By William M. Simpson
Editor’s note: This is the first of a three-part op-ed series exploring how simple, affordable prevention could change the trajectory of the opioid epidemic — if we have the will to act.
Introduction: The Most Accessible, Yet Overlooked, Providers
Pharmacists are the most accessible healthcare professionals in the United States. More than 90% of Americans live within five miles of a community pharmacy, and in many rural communities, the pharmacy is the only remaining healthcare outpost. We saw this vividly during the COVID-19 pandemic, when pharmacists stepped up to deliver millions of vaccinations, sometimes in towns where no other medical providers were available.
And yet, under federal law, pharmacists are not formally recognized as healthcare providers. Although CPT 98960 and similar codes exist to support patient engagement, Medicare Part B and many Medicaid programs still prevent pharmacists from billing for counseling or education services. This contradiction isn’t just an oversight, it is a structural barrier that prevents pharmacists from fully serving patients, scaling prevention, and helping address the opioid crisis.
The question before us is simple: how can the most accessible, most trusted professionals in American healthcare remain invisible to our federal reimbursement system? And more urgently: how much longer can we afford this gap, given the opioid epidemic ravaging our nation and the financial difficulties that are forcing pharmacies to close their doors?
The Frontline Workforce We Take for Granted
Pharmacists already provide frontline care every day:
• They counsel patients on how to take medications safely.
• They identify dangerous drug interactions before harm occurs.
• They manage chronic diseases such as diabetes and hypertension.
• They administer vaccines and often run community health programs.
Patients rely on pharmacists as educators, community health professionals and healthcare safety nets. During the darkest days of COVID, it was pharmacists, not always doctors or hospitals, who became the trusted point of access for millions.
But unlike physicians, nurse practitioners, or physician assistants, pharmacists cannot be reimbursed for clinical services under Medicare or many Medicaid programs. This sends the wrong signal to the healthcare system. It says: “Pharmacists’ expertise is free.” And in practice, that means pharmacists are expected to do more, without compensation, in an environment where staffing shortages and burnout are already widespread.
Why Pharmacist Recognition Matters for Opioid Prevention
Nowhere is the failure to recognize pharmacists as providers more consequential than in addressing the opioid crisis; this gap in recognition directly endangers families.
Opioids are prescribed to 4 out of 5 post-surgical patients. Of those, 6.5% go on to develop chronic opioid use. Many of these patients are left with extra pills and in fact, research published in JAMA Internal Medicine found that 12% of patients still have unused opioids where 60%–70% of these patients never dispose of them properly. This creates a dangerous surplus of unused and unwanted medications in households. According to the National Survey on Drug Use and Health (NSDUH, 2021), 70% of people who misuse opioids get them from friends or family. We know where misuse begins. Now we must act on it.
Each leftover prescription represents a point of risk — a chance for misuse, diversion, or accidental ingestion. And the professional best positioned to close this gap is the pharmacist, standing at the counter, counseling the patient, and providing medication education with safe disposal options.
But without provider recognition, pharmacists are not reimbursed for this counseling. Meaning that they cannot sustainably deliver disposal solutions or reinforce education to their patients and communities. The result is a system where we hand patients powerful medications and then leave them on their own to figure out what to do with the leftovers.
The SUPPORT Act’s Unrealized Promise
DisposeRx was proud to be present at the signing of the SUPPORT Act in 2018, when Congress recognized this issue and took action. Among its key provisions, the law gave the FDA the authority to strengthen Risk Evaluation and Mitigation Strategies (REMS) for opioid analgesics, integrating drug disposal into REMS as a risk mitigation measure, ensuring that safe disposal methods are considered part of the overall strategy to reduce misuse, diversion, and accidental exposure to controlled substances. Yet, despite this clear mandate, the FDA has not meaningfully or effectively exercised this authority, leaving a critical gap in national efforts to prevent at-home risk.
But the promise of the SUPPORT Act has not been fully realized. Instead of empowering pharmacists to deliver counseling and in-home disposal solutions, implementation has focused narrowly on mail-back envelopes, a method that research shows have compliance rates between just 4% and 19%. Meanwhile, FDA has failed to define or formally recognize “in-home drug disposal,” despite years of public comment urging it to do so.
The result is a mismatch between legislative intent and regulatory execution. Pharmacists are ready to help, have defined in-home disposal best practices and families want solutions. The tools exist, but the system is not aligned to make prevention standard practice.
Historical Lessons: Seat Belts, Poison Packaging, and Provider Gaps
We’ve been here before. Public health history is full of moments when common-sense reforms faced resistance — often on the grounds of cost or feasibility — only to later become baseline expectations.
• In the 1960s, child-resistant packaging was introduced after alarming rates of childhood poisonings. Industry balked at the inconvenience. Today, no one questions the value.
• In the 1970s, seat belt laws were controversial, framed as unnecessary regulation. Today, they are mandatory, and seat belts save thousands of lives annually.
• Motorcycle helmet laws were fiercely resisted in some states. Yet helmets dramatically reduce traumatic brain injury and death.
Pharmacist provider recognition falls into the same category. Critics may worry about cost or disruption, but the reality is simple: failing to empower pharmacists costs lives and societal harm costs every day.
International Comparisons
The United States is an outlier in failing to recognize pharmacists as providers. In many countries, including the UK, Canada, and Australia, pharmacists are integrated into primary care teams, reimbursed for counseling, and empowered to deliver frontline prevention.
For example:
• In the UK, pharmacists conduct medication reviews reimbursed by the National Health Service.
• In Canada, pharmacists are recognized as prescribers for certain conditions and compensated for counseling.
• In Australia, pharmacists are funded to deliver opioid substitution therapy and safe disposal programs.
These nations recognize what we continue to ignore: pharmacists are essential providers, and their work saves money and patients by preventing harm.
But we don’t need to look overseas to see what happens when pharmacists are empowered and reimbursed — we have proof here at home.
In Washington State, pharmacists have been recognized as healthcare providers since 2015. The results are clear: pharmacist-led programs for diabetes and hypertension management lowered A1c levels and improved blood pressure control, preventing ER visits and hospitalizations. Every dollar spent on pharmacist-provided medication therapy management saved $3–$5 in avoided medical costs.
In Idaho, where pharmacists hold the broadest prescriptive authority in the country, patients now receive faster, lower-cost access to care for minor ailments and preventive services. That shift has reduced unnecessary ER visits, saved Medicaid hundreds of dollars per episode of care, and freed physicians to focus on more complex cases.
In California, pharmacists are reimbursed for providing critical preventive care — from smoking cessation to HIV prophylaxis. Early data show reduced transmission rates improved quit rates, and long-term cost savings that stretch into the hundreds of thousands of dollars per case prevented.
And this is not unique to those states. Minnesota’s Medicaid program saves $12 for every $1 spent on pharmacist-led medication therapy management. New Mexico has demonstrated that pharmacist-managed hypertension care can match or exceed physician outcomes at a lower cost. Oregon has shown how pharmacist-prescribed contraceptives and cessation therapies expand access and deliver a strong public return on investment.
The lesson is unmistakable: when pharmacists are brought into the system and paid for their services, they deliver measurable improvements in access, outcomes, and cost savings. They stop problems before they escalate. They extend care into rural and underserved areas. And they create the kind of preventive impact that no other part of the healthcare system can match.
The Economics of Recognition
Failure to recognize pharmacists is not only a public health problem; it is an economic one.
Consider the costs of opioid misuse: the White House Council of Economic Advisers (2020) estimated the epidemic at $696 billion annually. More recent estimates put the figure at $2.7 trillion, nearly 10% of US GDP. Meanwhile, the cost of empowering pharmacists to deliver counseling and safe disposal at the point of care is minimal, yet the opportunity to prevent overdose, protect families, and close this public health gap remains largely untapped.
Billing codes like CPT 98960 already exist, designed for self-management education, a perfect pathway for pharmacist reimbursement. Allowing pharmacists to use these codes and others would unlock reimbursement without reinventing the system. And each counseling session paired with a $1.50 disposal packet represents a 100x return on investment by preventing even a fraction of misuse or overdose incidents.
Case Study: Pharmacies as Prevention Hubs
In community pilot programs, when pharmacists provided disposal packets with counseling, compliance skyrocketed.
• At Shriners Hospitals for Children, 92% of families disposed of leftover opioids when given packets and education. The cost: less than $2 per patient.
• At Penn Medicine, patients given disposal packets post-surgery had significantly higher disposal rates than those without.
These results are consistent across settings: when pharmacists are empowered, prevention works. When they are sidelined, leftovers remain — fueling addiction, diversion, and tragedy.
The Human Face of Prevention
Behind the data are families. A mother who loses her son to an accidental overdose from leftover painkillers. A grandfather who didn’t realize his unused medications could be stolen by a struggling teenager. A child rushed to the ER after swallowing pills from a bottle left in a drawer.
Pharmacists are often the last professional to see these families before such tragedies occur. With recognition and reimbursement, they can turn that final interaction into a moment of prevention.
A Call to Congress and CMS
Recognizing pharmacists as providers under Medicare and Medicaid is not radical. It is overdue. Congress can act by amending Section 1861 of the Social Security Act to include pharmacists as providers and CMS can act by clarifying reimbursement pathways for patient counseling and safe disposal.
Doing so would:
1. Compensate pharmacists fairly for the counseling they already provide.
2. Empower prevention at the point of greatest vulnerability: the medicine cabinet.
3. Save billions in avoided healthcare, criminal justice, and productivity costs.
Conclusion: Prevention Begins at the Counter
As President and CEO of DisposeRx, I have seen firsthand how simple, affordable solutions can change outcomes. But this is not about one product or one company. It is about aligning our healthcare system with common sense.
Pharmacists are providers. They always have been. It is time Washington caught up.
We cannot afford to keep treating pharmacists as invisible parts of our healthcare team, nor can we continue ignoring the power of in-home disposal. Prevention begins at the counter with the trusted professional who hands you your medication and has one last chance to keep your family safe.
Stay tuned for the next installment, Op-Ed 2: Closing the Medicine Cabinet Gap with Prescription Medication Safety, where we explore how overlooked risks in the home can be transformed into the front line of prevention.
For more data and resources on this topic, visit Medication Safety Made Simple.
William M. Simpson is President & CEO of DisposeRx, Inc.
