APhA and Health Care Reform
July 9, 2010
In March 2010, President Obama signed into law the
Patient Protection and Affordable Care Act (P.L. 111-148) and
the Health Care and Education Reconciliation Act of 2010 (P.L.
111-153). These two laws constitute health care reform and are
referred to as the Affordable Care Act (ACA). APhA actively engaged only
on the pharmacy-related issues to optimize the opportunity that health
care reform could offer pharmacists. APhA was instrumental in ensuring
the inclusion of several provisions that could be beneficial to
pharmacists. This success could not have occurred without APhA’s
members’ support.
APhA’s Position
The American Pharmacists Association (APhA) did not take a position on
the overall health care reform bills. There were too many elements of
each proposal on which the Association did not have a consensus on the
issue, such as how to expand access (e.g., health insurance exchange,
employer mandate) and how to fund expanded access. Instead, APhA focused
its advocacy efforts on the areas that were directly relevant to the
practice of pharmacy and the patients that the profession serves (see
below).
APhA’s Focus
APhA’s efforts were focused on increasing patient
access to pharmacists clinical services to improve the quality of care
and lower health care costs regardless of how the system was financed or
how coverage was expanded. Medications are the first line of defense in
fighting and preventing disease. However, improper medication use costs
our nation approximately $177 billion a year. Pharmacists, when provided
the opportunity to partner with patients and providers can improve
medication use, resulting in improved health outcomes and reduced
overall health care costs.
APhA leveraged the “lessons learned” from
successful public and private sector programs and persuaded Congress to
include several provisions that have the opportunity to optimize the
benefits of pharmacists clinical services, such as:
Testing the Best Way to Deliver Medication Therapy
Management (MTM) Services
Improving Current Medicare Part D Medication
Therapy Management (MTM) Programs
Including Pharmacists and Pharmacist-Related
Services in Integrated Care Models
Including Pharmacists and/or Pharmacist-Related
Services in Transitional Care Models
Other Pharmacy-Related Provisions
Some of the other ACA provisions that could have an
impact on pharmacy include:
"Fixes" the average manufacturer's price
(AMP)-based reimbursement formula for generic medications in the
Medicaid program (Section 2503); Exempts certain pharmacies from Medicare
accreditation requirements to supply durable medical equipment,
prosthetics, orthotics, and supplies (DMEPOS) and extends the deadline
for obtaining accreditation until January 1, 2011 (Section
3109); Creates pharmacy benefit managers (PBM)
transparency requirements (Section 6005); Establishes a National Health Care Workforce
Commission that includes pharmacists in the definition of the health
care workforce (Section 5101); Awards schools, including schools of pharmacy,
grants to offer courses that focus on geriatrics, chronic care
management, and long-term care (Section 5305); Makes pharmacists eligible for the Area Health
Education Centers interdisciplinary training grants (Section
5315); Advances research and treatment for pain care
management (Section 4305); Establishes payment and approval pathway for
biosimilars (Section 7002, 3139); Creates a Medicare coverage gap discount program
(Section 3301); and Addresses dispensing of outpatient prescription
drugs in long-term care facilities in the Medicare program (Section
3310).
For a detailed description, read the APhA
Summary of Affordable Care Act or the APhA
HCR Chart.
What You Can Do in the Implementation
Process?
While the major hurdle in the legislative process of
health care reform has passed, the health care reform implementation
process will continue for years to come. Whether it is securing
appropriations for the MTM grant program or ensuring pharmacists’
participation in integrated care models, APhA will need your help and
support in the coming months and years to build on our health care
reform successes. To ensure the best possible outcome for the
profession, we will need an “all-hands on deck” effort and
we encourage you and your colleagues to engage in APhA’s health
care reform implementation efforts today.
Now there are many ways for you to be engaged and stay
informed:
For additional information, visit APhA’s
Government Affairs page.
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