Community pharmacy certification for medical insurance to facilitate sustainability of COVID-19 testing

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J Pharm Pract. 12 Apr 2022: 8971900221087129. doi: 10.1177/08971900221087129. Online ahead of print.

ABSTRACT

BACKGROUND: In April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent expansions in the scope of pharmacists and to increase beneficiary access to testing and services from the coronavirus disease 2019 (COVID-19). The COVID-19 pandemic has accelerated Medicaid enrollment for pharmacists, but has not addressed coverage of medical services provided to privately insured for pharmacy screening services.

OBJECTIVE: This study aimed to describe the processes used by independent community pharmacies in Idaho to accredit themselves with private insurers and report the results.

METHODS: Relevant information and forms required for accreditation with the four major payers in the State of Idaho were collected. The packages were obtained through the websites of medical insurers and by direct contact. Questions posed by community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions.

RESULTS: Eight of the 13 participating pharmacies submitted an average of three accreditation files for their establishments. Thirty-five pharmacists also submitted an average of four accreditation files for themselves. By mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had been notified of the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt).

CONCLUSION: Efforts to support the education of pharmacists and medical insurers can streamline accreditation processes in the future.

PMID:35414327 | DOI: 10.1177/08971900221087129

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