House pharmacy caucus highlights provider status, MTM, care transitions

Panelists at Capitol Hill briefing speak for pharmacy groups including APhA


Provider status for pharmacists, legislation on medication therapy management (MTM), and a care transitions initiative were among the topics of a briefing hosted by the Congressional Community Pharmacy Caucus on June 6 in Room 122 of the Cannon House Office Building in Washington, DC.

Pharmacists’ patient care services are “a very smart spend in Washington that pays off in a big way,” Jonathan G. Marquess, PharmD, CDE, CPT, a member of the APhA Board of Trustees, said at the briefing as part of his example of an elevator speech for provider status. “Patients need to have access to pharmacists’ services both on the federal and the state levels but also within these employer groups all across the country.”

As the hour-long briefing began, Rep. Austin Scott (R-GA), the Co-Chair of the caucus, rushed down the center aisle of the packed room and up to the lectern in front of a bright window lined with heavy red curtains. “What you’ll find from Democrats and Republicans alike is that we share a lot of common goals and sometimes we have different ideas about how to get there,” Scott told the crowd. “But one of the things that we all understand is how important the individual health care provider is in patient care.” (Rep. Peter Welch [D-VT] is the other caucus Co-Chair.)

The briefing featured three panelists. The first panelist, Ed Kaleta, a lobbyist for Walgreens, was introduced by the National Association of Chain Drug Stores and pushed for cosponsors on the MTM Empowerment Act of 2013 (H.R. 1024/S. 557). The proposed legislation would bring the number of chronic conditions needed for eligibility down to one chronic condition, as well as require the bill to be budget neutral, Kaleta said.

As of June 9, H.R. 1024, introduced by Rep. Cathy McMorris Rodgers (R-WA), had accumulated 59 cosponsors. Kaleta cited two developments that have helped the legislation gain support in recent months.

First, in November 2012, the Congressional Budget Office announced a change in its estimating methodology, namely that a 1% increase in the number of prescriptions filled by Medicare beneficiaries would cause Medicare spending to fall by 0.2%.

Second, a January 2013 interim report on MTM in a chronically ill population that was prepared for the CMS Center for Medicare and Medicaid Innovation “showed that where the MTM program focused on chronic disease, and chronic disease management, and consultations with patients, dollars were saved … in the Medicare Part B program as a result of what was going on in the Medicare Part D program,” Kaleta said.

The second panelist, Cynthia Reilly, BSPharm, Director, Medication and Safety Quality Division, American Society of Health-System Pharmacists (ASHP), described the Medication Management in Care Transitions (MMCT) joint initiative between ASHP and APhA.

Transitions of care are a critical juncture where problems are more likely to arise, leading not only to a negative impact on patient outcomes but to substantial increases in costs to the health care system, Reilly said at the briefing.

Reilly explained that 18% to 20% of Medicare patients are readmitted within 30 days of hospital discharge, accounting for $15 billion to $17 billion per year, according to a 2007 Medicare Payment Advisory Commission report to Congress; and that approximately half of these patients have not seen any health care provider between the hospital discharge and readmission, according to a 2009 New England Journal of Medicine paper.

Pharmacists are accessible and can address this gap in care by providing MTM, providing patient education, and addressing issues associated with medication access, Reilly said. For MMCT, the goals included helping patients during transitions such as from the hospital to the home or from the hospital to a long-term care facility, and reducing readmissions.

The final panelist was Marquess, who noted that all of the day’s speakers represented groups in a provider status coalition of 14 national pharmacy organizations.

In addition to serving on the APhA Board of Trustees, Marquess is also a member of the National Community Pharmacists Association, President and CEO of the Institute for Wellness and Education, a specialist in diabetes care, and a co-owner of six Health Mart Pharmacies in Georgia. He said that Scott has “always been supportive of pharmacy issues.”

Pharmacists are not listed in section 1861 of the Social Security Act, which “holds back a lot of pharmacists who do want to save money for health care,” Marquess said. “I know on a personal level in Georgia, I’m actually being held back a little bit in these accountable care organizations being formed because they will say well great, we’ve got a physician, we’ve got a nurse—oh, wait a minute, pharmacists aren’t listed as providers.”

Marquess continued, “Employers play a big role in this” too. He added that state Medicaid departments were another way of being involved with provider status. “By pharmacists being providers,” Marquess said, “this could help increase the care that those patients get and lower the costs.”