ROLE OF THE PHARMACY WORKFORCE IN SUPPORTING PATIENT ACCESS TO MEDICAL SUPPLIES

To support patient access to medical supplies as part of a comprehensive treatment plan; further,

To advocate for policies that empower pharmacy personnel to facilitate patient access to and effective use of medical supplies, including reimbursement policies; further,

To educate pharmacists, other healthcare professionals, payers, and policymakers about the role of pharmacy personnel in helping patients obtain and use medical supplies; further,

To collaborate with other healthcare professional and patient advocacy organizations to advocate for expanded patient access to medical supplies.

 (Note: For purposes of this policy, “medical supplies” includes durable medical equipment, Food and Drug Administration-approved medical devices, and other nondurable disposable healthcare materials.)

Rationale

Pharmacists and pharmacy technicians have the knowledge and skills to support patient access to medical supplies and equipment, durable medical equipment (DME), and medical devices. These tools, like medications, are essential components to a patient’s personalized care plan. Although many providers combine medical supplies and equipment, DME, and medical devices under the umbrella term “medical supplies,” as is done here for purposes of this policy, there are critical differences between them that determine how these items are accessed and reimbursed. Under Centers for Medicare & Medicaid Services (CMS) rules, “medical supplies and equipment” (e.g., bandages and gauzes) are nondurable disposable healthcare materials used to serve a medical purpose that cannot be used in the absence of illness or injury or repeatedly by different individuals. CMS typically does not consider medical supplies and equipment as a covered benefit. DME (e.g., blood sugar monitors, blood sugar test strips, continuous glucose monitors, and infusion pumps and supplies) are durable healthcare materials used at home that can withstand repeated use, provide a medical purpose, and are not used in the absence of an illness or injury. In contrast to medical supplies and equipment, DME is covered under Medicare Part B. Finally, the Food and Drug Administration (FDA) defines a medical device as an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory (FDA. Medical Devices. Available at: https://www.fda.gov/medical-devices. Accessed August 20, 2020).

Pharmacists are experts in initiating and managing a patient’s comprehensive medication management (CMM) plan. A CMM is an individualized care plan that helps patients achieve specific goals of therapy. The patient-centered medical home: integrating comprehensive medication management to optimize patient outcomes resource guide, 2nd ed. www.pcpcc.org/sites/default/files/media/medmanagement.pdf). Any intervention that supplements medication goals and improves a patient’s quality of life and patient outcomes should be considered in the CMM process and plan, including use of medical supplies and equipment, DME, and medical devices, and provide an opportunity for a pharmacist or pharmacy technician to improve patient care.

ASHP has long advocated for the role pharmacists have in helping patients obtain and properly use drug delivery systems and devices. The ASHP Statement on the Pharmacist’s Role with Respect to Drug Delivery Systems and Administration Devices states:

Pharmacists bear a substantial responsibility for ensuring optimal clinical outcomes from drug therapy and are suited by education, training, clinical expertise, and practice activities to assume responsibility for the professional supervision of drug delivery systems and administration devices. As a natural extension of efforts to optimize drug use, pharmacists should participate in organizational and clinical decisions with regard to these systems and devices.

Extension of those responsibilities to medication-related medical supplies and equipment, DME, and medical devices is a natural progression in pharmacist patient care. There are many actions that pharmacists can implement to help improve patient outcomes in regards to medical supplies and equipment, DME, and medical devices. To increase patient access, pharmacists can collaborate with patients and physicians to determine which device to use based on patient indication, preferences, and product specifications. Pharmacists could also collaborate with CMS and other insurance plans to ensure that patients have adequate coverage of DME along with advocating to allow pharmacists to submit claims for reimbursement. Furthermore, ASHP could collaborate with patient advocacy organizations and disease specific organizations (e.g., American Diabetes Association) to advocate for increased patient access to specific medical supplies and equipment.

 Additionally, pharmacists can advocate for broader pharmacy management of medical supplies and equipment, DME, and medical devices along with medications as a part of the patient’s CMM plan. Pharmacists can support patient access through documentation required for coverage, provide education on how to use the device, monitor the device for safety and efficacy, and interpret results if applicable. Collaborative practice agreements and credentialing and privileging are two ways pharmacist can use data provided from the devices to help make necessary changes to the patient’s medication plan. Pharmacists’ expertise should be leveraged to help patients procure and manage their medical supplies and equipment, DME, and medical devices to provide all-encompassing comprehensive medication management.