ACCP Calls on Biden Administration to Address Pharmacoequity in Medicare

ACCP is calling on the Biden administration to include coverage for team-based comprehensive medication optimization services delivered by clinical pharmacists in the Fiscal Year 2024 Budget Request to Congress.

The Centers for Medicare & Medicaid Services (CMS) is the largest provider of health insurance in the United States, responsible for ensuring that more than 170 million individuals are supported by CMS programs (including Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplaces). In its 2022–2032 Framework for Health Equity, CMS states that it aims to identify and remedy systemic barriers to equity so that all persons it serves have a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.

Given the importance of pharmacotherapy in health care, equitable medication use is paramount to eliminating health disparities. Earlier this year, the Get the Medications Right Institute published a statement highlighting the importance of pharmacoequity to ensure that all patients – regardless of race, ethnicity, socioeconomic status, or availability of resources – are treated with the optimal medication regimen, have access to their medications, and can use their medications to manage their health conditions.

Lack of diversity in clinical trials suggests that treatments proven effective are not generalizable to or effective for all populations.¹ Furthermore, multiple studies have shown that racial and ethnic minorities are less likely to be prescribed newer pharmacologic agents and receive guideline-concordant care.² Clinical pharmacists are increasingly recognized as essential team members addressing medication therapy problems associated with social determinants of health to improve health outcomes.³ Incorporating CMM into the Medicare program is essential to achieving the goals of the Quintuple Aim for Health Care Improvement⁴ and has been shown to improve outcomes,⁵ increase patient satisfaction,⁶ improve physician work-life balance,⁷ and save money.⁸

Background to Medicare Medication Coverage

The Medicare Part D drug benefit successfully expanded Medicare to include prescription medications in the early 2000s. However, Medicare has never had a meaningful patient care benefit to ensure that expensive and complex prescription medications provide maximum value and contribute to optimal patient outcomes.

The time for that to change is now. ACCP supports the Biden administration’s efforts to lower the cost of prescription drugs to patients and believes that medication optimization is just as important as – if not more important than – medication affordability. Integrating clinical pharmacists into Medicare patient-centered teams could achieve this critically important goal at a national level.

ACCP’s Recommendation

Medication misuse is estimated to account for at least $528.4 billion in unnecessary health care spending annually. Comprehensive medication management (CMM) has been shown to improve outcomes, increase patient satisfaction, improve physician work-life balance, and save money.

CMM is a well-established standard of care in the nation’s leading private sector health systems, including Geisinger, Kaiser Permanente, Mayo Clinic, and Johns Hopkins. The Veterans Health Care system has systematically integrated clinical pharmacist specialists into PACTs (Patient Aligned Care Teams) to significantly improve patient outcomes for a range of chronic conditions.

CMM provided by clinical pharmacists, in close collaboration with physicians, is a critically important step to help ensure medication therapy is fully optimized, contributing to better care, lower costs, improved outcomes, and enhanced equity.

Click here to read ACCP’s December 2023 letter to the Biden administration calling for the inclusion of comprehensive clinical pharmacists’ services in the 2024 Budget Request to Congress.

References

1. Flores LE, Frontera WR, Andrasik MP, et al. Assessment of the inclusion of racial/ethnic minority, female, and older individuals in vaccine clinical trials. JAMA Netw Open 2021;4:e2037640.
2. Essien UR, Holmes DN, Jackson LR II, et al. Association of race/ethnicity with oral anticoagulant use in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II. JAMA Cardiol 2018;3:1174-82.
3. Cobb CD, Allen SN, Cusimano JM, et al. Social determinants of health in people living with psychiatric disorders: the role of pharmacists. Health Equity 2023;7:223-34. Available at http://online.liebertpub.com/doi/10.1089/heq.2022.0189.
4. Itchhaporia D. The evolution of the quintuple aim: health equity, health outcomes, and the economy. J Am Coll Cardiol 2021;78:2262-4.
5. Cobb CD. Optimizing medication use with a pharmacist-provided comprehensive medication management service for patients with psychiatric disorders. Pharmacotherapy 2014;34:1336-40.
6. Brummel A, Lustig A, Westrich K, et al. Best practices: improving patient outcomes and costs in an ACO through comprehensive medication therapy management. J Manag Care Spec Pharm 2014;20:1152-8.
7. Haag JD, Yost KJ, Kosloski Tarpenning KA, et al. Effect of an integrated clinical pharmacist on the drivers of provider burnout in the primary care setting. J Am Board Fam Med 2021;34:553-60.
8. Chung TH, Hernandez RJ, Libaud-Moal A, et al. The evaluation of comprehensive medication management for chronic diseases in primary care clinics, a Texas delivery system reform incentive payment program. BMC Health Serv Res 2020;20:671.