Catalyst: CPP Expansion

Jon Easter, Vice Chair of Practice Advancement, on expanding the pharmacist’s role in team-based patient care

Story by Jon Easter | photo credit Danny Alexander | Published November 28, 2023

As North Carolina’s only public pharmacy school, we are committed to impacting the health and economics of our state. An important part of this strategy involves the School working to convene, educate, and advocate for the role pharmacists play in addressing health challenges across the state.

“We cannot solve these problems and we cannot influence those who make policies if we continue to just take care of people one person at a time,” says North Carolina Senator Gale Adcock. Last month, Sen. Adcock presented with North Carolina Representative Wayne Sasser, BSPhar ’73, to an overflow crowd of students, faculty, and staff about how to work across the aisle to improve health care.

Under the leadership of Jon Easter, Vice Chair of Practice Advancement, the School is helping educate legislators at both the state and federal levels. In our Catalyst series, Carolina Pharmacy has asked Jon to share updates on key policy and practice advancement issues. Our first conversation will focus on a collaborative practice opportunity to expand team-based care to the community setting to improve patient outcomes.

Why is the School focused on advocacy?
For years, the profession of pharmacy has been looking in from the outside of the health policy and legislative process. Whether it’s at a national level with the lack of traction on provider status, or at the state level with antiquated collaborative practice privileges. It’s not for a lack of effort, but our great profession has struggled to make the case to policymakers that pharmacists should be reimbursed for high value services when, up until now, pharmacists have provided them for free as a part of the dispensing process. However, pharmacy is now at a crossroads, and engaging policymakers and payers is essential to position us for future success and to achieve our potential to improve patient outcomes.

What is the CPP and how did a proposal to expand the CPP come about?
According to the North Carolina Board of Pharmacy, a Clinical Pharmacist Practitioner (CPP) is a licensed pharmacist approved to provide drug therapy management, including controlled substances, under the direction of, or under the supervision of a licensed physician. The CPP was created through legislation back in 2000 and was considered to be an innovative approach to collaborative practice agreements (CPA) at the time. Much has changed with team-based care and the collaborative role between physicians and pharmacists over the last 23 years, but unfortunately, the CPP designation has stayed static. Many other states now have much more autonomy and flexibility to establish CPAs with physicians.

With an opportunity to modernize the CPP in North Carolina, Eshelman School of Pharmacy leadership engaged our partners in Western North Carolina, MAHEC, in November 2022. MAHEC created a Health Policy Initiative (HPI) to connect policymakers from Western NC and health-care leaders to talk about critical needs and opportunities. School leadership attended two HPI meetings and met Senator Ralph Hise, chairman of the appropriations committee at the NC General Assembly. Sen. Hise listened to the physicians talk about the importance of engaging pharmacists in team-based care, and Sen Hise became interested in expanding the role of the pharmacist. This led to a policy proposal to expand the CPP collaborative practice program and reimburse pharmacists for services. The proposal was vetted with physician colleagues, public health officials, and the North Carolina Association of Pharmacists (NCAP).

Why is CPP expansion important to the pharmacy profession in North Carolina?
The goal of expanding the CPP and collaborative practice in NC is to enhance the delivery of high-quality, team-based care to better manage patients with suboptimal health and chronic diseases. This provides physicians with needed support to manage their patient population, while positioning pharmacists to work at the top of their license and to be reimbursed for providing these services.

Specifically, the CPP expansion legislation or “An Act to Modernize and Expand Physician-Pharmacist Collaborative Practice,” focuses on three key areas to bolster pharmacy in NC:

• Expands criteria for becoming a CPP to currently licensed NC pharmacists.
• Expands protocols to “Health Care Services” with flexibility to work with multiple providers and in multiple settings (embedded or partially embedded) through a site-specific supervising physician, which provides flexibility to focus on the needs of local communities.
• Adds reimbursement and coverage of services by NC Medicaid and Commercial Insurers.

Expanding the CPP isn’t a panacea or silver bullet for our profession, but it does create a huge step in the right direction with a sustainable path to reimbursable patient care services while collaborating with physicians to improve health care and access to care in NC.

What can North Carolina pharmacists do to help advocate for CPP expansion?
The CPP expansion legislation came so close this past session, thanks to NCAP leadership and strong support in the Senate. We anticipate it being brought up again in the 2024 short session. It will be important to stay close to NCAP for updates and educate our legislators at the right time with the hope of pushing this across the finish line. Health policy is a marathon, not a sprint. With commitment and strong leadership, we are confident that real change to enhance our profession and improve patient outcomes is around the corner. It has to be.

Other stories from the Catalyst series:
Catalyst: Community Pharmacy at a Crossroads
Catalyst: Advocacy Day at the NC General Assembly