ACCP’s Medicare Initiative Advocacy Resources Now Available

Two important resources are now available related to our ongoing campaign to seek legislative changes to relevant sections of the Social Security Act that would recognize the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program:

Medicare Initiative Congressional Issue Brief

This two-page overview of the initiative was developed to help members of Congress and congressional staff understand:

• Why a comprehensive medication management (CMM) benefit would improve care for Medicare beneficiaries and why this benefit belongs under Part B of the Medicare program
• The process of care that constitutes CMM
• The definition of a “qualified clinical pharmacist”
• Action needed from Congress

Click here to access the Medicare Initiative Congressional Issue Brief.

Medicare Initiative Data Document

This fact sheet includes aggregated results from 19 distinct medication management service practices, provided by qualified pharmacists within settings such as community-based pharmacies, hospital-based clinics, free-standing medical clinics, and health systems. In all cases, a consistent and comprehensive process of care was used in the provision of the service. Data reflect 11,804 patients (older than 65 years) with 21,213 documented encounters.

From these data, ACCP projects that provide coverage for CMM services could help the Medicare program avoid:

• Almost 6 million physician office visits, saving more than $1 billion annually
• 670,000 emergency department visits, saving more than $500 million annually

Click here to access the Medicare Initiative Data Document

ACCP members are encouraged to familiarize themselves with these documents to guide communications with Congress related to the initiative and help ensure we deliver a consistent and coherent message around how CMM helps “get the medications right” and why Congress should enact legislation to achieve this.

For more information on our advocacy effort in general, visit our Medicare Coverage Initiative Web page for up-to-date resources and details about how to get more involved.

It’s Time for Action – Tell Congress Why Medicare Part B Needs a Comprehensive Medication Management Benefit

ACCP is well under way with a schedule of meetings with congressional offices aimed at generating support for our initiative and identifying champions to introduce legislation that would recognize comprehensive medication management (CMM) as a covered Medicare Part B benefit. It is vital that elected officials hear directly from clinical pharmacists delivering direct patient care services in their states and districts.

Contacting your elected officials is simple. We have prepared a letter to Congress describing our Medicare initiative that you can review and edit. You can send this letter to Capitol Hill in just a few easy clicks, but for maximum impact, we encourage you to personalize the letter by sharing some additional information about your clinical practice and the patients you care for. Click here to visit our Legislative Action Center and follow the instructions to send your message to Capitol Hill.

Please also consider inviting your senators and representative to visit your practice setting so that they can learn firsthand about the value that clinical pharmacists bring to the health care delivery team. For more information on setting up a site visit, click here or contact ACCP’s associate director, government affairs at [email protected] or (202) 621-1820.

Thank you for participating in this important advocacy effort.

Legislative Strategy

ACCP’s Medicare initiative represents a legislative proposal that is fundamentally different from previous efforts to secure Medicare Part B “provider status.” In the past, we sought coverage for a loosely defined set of services delivered by all pharmacists, regardless of credentials or clinical experience. In contrast, our current effort is narrowly targeted on a clearly defined, comprehensive clinical pharmacy practice delivered by clinical pharmacists providing care as members of interprofessional teams, with established collaborative drug therapy management (CDTM) agreements or formal clinical privileges granted using local credentialing processes.

ACCP believes this approach is correct from both a political and a professional perspective. The policies, position statements, and core values of the College lead ACCP to believe that direct patient care services should be provided by clinical pharmacists who possess the education and training needed to competently provide that level of care. In addition, ACCP’s view is that formal documentation of the patient care privileges and responsibilities of the clinical pharmacist, in collaboration with other health professionals caring for a patient, is critically important to ensure (1) increased coordination and efficiency of patient care, (2) clarity of expectations by other members of the care team regarding the clinical pharmacist’s roles and responsibilities, and (3) greater flexibility and breadth of responsible decision-making by the clinical pharmacist.

State Activity

Our Medicare initiative is focused at the federal level, but recent interesting developments at the state level are consistent with our approach:

California

Legislation currently being considered in California (S.B. 493) is meant to address the state’s primary care crisis by recognizing pharmacists as health care providers. The bill seeks to improve patient access to health care by empowering pharmacists to provide basic care services in collaboration with physicians, medical homes, and other systems of care in which patients receive treatment. All of the authorities addressed in S.B. 493 are currently within the pharmacist scope of practice, but they are generally tied to specific care settings. The bill would simply expand the types of settings in which pharmacists can practice these services.

The bill would establish recognition for advanced practice pharmacists (APPs). Participating providers would be required to qualify as APPs to order and interpret drug therapy–related tests, participate in the evaluation and management of diseases and health conditions in collaboration with other health care providers, and initiate, adjust, or discontinue drug therapy.

To achieve APP recognition, pharmacists must satisfy two of the following three criteria:

• Have earned certification in a relevant area of practice such as ambulatory care, critical care, oncology pharmacy, or pharmacotherapy
• Have completed a postgraduate residency program
• Have provided clinical services to patients for 1 year under a collaborative practice agreement or protocol with a physician, APP pharmacist, CDTM pharmacist, or health system

In May 2013, S.B. 493 passed the Senate with an almost-unanimous 34-4 vote. The bill was then taken up by the Assembly for further hearings. On August 15, 2013, the bill was approved in the Assembly by the Committee on Health and will now be considered by the Committee on Appropriations.

In an important development, the California Medical Association (CMA) wrote to Senator Hernandez, the original sponsor of the bill, on July 19 to inform him that the CMA had revised its earlier opposition to the bill and had adopted a “neutral” stance on the legislation. The letter stated that this decision was made partly because direct patient care services would be delivered by pharmacists with the appropriate education and training to attain an APP designation.

Click here to read the letter from the CMA to Senator Hernandez.

Click here to read a summary of S.B. 493.

Click here to read the text of the California legislation.

Maine

On June 19, 2013, Maine governor Paul LePage signed into law LD 1134 – An Act to Allow Collaborative Practice Agreements Between Authorized Practitioners and Pharmacists. The new law will allow authorized practitioners, within their scope of practice, to voluntarily enter into collaborative agreements with qualified pharmacists to provide patient-centered CDTM services. Under the new law, qualified pharmacists can initiate, modify, or continue drug therapy; order related laboratory tests; and perform related physical examination assessments.

The law requires that, to enter into a collaborative practice agreement, qualified pharmacists possess certification from the Board of Pharmacy Specialties or a successor organization or complete an accredited residency program. Reports from pharmacists who were engaged in the process of securing passage of this legislation indicated that these provisions were critical to overcoming opposition from the Maine Medical Association.

Click here for the text of the Maine legislation.

Of note, neither of these state initiatives has any direct connection to our Medicare proposal. However, because recent state policy on medication management and pharmacist-delivered patient care is consistent with what ACCP is advocating for at the federal level, this could be an important factor in our ongoing discussions on Capitol Hill.

Capitol Hill Update

ACCP in Washington, D.C., is currently working to identify legislative champions on Capitol Hill who will be committed not only to introducing a bill on our behalf, but also to working with us to advance it and move it through the legislative process.

Ideally, our goal is to secure the bipartisan introduction of legislation, with a Republican lead sponsor and a Democratic original cosponsor in the House, with both sponsors on a committee of jurisdiction. With Democratic control in the Senate, we will seek the reverse in that chamber – a Democratic sponsor and a Republican original cosponsor.

Congressional committees with jurisdiction over the Medicare program are the Ways and Means Committee and the Energy and Commerce Committee in the House of Representatives and the Finance Committee in the Senate. Our goal to identify legislative champions in the House and Senate members who sit on these influential committees and will accordingly be best positioned to advance its passage through the legislative process.

Your Contribution to ACCP-PAC Can Help Advance Our Medicare Coverage Initiative

ACCP-PAC is the only political action committee dedicated to electing members of Congress who are committed to advancing our Medicare initiative. Contributions from ACCP-PAC to congressional members will raise our profile on Capitol Hill, improve our standing among key lawmakers, and provide unique opportunities to discuss our initiative with potential congressional champions. Our PAC will also help ensure that elected officials who support our 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 us to make these vital political contributions. With more than 14,000 ACCP members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, we need the widespread support of our membership.

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

Advocacy Session – ACCP 2013 Annual Meeting, Albuquerque, New Mexico

ACCP Medicare Initiative: Policy and Politics. (Monday, October 14, 2013. 9:15 a.m.–11:15 a.m. Convention Center, La Cienega)

Learn more about ACCP’s comprehensive initiative to pursue legislation that would recognize the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program. Hear updates about our progress on Capitol Hill and learn how you can get involved through grassroots advocacy and ACCP-PAC to help move this initiative forward in Congress.

Contact Us!

For more information on any of ACCP’s advocacy efforts, please contact:

John K. McGlew, Associate Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue NW
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]