Test and Treat Made Simple with MedRx


The role of pharmacists has greatly expanded, particularly during the COVID-19 pandemic.  Test and treat is the concept of allowing pharmacist to test the patient for a particular condition or disease state, then treat that patient as applicable.  Billing for some of these types of services can be tricky and MedRx™ makes it simple.

By: Kristol Chism, RPh, director of industry relations at Change Healthcare

What is Test and Treat?

The pharmacist’s role has expanded greatly over the last few years. Pharmacists have had prescriptive authority in some states for four decades, mostly under collaborative practice agreements (CPA), whereas autonomous prescribing is a newer concept. Under a CPA, a pharmacist enters into a contract with a prescriber to gain the ability to initiate or modify a drug therapy within specified parameters.  Autonomous prescribing by pharmacist can also be called Test and Treat when a diagnostic test is used to form the treatment decision making. 

Test and Treat is a pharmacy concept that came into national focus with the COVID-19 pandemic. The idea is that a pharmacist would be able to “test” the patient for a particular ailment, mainly via CLIA-waived type testing, and, if applicable, “treat” that patient who had a positive test result. This type of autonomous prescribing may be granted via CPAs or statewide protocols. Test and treat started with influenza and strep and has evolved to include COVID-19, UTI, other respiratory illnesses and various skin conditions. Not only does this help to expand the services provided in a community pharmacy, but also allows for added convenience and accessibility for patients and reduced workload for otherwise stressed hospitals and medical clinics.

Why pharmacists are key to Test and Treat

Pharmacists are perfectly positioned to perform these type of services. They are fully trained and, in many cases, certified in these processes, allowing them to practice at the top of their license. Adding these services to an already expanded list of offerings for most pharmacies makes practical sense for both the pharmacy and their patients. These services could become a new revenue stream for the pharmacy, helping to mitigate the effects of lower reimbursement on traditional dispensing activities.  Community pharmacies are more assessable than medical facilities for most patients, allowing them to be tested and then treated quicker, resulting in better health outcomes.

How states are supporting Test and Treat

States have gotten on board with test and treat by supporting this through various legislative and regulatory processes. In 2018, Idaho was one of the first states to adopt into their regulations the ability for a pharmacist to test for various conditions with the creation of broad sweeping legislation that allows pharmacists to prescribe any drug for prevention for conditions that do not require a new diagnosis, is used in an emergency, is for a minor/self-limiting condition, or can be diagnosed through a CLIA-waived test. 

At least five other states have added autonomous prescribing via statewide protocols utilizing CLIA-waived tests including Arkansas, Colorado, Delaware, Iowa, and Kansas. 17 states have added Test and Treat prescribing via CPA as well. The federal government drew the country’s attention to Test and Treat during the COVID pandemic with the request for pharmacists to be involved with COVID treatments. This prompted the FDA to change their stance on the EUA language for Paxlovid now allowing pharmacists to prescribe and dispense this pivotal treatment.

MedRx simplifies billing

Providing the test and treat service is, however, not without its hurdles for pharmacists.  Although supported legally, billing and payment for these services can be a challenge. Some Test and Treat services are covered under pharmacy benefits, others are covered under medical benefits.  Medical billing for pharmacists can be confusing with rules and billing parameters that can be tricky to navigate.

This is where Change Healthcare’s MedRx can assist. MedRx is a solution for pharmacies that want to improve their medical-claims billing efficiency, increase their revenue, and improve customer satisfaction.  This powerful platform allows pharmacists to process claims for medical items and services to Medicare Part B, state Medicaid agencies, and numerous commercial payers, all through their existing dispensing systems. The procedure for billing diabetic testing equipment and supplies, immunizations, or OTC COVID tests looks and feels exactly like billing any other prescription drug.  Edward “Ted” Colvin, Product Manager for MedRx, had this to say, “The last thing pharmacists and their staff need is an unfamiliar billing standard or a one-off process that sits outside of workflow. MedRx solves both of those problems by letting providers use their own software to bill for medical services and removes the need to learn medical coding. We handle all of the tricky and tedious billing processes so providers can focus on patient care.” With the help of MedRx, pharmacists can incorporate test and treat services into their pharmacy offerings with ease, knowing that the problems associated with billing are solved!

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