ACCP’s Washington office is fully focused on the College’s advocacy initiative to achieve full integration of a coordinated comprehensive medication management (CMM) service for Medicare beneficiaries delivered by qualified clinical pharmacists practicing as part of interprofessional health care teams.

Despite the well-documented political dysfunction gripping Capitol Hill, it is encouraging that moderate legislators remain willing to work in a bipartisan manner to address several important health care issues, including efforts to improve chronic care. In addition, ACCP is expanding its focus to explore regulatory opportunities to advance the College’s initiative, particularly within the context of evolving Medicare alternative payment models (APMs) that have been embraced by the Centers for Medicare & Medicaid Services (CMS). The leadership of key CMS staff as part of ACCP’s recent Patient-Centered Team-Based Practice Forum in Jacksonville, Florida, demonstrates that the agency is increasingly prioritizing the issue of improving medication use among America’s seniors.

The following are just some of the activities ACCP was engaged in throughout the first quarter of 2018.

HHS Secretary Alex Azar Responds to ACCP’s Medication Management Questions

On January 29, 2018, Alex Azar, a former drug industry executive, was sworn in by Vice President Mike Pence as the secretary of the Department of Health and Human Services (HHS). Azar will serve as the Trump administration’s second HHS leader. His predecessor, Tom Price, resigned following widespread criticism of his use of expensive private charter planes for official business travel at taxpayers’ expense.

With an annual budget of over $1 trillion, HHS is the largest department within the federal government and has jurisdiction over the Centers for Medicare & Medicaid Services (CMS) as well as agencies such as the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA) and National Institutes of Health (NIH).

Azar previously served under President George W. Bush as HHS general counsel in 2001–2005 and later as deputy secretary. However, Azar’s nomination was controversial to many Democrats, given his background in the pharmaceutical industry as president of Indianapolis-based Lilly USA and his public opposition to the Affordable Care Act (ACA). His nomination was eventually confirmed in the Senate by a vote of 55-43. Seven Democrats voted for Azar’s confirmation, and one Republican, Senator Rand Paul (KY), opposed him.

As part of the Senate nomination hearing, Senator Tom Carper (D-DE) introduced the following questions on behalf of ACCP to Azar related to his positions on policy approaches to improving medication use among Medicare beneficiaries:

Question: You served at the Department of Health and Human Services during the initial implementation of the Medicare Part D program. That program has been successful in ensuring that seniors have coverage for the medications their doctors prescribe. In addition to covering the cost of drugs for seniors, the Part D law included medication therapy management services to help seniors take their medications correctly and to obtain the greatest health care benefit. Unfortunately, that part of the program has not been as successful as we had hoped. A recent report by the Medicare Payment Advisory Commission indicated that the medication therapy management programs are “falling short” of their goal to reduce unnecessary expenditures and improve quality. The report also indicated that physicians might be reluctant to accept recommendations on medication management from Part D drug plans. Given that MTM in the Part D program isn’t meeting its intended goals, what more should we do to help seniors use their medications effectively? Do you think we should do more to make sure proven medication adherence programs such as comprehensive medication management and medication synchronization are available to seniors in Medicare? How can we make sure that doctors and clinical pharmacists are collaborating to help Medicare beneficiaries take the right drugs in the right ways at the right times?

Response: As I indicated in my opening statement, one of my top four priorities as Secretary, if confirmed, will be to use the power of Medicare to drive transformation of our health care system from a procedure-based system that pays for sickness to a value-based system that pays for quality and outcomes. The Center for Medicare & Medicaid Innovation (CMMI) will be a critical part of these efforts. I understand that CMMI currently has an ongoing model, the Part D Enhanced MTM Model, which offers an opportunity and financial incentives for basic stand-alone Part D prescription drug plans (PDPs) in selected regions to offer innovative MTM programs in lieu of the standard CMS MTM model, aimed at improving the quality of care while reducing costs. I believe CMS is also testing changes to the Part D program that aim to achieve better alignment of PDP sponsor and government financial interests while creating incentives for robust investment and innovation in MTM targeting and interventions. If confirmed, I look forward to coordinating with CMS as they work toward their goal of fostering an affordable, accessible health care system that puts patients first.

Azar also testified that his broad priorities as secretary would include working to make health care more affordable, altering Medicare to reward providers for promoting good health, and tackling the opioid epidemic.

Carper has established himself as a leading voice in the Senate on issues related to medication use. As part of the negotiations related to the Bipartisan Budget Act of 2018, Carper – together with his Republican colleague from Kansas, Senator Pat Roberts – introduced an amendment requiring the Secretary of HHS to establish a process, beginning in plan year 2020, by which a Medicare Part D plan sponsor may submit a request to HHS for claims data under Medicare Parts A and B.

ACCP Submits Comments to Senate Finance Committee on how to Improve Medicare and Medicaid Responses to the Opioid Epidemic

Following the October 2017 announcement by the Trump administration directing the Department of Health and Human Services (HHS) to declare the ongoing opioid crisis a public health emergency, health policy leaders on Capitol Hill have worked to develop legislation that would impose new rules to restrict access to opioid painkillers and open up access for opioid addiction treatment.

As part of this process, in February 2018, Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) issued a request for feedback from health care stakeholders across the country on how to improve Medicare, Medicaid, and human services program responses to the opioid epidemic.

Citing alarming data that indicate opioid prescriptions made up $4 billion in Medicare Part D spending in 2016 and services and care for those with opioid use disorders amounted to $9 billion in Medicaid spending in 2015, Hatch and Wyden called for “policy recommendations along the continuum that spans from addressing the root causes that lead to, or fail to prevent, opioid use disorder and other substance use disorders to improving access to and quality of treatment.”

In response to this request, ACCP submitted comments to the Senate Finance Committee, calling on Congress to include reforms to the Medicare program that provide for coverage of comprehensive medication management (CMM) services provided by qualified clinical pharmacists as members of the patient’s health care team.

Specifically, ACCP’s comments focused on how pharmacists providing CMM identify appropriate goals for opioid therapy in individual patients, recommend alternatives if these goals are not met, and monitor adverse effects of opioids to mitigate the risks of oversedation and overdose. The comments also described how clinical pharmacists help:

• Ensure that patients reach medication-related clinical goals that are established through shared decision-making with all members of the health care team.
• Address opioid use and/or misuse, when applicable.
• Educate patients and health care providers about acute and chronic pain therapeutics.
• Evaluate and implement clinical pathways and systems to optimize use of opioids and other controlled substances for therapeutic use.

In addition, the comments recommended increased use of clinical pharmacists to administer naloxone and provide appropriate education on its use in patients experiencing an opioid overdose, and ensure that patients identified as having opioid use disorder are appropriately referred to treatment centers to address their addiction.

On February 27, a bipartisan group of senators introduced legislation that would establish a 3-day initial prescribing limit on opioids for acute pain, increase the availability of treatment, and improve services to promote recovery. The Senate bill authorizes $1 billion in additional funding that includes:

• $10 million to fund a national education campaign on opioids.
• $300 million to increase training for first responders and their access to opioid overdose reversal drugs.
• $300 million to expand medication-assisted treatment.
• $200 million to help build more recovery support services.

On the House side, the Energy and Commerce Committee is working on legislation aimed at combating the opioid epidemic. Chairman Greg Walden (R-OR) indicated that he hopes to pass the measures out of the House by the Memorial Day weekend.

Click here to read ACCP’s comments in full.

Click here for more information on the Senate effort to reauthorize and expand the Comprehensive Addiction and Recovery Act of 2016.

ACCP is the Voice of Clinical Pharmacy in Washington, DC: Introducing the ACCP-PAC Governing Council

A well-funded Political Action Committee (PAC) provides ACCP with important financial resources to support its friends on Capitol Hill. ACCP-PAC is the only political action committee dedicated to electing members of Congress who are committed to advancing the College’s Medicare Initiative.

As with many of ACCP’s initiatives, ACCP-PAC is member-driven, and strategic policy decisions – including those related to which candidates to support – are made by the PAC Governing Council. The current ACCP-PAC Governing Council consists of the following ACCP members:

President

• Sara Brouse, ACCP Regent.

Treasurer

• Gary Matzke, ACCP Past President.

Secretary

• Michael Maddux (supported by ACCP staff member John McGlew).

Members

• Brad Phillips, University of Georgia.
• Daniel Nam, America’s Health Insurance Plans (AHIP) and former Congressional Fellow.
• Tracey Hagemann, ACCP Regent.

All decisions regarding financial contributions to candidates are made by the PAC Governing Council on the basis of certain established criteria:

• Position on key health care committees in Congress.
• Proven support for pharmacy and health care–related issues.
• Previous health care experience.

Contributions from ACCP-PAC to members of Congress help raise the College’s profile on Capitol Hill, improve its standing among key lawmakers, and provide unique opportunities to discuss the College’s initiative with potential congressional champions. ACCP-PAC will also help ensure that elected officials who support the initiative remain in office to advance the goals of the proposal in the future.

Only ACCP members are eligible to contribute to the PAC and allow the College to make these vital political contributions. With its almost 18,000 ACCP members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, the widespread support of ACCP membership is needed.

If each ACCP member contributed just $25, ACCP-PAC would raise over $350,000. All ACCP members should consider donating at least $25 to ACCP-PAC. CLICK HERE to support your PAC today!

Now Accepting Applications – ACCP/ASHP/VCU Pharmacy Policy Fellow Program

The Congressional Healthcare Policy Fellow Program is a collaborative effort of ACCP, the School of Pharmacy at the Medical College of Virginia/Virginia Commonwealth University, and the American Society of Health-System Pharmacists.

The program provides a unique health care policy learning experience designed to demonstrate the value of pharmacy-government interaction and to facilitate practical contributions to the effective use of scientific and pharmaceutical knowledge in government policy development. Fellows spend the first 2 months of the program with each of the professional organizations as members of their respective government and professional affairs staff. In September of the fellow year, the Fellow begins working in a legislative environment requiring health care input on the staff of an individual senator or representative or a relevant congressional committee.

The program is an enriching opportunity for the Fellow to develop legislative evaluation and policy development skills, improve research and writing skills, and integrate practical policy experience with theory. The Fellow will be expected to undertake a wide array of responsibilities, including researching and preparing briefs on health care issues; assisting with policy decisions; drafting memoranda; and planning, organizing, and carrying out program and management objectives.

Fellows typically seek congressional office placement with one of the committees that predominantly deal with health issues such as the Senate Health, Education, Labor, and Pensions (HELP) Committee and Senate Finance Committee or the House Ways and Means or Energy and Commerce committee. Interested candidates should visit the Pharmacy Healthcare Policy Fellow program’s website for more information and instruction on submitting and application.

Contact Us! For more information on any of ACCP’s advocacy efforts, please contact the ACCP Government and Professional Affairs team:

John K. McGlew
Director, Government Affairs
[email protected]

Daniel S. Aistrope, Pharm.D., BCACP
Director, Clinical Practice Advancement
[email protected]

Katherine Pham, Pharm.D., BCPPS
Director of Policy and Professional Affairs
[email protected]

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