CAPPRE Achieves Major Milestone in Advancing Medical Billing Opportunities for Pharmacists

The Center for Advancing Pharmacy Practice and Research Excellence (CAPPRE) at the L.S. Skaggs College of Pharmacy is proud to announce a significant breakthrough in its advocacy efforts to expand medical billing opportunities for community pharmacists and those in primary or specialized care clinics.

Through coalition-building with value-based organizations, the Idaho Board of Pharmacy, and key stakeholders, CAPPRE has led the charge to identify administrative barriers and engage decision-makers to develop solutions that ensure commercial and state health plans credential and privilege pharmacists as ‘rendering providers’ of healthcare services within their state-defined scope of practice. This also includes community pharmacies to be recognized as billing providers for healthcare services.

Breaking Down Barriers, Building Momentum

Situated within the L.S. Skaggs College of Pharmacy, CAPPRE’s dedicated efforts have kept key issues at the forefront of discussions while educating payers in Idaho and Alaska about insurance statutes and pharmacists’ scope of practice.  

Notably, this advocacy has yielded tangible results:

• Idaho Medicaid has opened its enrollment portal, enabling pharmacies and pharmacists to enroll as rendering providers and submit evaluation and management CPT codes alongside other relevant billing codes. Pharmacists are now recognized as non-physician providers (NPPs), similar to nurse practitioners and physician assistants.
• Blue Cross of Idaho, after nearly two years of persistent dialogue and cooperation, now allows pharmacists to be added to billing group rosters as rendering providers. Pharmacists can submit healthcare service CPT codes and be reimbursed at the NPP rate.

Transforming Pharmacy Practice

“This is a major milestone in normalizing the healthcare services that pharmacists have been providing for decades,” said Tom Wadsworth, Dean of the College of Pharmacy. “CAPPRE has been the unifying component in bringing together the right voices at the right time to address long standing regulatory and administrative barriers. These efforts are key to ensuring patients have access to the medication expertise of pharmacists.”

Allowing pharmacists to bill the medical benefit of health plans generates sustainable revenue streams that support their integration into primary care and specialty clinics. This advancement directly improves patient access to healthcare services and increases the capacity of physicians and non-physician providers to deliver care.

While these achievements are a cause for celebration, there is still more work to be done. CAPPRE remains dedicated to guiding clinics and pharmacies in establishing these practices and continuing the advocacy needed to advance pharmacy practice across Idaho, Alaska, and beyond.

CAPPRE calls on stakeholders and supporters to contribute to this transformative work. Donations to CAPPRE will enable the Center to sustain its efforts, convene key stakeholders, and use its proven unifying advocacy model to overcome additional barriers.

“CAPPRE’s activities are essential to continuing this effort and normalizing practices that patients in Idaho and Alaska desperately need,” added Dean Wadsworth.

The Center for Advancing Pharmacy Practice and Research Excellence (CAPPRE) is dedicated to fostering innovative pharmacy practices, advancing healthcare policies, and empowering pharmacists to provide high-quality care. CAPPRE’s advocacy efforts aim to create sustainable, patient-focused solutions that benefit communities and healthcare systems.

For more information, contact:
Zachary Rosko, PharmD, BCPS, CAPPRE Director at zacharyrosko@isu.edu.