Pharmacist Ginger Lemay noticed something was off when one of her regular customers approached the counter several weeks ago at the chain pharmacy where she works.
The customer had what looked like an inflamed rash around one of his eyes. Soon she learned he was dealing with pain and had a rash on his abdomen, too – hallmark signs of shingles, which she says requires antiviral treatment right away.
Lemay says she referred the man to an urgent care facility and prepared a prescription because she knew if he didn’t get medication soon, his condition could worsen. The man was reluctant to get treatment, but she coaxed him to go. When he returned to the pharmacy with a prescription slip, he thanked Lemay for stepping in because he had planned to go home in hopes the symptoms would disappear on their own.
Lemay says these interactions with patients happen all the time.
“Pharmacists are always involved in primary care assistance with patients,” said Lemay, who is a clinical professor at the University of Rhode Island’s College of Pharmacy and residency program director for URI’s year-one postgraduates. “I always say you can’t underestimate the power of a community pharmacist.”
Though the role of pharmacists is often viewed as simply filling prescriptions, Lemay and others in the industry say they are capable of much more. Pharmacists administer vaccines and tests, refer patients to specialists and can answer questions that sometimes don’t get addressed during, or come up after, primary care appointments.
That’s why, with a shortage of primary care physicians across the nation, many pharmacists are now pushing for a larger role in health care. But, at least in Rhode Island, some regulations and restricted reimbursements are among the factors holding them back.
Indeed, 90% of Americans live within 5 miles of a pharmacy and patients visit their pharmacists many more times a year than their primary care providers, says Chris Federico, president of the Rhode Island Pharmacy Association. This means patients have a much easier time accessing pharmacists than primary care providers, who often have waiting lists.
“Pharmacies are everywhere; it’s not enough for some to see their providers once every few months,” Federico said. “We’re not replacing care but simply supplementing it.”
This accessibility was highlighted during the COVID-19 pandemic as pharmacists were called on to provide even more vaccines and tests than usual. But they continued advocating for adjusted regulations and increased payments that will allow them to expand their services.
Federico and fellow local pharmacists celebrated last year when the General Assembly passed legislation that allows pharmacists in Rhode Island to prescribe birth control and HIV prevention medications for eligible patients, with reimbursements and payments for those services included in both bills.
But despite these legislative accomplishments, pharmacists say more still needs to be done.
A House bill introduced on Jan. 24 would require insurance coverage for all services provided by a pharmacist if they would have been covered if provided by a physician, advanced practice nurse or physician assistant. That measure, sponsored by seven lawmakers, has been referred to the House Finance Committee.
Helping ensure pharmacists play a larger part in health care is one of Kerry LaPlante’s top priorities in her new role as dean of URI’s College of Pharmacy.
“Pharmacists are some of the most underutilized positions in health care – we’re here, we’re ready to go,” said LaPlante, who started in January. “It’s frustrating because our education and training is already there, but we’re limited by regulations.”
LaPlante says she’s optimistic because there is support from the Center for Medicare and Medicaid Services for increasing reimbursements.
But at the same time, the American Medical Association has opposed expanding pharmacists’ roles in health care.
In May 2023, the AMA published an article opposing the federal Equitable Community Access to Pharmacist Services Act, which would provide Medicare reimbursements for shots, tests and treatments for COVID-19, respiratory syncytial virus and other illnesses. But the AMA says the bill enables what it calls scope creep as it “inappropriately expands pharmacists’ scope of practice in a manner that threatens patient safety.”
More specifically, the AMA says pharmacists are overworked and don’t have the training or education to take on the role of a physician.
LaPlante says the only reason pharmacists feel overworked is because they aren’t reimbursed for certain services. For example, if a pharmacist takes a few hours to help a patient get their medications up to date, they cannot bill for that time because they are not recognized as providers under state regulations.
But, with residency training and Doctor of Pharmacy programs, LaPlante says pharmacists are well prepared to take on these responsibilities. “It’s not an education issue, it’s not a shortage issue; it’s a reimbursement issue,” LaPlante said.
