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Health Reform Bill Becomes Law: Includes Key Clinical Pharmacy Provisions

Washington, D.C. - On Sunday, March 21, 2010, the U.S. House of Representatives passed historic health care and health insurance reform legislation containing several provisions that expand opportunities for patients to access and receive clinical pharmacists’ services.

The landmark bill, known as the Patient Protection and Affordable Care Act (H.R. 3590), recognizes among its many critical reform provisions the medication use problems our country faces and provides support for expanding and supporting the role of the clinical pharmacist in addressing these problems. The law also delivers a series of health care delivery reforms to promote coordination among health care providers and several important changes to the Medicare Part D Medication Therapy Management (MTM) benefit.

The final vote on the measure was 219–212, just clear of the 216 votes required to pass it. No Republicans voted for the bill. 34 Democrats opposed its passage. President Obama signed the bill into law at a ceremony in the East Room of the White House on March 23.

Clinical Pharmacy Services

Specific to clinical pharmacy services, the law provides for:

MTM Grant Programs. The new law establishes a stand-alone grant program to ensure pharmacist-provided MTM services as defined by the pharmacy profession’s consensus definition on the Core Elements of an MTM program. The program ensures the testing of practice and care delivery models, such as patient-centered self-management programs, that improve patient outcomes through team-based collaborations between prescribers and pharmacists.

Integrated Care Models. The law also includes provisions to ensure that providers with expertise in pharmacotherapy, including pharmacists, are fully engaged in integrated, collaborative, team-based approaches to delivering care, including medical homes, accountable care organizations, community health teams, and home-based chronic care programs.

Transitional Care Activities. The law recognizes the gaps in care coordination and communication that often occur when patients are transferred from one care setting to another. Problems arising from inappropriate medication use are a primary reason for hospital readmissions. Pharmacists—by helping manage pharmacotherapy as part of a transitional care team—will be able to play major roles in preventing these events. Transitional care activities might include medication reconciliation, improved use of personal medication records, and discharge planning that may include MTM services.

Medicare Advantage Plan Incentives. The law provides bonus payments to Medicare Advantage plans that conduct care coordination and management activities. In particular, it acknowledges the need for MTM programs to address medication use issues such as poly-pharmacy through medication reconciliation, periodic reviews of drug regimens, and integration of medical and pharmacy care for chronically ill, high-cost beneficiaries.

Workforce. The law establishes a National Health Care Workforce Commission that will study health care workforce supply issues and make recommendations to Congress.

Next Steps

The law, among the most important pieces of social legislation in the past half-century, represents a formal recognition at the federal level that improved MTM is a vital component of the nation’s health care reform initiatives. It is also a recognition that pharmacists as health professionals are uniquely qualified to deliver these services as members of the health care team.

This recognition is the result of an ongoing, profession-wide effort to educate lawmakers, advocate for expanded access to pharmacists’ services, and draw attention to the issue of medication use.

Even before the bill was signed into law on Tuesday, ACCP and our pharmacy stakeholder colleagues had initiated discussions with key leaders in Congress and the administration regarding the scope and structure of the clinical pharmacy provisions outlined in the legislation. Meetings with the leadership of the Agency for Healthcare Research and Quality are already scheduled to begin this important dialogue.

These discussions have also included meetings with congressional appropriators, who ultimately determine the funding of the provisions, outreach to administration officials in the Health and Human Services agencies that will administer the programs, and ongoing participation in the Patient-Centered Primary Care Collaborative (PCPCC). The PCPCC is a coalition of more than 500 primary employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians, and others who have joined together to develop and advance the patient-centered medical home. The PCPCC is considered the primary policy and advocacy work group for the continuing development of the patient-centered medical home.

For more information please contact ACCP in Washington, DC:
American College of Clinical Pharmacy
1455 Pennsylvania Avenue NW
Suite 400
Washington, DC 20004-1017
Telephone: (202) 621-1820