of a variety of disease states.

As healthcare costs rise in the U.S., changes to the healthcare delivery system are being directed at cost-effective delivery and payment models, such as accountable care organizations (ACOs).  Within ACOs each healthcare provider is held jointly accountable for delivering quality care while minimizing spending. 

Dr. Marilyn Stebbins, Professor of Clinical Pharmacy, stressed the need for pharmacists to move away from being reimbursed for providing care alone, but rather to operate within ACOs as paid members of a health-care team with a patient-centered focus.

“We must build a partnership with the provider in order to gain trust and become recognized as a valuable team member in an ACO,” she stated.