SB-493 Pharmacy practice signed by Governor ....what's the big deal?

[lisinopril]

"This bill, instead, would authorize a pharmacist to administer drugs and biological products that have been ordered by a prescriber"

NO. I don't want to administer meds to patients. This job belongs to RN and LVNs. This job is below me

."The bill would authorize pharmacists to perform other functions, including, among other things, to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers, as specified."
NO! I don't want to be more responsible for things that I am not even remotely interested into

"Additionally, the bill would authorize pharmacists to order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies, and to independently initiate and administer routine vaccinations, as specified"

This part is okay

." This bill also would establish board recognition for an advanced practice pharmacist, as defined, would specify the criteria for that recognition, and would specify additional functions that may be performed by an advanced practice pharmacist, including, among other things, performing patient assessments, and certain other functions, as specified. The bill would authorize the board, by regulation, to set the fee for the issuance and renewal of advanced practice pharmacist recognition at the reasonable cost of regulating advanced practice pharmacists pursuant to these provisions, not to exceed $300."

WTF? NO, I don't wanna do assessments. If I want , I would have gone to med school becoming an MD. And what's up with the fee not exceed $300? Why not $30,000? So NO, I don't wanna touch anyone.

Seriously, I feel sick of the so-called "MTM" cool-aid that professors have been preaching for years and years but nothing actually happens. We don't need MTM ! MTM has not been successful and never will be!!!! PERIOD!

Btw, it's sadden to see some pharmD students excited about giving flu shots to patients. To them, it's like "Wow!!! I can give flu shots to patients". PLease please!!!! This is nothing to be excited about. This is the NURSE's JOB. Nurse's job is below me! PERIOD!

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[WhiteSnows]

I feel great about it. I would love to do more as a pharmacist than verifying prescriptions all day. If you do not want to do certain things, don't do it. Noone will force anyone to do anything, you have a choice you know.

 

[lisinopril]

If you want to do more, you should have gone to med school or PA school. You will have a lot of opportunities and things to do...

Until we are allowed to prescribe and diagnose (which WILL NEVER HAPPEN)....then nothing much pharmacists can do...And no, the MTM isn't working and won't work. Why would a patient wanna pay for such services when they can just walk in a clinic with those advices and out with an actual prescription.

And No, I don't want to do jobs below me. Pharm techs fill meds for me, do IV. RN gives meds to patients, Cashiers ring up meds, bags. Those jobs are specifically for these people. What's so proud of doing some job that is below you? You go to school, get a Pharm.D and be so excited about giving flu shots? What a joke! Have you ever seen a doctor cleaning up patient's vomit nowsaday? This is nurse's job. I don't even see MD giving flu shots anymore....Why should I? These are LVN, RN jobs....which is below me.
I will be excited if they let me do radiology intervention or cath lab or surgery.

 

[Momus]

Everything is below you >_>; I just want to scan my fingerprint and sit all day...

 

[WhiteSnows]

If you want to do more, you should have gone to med school or PA school. You will have a lot of opportunities and things to do...

Until we are allowed to prescribe and diagnose (which WILL NEVER HAPPEN)....then nothing much pharmacists can do...And no, the MTM isn't working and won't work. Why would a patient wanna pay for such services when they can just walk in a clinic with those advices and out with an actual prescription.

And No, I don't want to do jobs below me. Pharm techs fill meds for me, do IV. RN gives meds to patients, Cashiers ring up meds, bags. Those jobs are specifically for these people. What's so proud of doing some job that is below you? You go to school, get a Pharm.D and be so excited about giving flu shots? What a joke! Have you ever seen a doctor cleaning up patient's vomit nowsaday? This is nurse's job. I don't even see MD giving flu shots anymore....Why should I? These are LVN, RN jobs....which is below me.
I will be excited if they let me do radiology intervention or cath lab or surgery.

I do not see why we can't never prescribe in the future. I do think it is good to take one step stronger forward before we can get something else more desirable in the future.

 

[lisinopril]

My point is I went to Pharm school not to prescribe, diagnose patients. If I wanted these, I could have gone to med schools already.

I enjoy my chilling pharmacy job....getting paid for doing nothing is best feeling ever.

 

[WhiteSnows]

My point is I went to Pharm school not to prescribe, diagnose patients. If I wanted these, I could have gone to med schools already.

I enjoy my chilling pharmacy job....getting paid for doing nothing is best feeling ever.

I feel you, but if we don't expand then there are no jobs left.

 

[lisinopril]

Everything is below you >_>; I just want to scan my fingerprint and sit all day...

I like the second part...sitting all day...and getting paid...

 

[confettiflyer]

little steps, and if it opens another income stream, why not?

PGY-1 + BCPS will get you the credential once they hammer out the process. Wahoo.

 

[zelman]

"This bill, instead, would authorize a pharmacist to administer drugs and biological products that have been ordered by a prescriber"

This means you can charge up to $300 to put a patient's meds in a weekly med planner.

 

[pharmasaur]

My point is I went to Pharm school not to prescribe, diagnose patients. If I wanted these, I could have gone to med schools already.

I enjoy my chilling pharmacy job....getting paid for doing nothing is best feeling ever.

First of all, there will be 2 classes of pharmacists in CA. The ones with residency and BCPS can become the "advanced practice pharmacist" and do more things. You don't have to do it if you don't want to. You can still belong to the class of pharmacists that just sit and verify.

Pharmacists already give flu shots...soooo.....I don't know why you're complaining about that. The administering of meds/biologics will affect pharmacists working in specialized areas where this may be necessary. Don't worry CVS isn't going to open a chemo infusion center and put you in charge of it


Lastly....healthcare is changing....so, get in or get out. Some new grad wants your job, I promise you!

 

[confettiflyer]

First of all, there will be 2 classes of pharmacists in CA. The ones with residency and BCPS can become the "advanced practice pharmacist" and do more things. You don't have to do it if you don't want to. You can still belong to the class of pharmacists that just sit and verify.

Pharmacists already give flu shots...soooo.....I don't know why you're complaining about that. The administering of meds/biologics will affect pharmacists working in specialized areas where this may be necessary. Don't worry CVS isn't going to open a chemo infusion center and put you in charge of it


Lastly....healthcare is changing....so, get in or get out. Some new grad wants your job, I promise you!

Post of the day, I tell ya.

 

[owlegrad]

This means you can charge up to $300 to put a patient's meds in a weekly med planner.

I think you read that wrong. The $300 cap is how much the BOP can charge for becoming an "advanced whatever", not how much they can charge a patient/insurance.

 

[Reirrac]

I would be willing to do residency to be an advanced practice pharmacist if that correlates to a substantially higher compensation. If not, then I wouldn't bother haha.

 

[Its Z]

First of all, there will be 2 classes of pharmacists in CA. The ones with residency and BCPS can become the "advanced practice pharmacist" and do more things. You don't have to do it if you don't want to. You can still belong to the class of pharmacists that just sit and verify.

Pharmacists already give flu shots...soooo.....I don't know why you're complaining about that. The administering of meds/biologics will affect pharmacists working in specialized areas where this may be necessary. Don't worry CVS isn't going to open a chemo infusion center and put you in charge of it


Lastly....healthcare is changing....so, get in or get out. Some new grad wants your job, I promise you!

Well said,

We are trying to design pharmacy practitioners utilizing sb493 for family practice, oncology infusion and pain management. And reimbursement over$60 per patient will be more than cost effective.

 

[Fatpharm]

Being a California advanced practice pharmacist seems way too easy to get in to. With no specified patient contact hours or certification class, I would already qualify and I did not do a residency.

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB493
SEC. 15.
Section 4210 is added to the Business and Professions Code, to read:
4210.
(a) A person who seeks recognition as an advanced practice pharmacist shall meet all of the following requirements:
(1) Hold an active license to practice pharmacy issued pursuant to this chapter that is in good standing.
(2) Satisfy any two of the following criteria:
(A) Earn certification in a relevant area of practice, including, but not limited to, ambulatory care, critical care, geriatric pharmacy, nuclear pharmacy, nutrition support pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, or psychiatric pharmacy, from an organization recognized by the Accreditation Council for Pharmacy Education or another entity recognized by the board.
(B) Complete a postgraduate residency through an accredited postgraduate institution where at least 50 percent of the experience includes the provision of direct patient care services with interdisciplinary teams.
(C) Have provided clinical services to patients for at least one year under a collaborative practice agreement or protocol with a physician, advanced practice pharmacist, pharmacist practicing collaborative drug therapy management, or health system.

Compare that to NM
http://www.nm-pharmacy.com/Pharmacist_Prescribing/Pharmacist_Clinician/Laws/b_o_p__regulations.html
(3) To obtain initial certification and registration as a pharmacist clinician, she/he must submit the following:

• 
  (a) proof of completion of sixty (60) hour board approved physical assessment course, followed by a 150 hour, 300 patient contact preceptorship supervised by a physician or other practitioner with prescriptive authority, with hours counted only during direct patient interactions;
  (b) the applicant will submit a log of patient encounters as part of the application;
  (c) patient encounters must be initialed and completed within 2 years of the application.
  
  Anyone care to comment on the NC process?

 

[Its Z]

I don't think it's an "easy" qualification process yet not requiring the need to be an MD.

The Best of both worlds so to speak.

Past 30 years in pharmacy, we had "clinical pharmacy," "pharmaceutical care," & "MTM." Those were well intentioned innovative phrases but I don't think we discredit any of it. After all, I do believe that's why we have SB493.

And SB493 will be the game changer for us. Because it will allow us to finally bill for cognitive service as a provider instead of reimbursement based on product distribution.

It is the job of pharmacy leaders to be innovative and create the next generation pharmacy practice we have been trained for.

 

[Its Z]

Because it requires a year of residency or a year of collaborative practice, many pharmacists won't be able to simply apply and become a practitioner. I don't particularly think either are easy to accomplish.

 

[JoBreeze]

I don't get it... 60 hrs of an "assessment" course and a month in a primary care office...

What does that then qualify a person to do that he couldn't already?

 

[Its Z]

I don't get it... 60 hrs of an "assessment" course and a month in a primary care office...

What does that then qualify a person to do that he couldn't already?

Bill for service and get paid? Become a "mid level" practitioner?

 

[BMBiology]

Bill for service and get paid? Become a "mid level" practitioner?

I feel "status provider" is just another buzz word pharmacy schools use to get students all excited.

When I was an intern, I was telling this pharmacist, who graduated 20 years ago from my school, about how pharmacists will be able to bill for clinical services in the near future. He burst out laughing and shot back, "that's what they told me too!"

(1) Reimbursement: do you know private insurance companies still refuse to reimburse pharmacists for immunization? They would rather pay a nurse at a doctor office $80 to administer the shot. Like immunization, pharmacists can provide the service but insurance companies may not pay for it
(2) NPs/PAs: pharmacists will be competing with them. They have more patient interaction, cost less and they don't need to go to school for 6-8 years . Remember, nurses are also allow to MTM and they are doing that as well.

This bill is good for the profession but it is just a first step. There's still a long way to go.

 

[njac]

I like the administration clause, as it is CYA for me.

As an EM clinical pharmacist, I am often setting pumps and titrating drips. But at this point in time not connecting them to patients.

There are other times when I've drawn up medications and I have the only free hands in the room.

In residency, I administered medications. In practice, I currently do not. But this will change my practice.

 

[moolman]

In a past life I worked MTM, MTM is mandated by CMS for some medicare populations, there are whole companies dedicated to doing it. It can be profitable if you know how to do it right. At least it keeps a bunch of people employed, which is a good thing.

 

[VCU07]

I'm not in California, but what about pharmacists with considerable clinical experience with their BCPS? Why should I have to go back and do a PGY1? I dont know what I would get out of a general residency at this point. I think the law should allow those who can show evidence of experience/competence to have an equal right.

 

[moolman]

I'm not in California, but what about pharmacists with considerable clinical experience with their BCPS? Why should I have to go back and do a PGY1? I dont know what I would get out of a general residency at this point. I think the law should allow those who can show evidence of experience/competence to have an equal right.

You would do bcps and part c, the collaborative agreement for 1 year. If you work in a situation that requires this part c should be just paperwork.

 

[pharmasaur]

In a past life I worked MTM, MTM is mandated by CMS for some medicare populations, there are whole companies dedicated to doing it. It can be profitable if you know how to do it right. At least it keeps a bunch of people employed, which is a good thing.

yeah, MTM is out there...there are patient profiles waiting to be picked up and worked on and Medicare will reimburse for this. Pharmacists in retail setting don't know how to incorporate this into their work flow which is one problem, another problem is that the vast majority of pharmacists don't care/aren't interested. They are happy with their job and pharmacists for some reason are hesitant to learn new things and expand their skills. Out of all the professions out there, they are probably the most resistant to change. I can't believe we still learn grains and scruples and all that cr@p in school...we just loooove clinging on to the past....you don't see MDs learning about techniques done 80 years ago just for the sake of history.

 

[moolman]

I know a health plan that pays an independent pharmacy to do mtm on their patients. Ideally, you'd want to pay someone at Walgreens to do it too, you never know.

 

[confettiflyer]

I can't believe we still learn grains and scruples and all that cr@p in school...we just loooove clinging on to the past.....

Eh? That was like on one PowerPoint slide in one random class for me. Surprised your school wasted time on that.

 

[pharmasaur]

Eh? That was like on one PowerPoint slide in one random class for me. Surprised your school wasted time on that.

my school wastes time on everything but that's another story
pharmacy school is longer than necessary so they have to fluff it up with a lot of BS i guess

 

[BenJammin]

Because it requires a year of residency or a year of collaborative practice, many pharmacists won't be able to simply apply and become a practitioner. I don't particularly think either are easy to accomplish.

Read again. Residency isn't required if you meet the other two requirements which I believe most pharmacists should be able to achieve.

 

[Its Z]

Read again. Residency isn't required if you meet the other two requirements which I believe most pharmacists should be able to achieve.

You read again. I wrote residency Or collaborative practice not residency required. And How does a pharmacist get a gig in a collaborative practice? Not an easy job to find.

 

[BMBiology]

my school wastes time on everything but that's another story
pharmacy school is longer than necessary so they have to fluff it up with a lot of BS i guess

they got to charge 4 years of tuition right?

 

[moolman]

You read again. I wrote residency Or collaborative practice not residency required. And How does a pharmacist get a gig in a collaborative practice? Not an easy job to find.

They had to put that in to satisfy the AMA/CMA lobby. If it's something you do, it should be easy, let's say you work at a hospital you just draw up the paperwork, if you wanted to do it at the retail level, remember the flu shots required a physician signed protocol, so the chains had a MD that signed off on all of them, just paperwork in the end.

 

[Its Z]

I understand that.

But when im creating a role for PP (Pharmacy Practitioner) in oncology, pain management, and intensive care I Don't think my admin and physician practice will be thrilled with someone who spent a year administrating flu vaccines.

 

[moolman]

Wouldn't it be the same person who's currently your onc pharmacist be the one who gets it, in the slim chance they can now bill for their services. When we saw the bill at work, we knew it was easy to get but implementing it to do something useful, that's another story.

 

[moolman]

I never saw the bill as a job creator, more of an expander.

 

[Its Z]

I see it differently.

I see PP working for physician practice instead pharmacy. But will be employed by health system and Or physician group.

 

[BMBiology]

Wouldn't it be the same person who's currently your onc pharmacist be the one who gets it, in the slim chance they can now bill for their services. When we saw the bill at work, we knew it was easy to get but implementing it to do something useful, that's another story.

That's the unfortunate truth.

Why would anybody start a business where you can't bill? Why not just hire a NP who can bill for her service and cost only $35 an hour?

 

[moolman]

I see it differently.

I see PP working for physician practice instead pharmacy. But will be employed by health system and Or physician group.

I've already seen this, many of the physician groups have a pharmacist on staff to increase 5 star measures or the have a pharmacist for recs, the health systems do it to. .. maybe this will expand it, who knows

 

[moolman]

That's the unfortunate truth.

Why would anybody start a business where you can't bill? Why not just hire a NP who can bill for her service and cost only $35 an hour?

Exactly, at work we discussed hiring a NP to reach out to the groups, saves 50k a year in salary and they can prescribe.

 

[Its Z]

That's the unfortunate truth.

Why would anybody start a business where you can't bill? Why not just hire a NP who can bill for her service and cost only $35 an hour?

You fail to comprehend this bill will allow Pharmacy Practitioners to bill under the collaborative practice. Hello! LOL.

 

[BMBiology]

You fail to comprehend this bill will allow Pharmacy Practitioners to bill under the collaborative practice. Hello! LOL.

Show me.

The more post you, the more it shows you don't have a good understanding of this bill.

 

[Its Z]

Exactly, at work we discussed hiring a NP to reach out to the groups, saves 50k a year in salary and they can prescribe.

Show me.

The more post you, the more it shows you don't have a good understanding of this bill.

mmmm... the bill just passed dood. This aint gonna happen overnight...and certainly won't happen in your little world.

 

[Its Z]

There are several pain management pharmacists with NPI & DEA registration who's doing this already. You'll hear more.

 

[Its Z]

I've already seen this, many of the physician groups have a pharmacist on staff to increase 5 star measures or the have a pharmacist for recs, the health systems do it to. .. maybe this will expand it, who knows

And using your own statement and argument, why do they employ pharmacists instead NP or PA to do what they do?

 

[BMBiology]

mmmm... the bill just passed dood. This aint gonna happen overnight...and certainly won't happen in your little world.

Look it up and show me the wording in this bill that changed how pharmacists are being reimbursed.

There are several pain management pharmacists with NPI & DEA registration who's doing this already. You'll hear more.

What does this have to do with this bill?

This bill is not going to change as much as people think. Pharmacists have already been doing all of these things. Look at Kaiser, the VA. The difference is that they worked under a physician approved protocol.

The elephant in the room is pharmacists still can't bill for their clinical services. This bill does not address this.

 

[eagles22]

I don't get how this is going to benefit anyone other than those in the ivory tower of academia who can now discuss the the bright future of pharmacy practioners for the next 20 years (a la MTM) while nothing actually happens. I don't see anything a pharmacist is going to be allowed to do that an NP or PA (who can and do bill) can't already do for much cheaper. It doesn't make any sense to me to train a pharmacist (which costs $$$) to do this stuff then to pay them more than an existing mid-level practioner. But at least uninformed pharmacy students will be excited by the idea of this.

 

[opinionfree]

"And No, I don't want to do jobs below me. Pharm techs fill meds for me, do IV. RN gives meds to patients, Cashiers ring up meds, bags. Those jobs are specifically for these people. What's so proud of doing some job that is below you? You go to school, get a Pharm.D and be so excited about giving flu shots? What a joke! Have you ever seen a doctor cleaning up patient's vomit nowsaday? This is nurse's job. I don't even see MD giving flu shots anymore....Why should I? These are LVN, RN jobs....which is below me."

What a fun little fortune cookie you must be to work with. The only thing more disturbing than an individual posting such professional bigotry, are the egocentric responses from delusional pharmacists desperate to play physician. If you all feel so professionally impotent, spend two years getting a PA, instead of wasting time and money on all this post residence, summer internship, clinical externship, etc. We get it, you don't want to fill scripts. The economic climate isn't going to support your psychological need to play doctor. Surely you understand, no matter how hard you try to wedge yourself into the back door of 'practitioner status', you will always be perceived as the unloved stepchild of a new union.

As for this new bill, it's akin to reimbursement 'pork'. Rules and regulations are being enacted daily in an attempt to ensnare ANY return for ANY services. Think, throwing mud at the wall: some will stick and most will get washed away. Don't put a shingle on your front porch, now or ever, offering services. Clinical settings have an hierarchy. As reimbursement rates are reduced for physicians, they will pick up or loose, ANY billable tasks or personnel, required to keep their salaries. One of the biggest issues against pharmacists are salaries. If the chains can send text messages about prescriptions, computer programs can send messages for patients to get blood tests or alert physicians to lab anomalies that require PHYSICIAN intervention. Where does the 'pharmacist practitioner' fit in? Write scripts, really? We are not trained, licensed or able to chart a blood pressure reading or use a stethoscope. How many are CPR or first aid certified?

As an American, I am empowered to stop criminals utilizing a 'Citizen's Arrest". Does that make me a police officer?

 

[BenJammin]

You read again. I wrote residency Or collaborative practice not residency required. And How does a pharmacist get a gig in a collaborative practice? Not an easy job to find.

(C) Have provided clinical services to patients for at least one year under a collaborative practice agreement or protocol with a physician, advanced practice pharmacist, pharmacist practicing collaborative drug therapy management, or health system.

How does someone using an MTM service like Outcomes not qualify? Even then, this bill doesn't force insurance companies to provide pay for service. This is all about titles, not about money.

 

[moolman]

And using your own statement and argument, why do they employ pharmacists instead NP or PA to do what they do?

I was referring to starting your own business to see patients, I can't see pharmacist doing this since PA or NP gets paid less, from personal experience we've priced ourselves out but give it a couple of years of new schools and stagnant wages, we'll be cheaper soon enough...