Bridging the Gap: Pharmacy Compliance and Evolving Clinical Practice

Regulatory changes at the federal and state level are ongoing, specifically concerning PBMs and the expanded role of pharmacists in some states.

PBMs are now required to report on drug spending, rebates and fees to help reduce drug prices for patients and a lot of the data needed for these reports comes from pharmacies, which can create administrative strain.

At the same time, in some states, pharmacists can now provide clinical services such as vaccine administration, but a disconnect between state rules and payer practices affects billing and payment.

“It's a tightrope that [pharmacies] have to balance on,” Amanda Bogle, healthcare attorney at Sheppard Mullin, said in a recent video interview with Managed Healthcare Executive. “A lot of pharmacies, especially smaller, independent ones, aren't really equipped to manage all that information and get it out in a format that's accessible.”

As scope of practice laws expand, Bogle said she anticipates more regulatory oversight.

“As this expands, you're going to see more regulatory oversight for pharmacists because there's obviously a lot more at stake when you're providing clinical services,” Bogle said.