APhA and Health Care Reform
August 26, 2009
Where does APhA stand?
The U.S. House of Representatives and Senate are currently considering
health care reform legislation which seeks to improve access to, reduce
costs, and improve quality of health care. The American Pharmacists
Association (APhA) has not taken a
position on any of the current proposals and does not plan to take any
position on the comprehensive bills. There are too many elements of each
proposal for which we do not have policy, such as how to expand access
(e.g., public option, employer mandate) and how to fund expanded access.
Instead, APhA has and will continue to focus its advocacy efforts on the
areas that are directly relevant to the practice of pharmacy and the
patients that the profession serves (see below).
APhA’s Message to
Congress
Regardless of how you finance or expand coverage, we must take advantage
of this health reform opportunity to improve the quality of care and
lower health care costs. Medications are a primary form of therapy for
preventing or treating disease. Unfortunately, data show that patients
– particularly the chronically ill – face great challenges
in managing their medication therapy; these prevent them from meeting
their treatment goals and result in preventable adverse events and
avoidable costs. Health reform must address our nation’s
medication-use crisis.
Pharmacists, when provided the opportunity to partner
with patients and prescribers to help patients manage their medication
therapy, improve health outcomes and reduce overall health care costs.
Policymakers must take advantage of the lessons learned from public and
private sector programs and fully optimize the clinical expertise and
accessibility of pharmacists to help empower patients to manage their
medication therapy.
Though many elements of current health care reform
proposals that affect pharmacy and the patients that they serve are
important, APhA’s priority is to change how health care is
delivered by fully optimizing the skills and expertise of pharmacists.
To accomplish this, policymakers must:
Include Pharmacists as Part of Integrated
Care Models. The health care system must take advantage of the
specialized knowledge and skills of all professionals working as part of
a care team. The incorporation of pharmacists’ clinical services
is necessary given the nearly universal role of medications in the care
of patients with both chronic and acute disease. Include Pharmacists in Payments for
Transitional Care Activities. Pharmacists are medication
experts and one of the most readily accessible providers. Medication use
is a top reason for hospital readmissions. Pharmacists on the
transitional care team can play a major role in preventing these events,
as patients are discharged from the hospital or transferred from one
care setting to another. Provide Medication Therapy Management
Services. All health plans must provide a comprehensive
pharmacy benefit that covers both medications and pharmacist services
that ensure that the use of those medications is fully optimized and
that therapeutic outcomes are achieved. Conduct a Medication Therapy Management
Pilot. As CMS and/or AHRQ are given additional authority and
direction to conduct pilot projects, legislative proposals should ensure
that the clinical role of pharmacists is an element of at least one
project. Include Pharmacists in Workforce
Strategies. To assure that all Americans have access to the
services of well-educated and trained pharmacists competent to meet
specific health care needs of patients, legislative proposals must
establish and finance a comprehensive federal health professions
workforce strategy that includes pharmacists and schools of pharmacy.
How will it impact pharmacy?
Several elements of the House “Tri-Committee” and Senate
Health, Education, Labor and Pensions Committee’s proposals would
directly impact pharmacy; for example there are proposals to:
Include medication compliance activities in
efforts to reduce hospital readmissions. Improve the Medicaid reimbursement formula for
generic drug products. Require proposed care teams to provide primary
care providers support to assist in chronic care management activities
such as medication therapy management services and medication
reconciliation. Require transitional care programs to include
medication reconciliation and to develop discharge plans that include
medication therapy management (MTM) services as appropriate Exempt certain pharmacy suppliers from Medicare
DMEPOS surety bond and accreditation requirements. Deem certain
accreditation applications as meeting accreditation
requirements. Phase-out the Medicare Part D coverage gap
(doughnut hole). Require manufacturers to provide a 50% discount
for beneficiaries in the doughnut hole; count 100% of the cost of the
drug towards the patient’s true out-of-pocket (TrOOP)
costs. Repeal the Medicare Part D requirement that
pharmacies serving long-term care facilities submit claims within 90
days. Establish a grant program for medication therapy
management services provided by pharmacists. Establish pharmacy benefits management
transparency requirements. Establish prevention and wellness program
grants. Provide the Secretary of HHS the discretion to
establish reimbursement rates for prescription drugs in a public
plan. Include schools of pharmacy in quality improvement
demonstration programs. Include medication compliance activities when
developing and implementing quality incentive payment
structures. Include pharmacists and pharmacies in the
manufacturer/distributor “gift” reporting requirements; and
to include compounding pharmacies/ists in the definition of
“manufacturer”. Include pharmacists and schools of pharmacy in
workforce strategies, including establishing a new loan repayment
program that includes pharmacists.
For a detailed description, see the APhA Health Care Reform Message and Issue
Chart.
What you can do to help?
The
profession to ensure that we are successful. Congress will be
looking for cuts. We don’t want to be among them. Connect with
your Members of Congress and their staff when they are home this month.
Don’t let the August recess pass by without lending your voice
— pharmacy’s voice — to the health care reform
debate.
To stay informed, join APhA’s Facebook
Fan Page, Twitter, health care
reform (HCR) e-community, and Advocacy Key
Contact Network. Read CEO Tom Menighan’s
blog and our daily HCR Hub
updates. For additional information, go to APhA’s Government Affairs page.
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