Advocacy Highlights at the 2022 ACCP Global Conference

ACCP’s Government and Professional Affairs team is planning several exciting programs at the 2022 ACCP Global Conference on Clinical Pharmacy in San Francisco. This year, the College will highlight the following programs.

Keynote Address: Can Comprehensive Medication Management Save the Value-Based Payment Movement?

Saturday, October 15, 2022, 8:00 a.m. to 9:30 a.m. (PDT)

Speaker: Michael S. Barr, M.D., MBA, MACP, FRCP, President and Founder, Medis, LLC

Over the past 10 years, the CMS Innovation Center has launched over 50 models, but only six have generated statistically significant savings for Medicare. Analyses of commercial health plan experience with value-based payment models have demonstrated similarly mixed success. Yet there is seemingly tremendous momentum behind value-based models. Why aren’t there better results? Could comprehensive medication management (CMM) help value-based payment models deliver on their promise?

During this presentation, Barr will argue that interprofessional teams are the best approach to the delivery of excellent health care and that clinical pharmacists, as members of these interprofessional teams, are essential to meaningful improvements in care. Although new, better, digital-quality measures will be used in the future, the current (and future) portfolio of measures will continue to emphasize clinical conditions for which optimal medication management can produce better clinical and financial performance. Appropriate support for team-based care and broad implementation of CMM could generate the outcomes needed and the evolution of value-based payment models.

Beyond Provider Status: Developing, Advancing, and Positioning Clinical Pharmacists Through Interprofessional Efforts

Monday, October 17, 2022, 8:30 a.m. to 10:30 a.m. (PDT)

Available for 2.0 hours of CPE credit

Speakers:

• Katherine D. Pham, Pharm.D., BCPPS, Director, Policy and Professional Affairs, American College of Clinical Pharmacy (ACCP), Washington, D.C.
• Kelly R. Ragucci, Pharm.D., FCCP, BCPS, Vice President of Professional Development, American Association of Colleges of Pharmacy; Professor Emeritus, Medical University of South Carolina
• Brian L. Erstad, Pharm.D., MCCM, FCCP, FASHP, BCPS, Professor and Head, Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, Arizona
• Curtis E. Haas, Pharm.D., FCCP, Chief Pharmacy Officer, University of Rochester Medical Center, Rochester, New York

Pharmacists are said to “lack recognition” at the federal level, and the pursuit of provider status appears to alienate some provider organizations like the American Medical Association. This activity will address the interprofessional relationships and activities within clinical pharmacists’ scope of practice through education, collaboration, and a broader approach to advocacy.

Advancing Medication Optimization Through State-Based Models and Legislative Efforts

Tuesday, October 18, 2022, 10:15 a.m. to 11:45 a.m. (PDT)

Available for 1.5 hours of CPE credit

Speakers:

• Paul T. Kelly, M.A., B.A., President, Capitol Advocacy and Government Affairs, Washington, D.C.
• Emily Zadvorny, Pharm.D., BCPS, Clinical Pharmacy Specialist, Cardiac Risk Service; Pharmacy Academic Affairs Coordinator, Kaiser Permanente; Clinical Associate Professor, University of Colorado Denver, Aurora, Colorado
• Magaly Rodriguez De Bittner, Pharm.D., BCPS, CIPS Executive Director, University of Maryland, Baltimore, Maryland

This learning session will provide an overview of key legislative opportunities to leverage the pharmacy workforce and advance medication optimization (e.g., Cures 2.0 and Equitable Community Access to Pharmacist Services), as well as an overview of state legislative efforts to advance recognition, coverage, and payment for clinical pharmacy. Through active discussion with expert panelists, attendees will evaluate the potential impact of comprehensive medication management (CMM) on chronic care management and acquire advocacy resources for advancing clinical pharmacist integration into value-based care team models. Speakers will summarize these resources, and panelists will discuss how they can be applied to advocate for payment and policy reform and engage key stakeholders.

Prescription Drug Reform in Congress: Is This an Opportunity to “Get the Medications Right”?

Extreme partisan dysfunction is often taken for granted in Washington, D.C. Thus, it is perhaps surprising that Democrats and Republicans appear to have found common ground on a prescription drug reform initiative that is gaining momentum in Congress with bipartisan support. As leaders on Capitol Hill and in the White House argue over how to limit drug prices in order to slash the federal deficit and reduce out-of-pocket spending by Medicare beneficiaries, ACCP believes there is an opportunity to advance a comprehensive medication management (CMM) benefit.

Take Action!

With prescription drug price reform a top priority on Capitol Hill, it is vital that elected officials hear from you as clinical pharmacists delivering direct patient care services in your state or district to learn firsthand the value you bring to the medication optimization process.

Contacting the offices of your elected officials is simple. We have prepared a letter for you to review and edit. Simply follow the instructions to send this message to Capitol Hill. Please take the time to personalize the letter by providing additional information about your practice and the patients you care for. If appropriate, highlight what the COVID pandemic has meant for your practice and your patients. Click here to take action today!

Background on Medicare Prescription Drug Coverage

Historically, Medicare prescription drug reform has been an issue on which ideologically opposing sides had difficulty reaching a consensus. In 2020, for example, President Donald Trump alarmed many of his allies in the business community by announcing an initiative to reduce the price of medications for American consumers that was widely criticized by pharmaceutical manufacturers.

Back in 2003, with the George W. Bush administration focused on the aftermath of the attacks of September 11, 2001, the Medicare Modernization Act (MMA) passed Congress by a razor-thin margin and resulted in the largest Medicare overhaul in the program’s 38-year history. To steer this landmark legislation though a bitterly divided Congress, the final law included a provision that expressly prohibited Medicare from negotiating bulk prescription drug prices and required that only the private insurance entities administering the Medicare prescription drug program – not the federal government – have the legal right to negotiate drug prices directly from drug manufacturers.

The Bush administration touted that Part D private health plans would compete for seniors’ business and help control Medicare costs by using marketplace competition, not government price setting.

The result was the rapid expansion of prescription drug plans (PDPs), which were established to administer the newly created drug benefit. With almost 40 million Medicare beneficiaries in private PDPs and an increasing share also integrated within Medicare Advantage programs, this private-market approach to Medicare expansion is considered highly successful.

Of importance, the 2003 MMA also included the requirement that participating PDPs establish medication therapy management (MTM) programs that:

• Ensure optimal therapeutic outcomes for targeted beneficiaries through improved medication use
• Reduce the risk of adverse events
• Are developed in cooperation with licensed and practicing pharmacists and physicians

In comments related to the Part D final rule, CMS stated that the MTM program would be a “cornerstone of the Medicare prescription drug benefit.” MTM was intended to be a “patient-centric and comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.” However, CMS has acknowledged that it has not been possible to fully demonstrate the value and success of the Part D MTM program.

The Medicare Prescription Drug Act

Fast forward to 2022, and the Medicare prescription drug program is subject to intense political speculation. Congress recently passed legislation that could fundamentally alter the domestic pharmaceutical market by establishing a federal Drug Price Negotiation Program. Under the new law, Medicare could start the new pricing procedures next year, with the secretary of Health & Human Services identifying up to 10 drugs subject to bargaining. The resulting prices would go into effect in 2026. As many as 10 additional drugs would follow by 2029.

Advancing Coverage for Team-Based Services That Optimize Medication Use

ACCP is fully committed to advancing Medicare coverage for team-based clinical pharmacists delivering services that help optimize medications on behalf of patients. In March 2022, in recognition of the growing momentum around prescription drug reform on Capitol Hill, ACCP submitted comments to the Senate Finance Committee urging Congress to advance a patient-centered, team-based, and evidence-driven approach to medication management that better ensures the optimization of rational and economical use of specialty drugs for both patients and the health care system. ACCP called on Congress to enact coverage for CMM services to ensure access to interprofessional, patient-centered care that could better ensure optimized, economical specialty drug use.

ACCP also urged Congress to pursue specialty drug pricing models that ensure patients and health systems receive commensurate value from the appropriate use of specialty drugs, employ rational and transparent pricing practices, and enable pharmaceutical manufacturers to sufficiently recoup research and development investments. Value-based pricing models might include indication-specific pricing, bundled payments, and explicit investigations of cost, value, and comparative effectiveness and safety of specialty drugs.

Click here to read ACCP’s comments, and don’t forget to write to your elected officials on Capitol Hill!

Key Messages for Understanding ACCP’s Advocacy Platform

1. Coverage and Payment for Clinical Medication Management Services

ACCP’s top advocacy priority is to secure coverage and payment for clinical pharmacists’ services. However, ACCP’s advocacy strategy also goes beyond provider status. Like with provider status, the College seeks to amend Section 1861 of the Social Security Act to recognize qualified clinical pharmacists as Medicare providers. But for pharmacists to be paid for taking care of patients, it is essential that Medicare specifically establish a medication management benefit. Dentists, for example, are recognized Medicare providers, but their services are not covered by Medicare; hence, they do not qualify for payment.

2. Advocacy Strategy Targeting Multiple Payers

ACCP’s advocacy strategy also looks beyond Medicare. Medicare is the largest single payer of health care services in the country. But innovative clinical pharmacy practice is delivered across a wide variety of care settings and structures. It would not make sense to request that commercial payers recognize clinical pharmacists as providers and allow them to submit claims. The approach used when engaging Medicare is based on the same strategies the College uses within the commercial sector and the Veterans Affairs health system, focusing on securing integration and payment for clinical services in team-based environments.

3. Value-Based Alternative Payment Models

Finally, ACCP’s advocacy strategy also looks to the future of health care payment. The College recognizes that fee-for-service payments remain the reality in many health systems. But the political environment demands that Medicare expansion evolve under value-based payment structures. Even while fee-for-service payment remains a vital revenue source for existing practices, policy-makers across the public and commercial sectors have made it clear that any benefit expansion to include coverage for clinical pharmacists’ services must be aligned with value-based alternative payment models.

Hernandez Selected as Sixth NAM Fellow in Pharmacy

The National Academy of Medicine (NAM) has selected seven outstanding health professionals for the NAM Fellowships for Health Science Scholars. Dr. Inmaculada (Inma) Hernandez, Pharm.D., Ph.D., has been named the 2022–2024 NAM Fellow in Pharmacy. The fellows were chosen on the basis of their professional qualifications, reputations as scholars, professional accomplishments, and relevance of current field expertise to the work of NAM and the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. They will collaborate with eminent researchers, policy experts, and clinicians from across the country during their 2-year fellowship. In addition, they will help facilitate initiatives convened by the National Academies to provide nonpartisan, scientific, and evidence-based guidance to national, state, and local policy-makers; academic leaders; health care administrators; and the public.

Hernandez is currently an associate professor with tenure at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences. She grew up in a small rural village in Spain, where the ground floor of her parents’ home served as an independent community pharmacy operated by her mother. Having grown up in a pharmacy, she learned the crucial role that pharmacists play in maintaining the health of the community. After graduating from pharmacy school in Spain, she completed her Ph.D. degree in health services research and policy at the University of Pittsburgh, where she also held her first faculty appointment in 2016. Her research has focused on evaluating the clinical and economic outcomes of oral anticoagulant agents and studying pharmaceutical pricing. She has published over 90 peer-reviewed manuscripts, with more than 65 as first or senior author. Some of these articles have been published in top-tier journals, including JAMA, Annals of Internal Medicine, JAMA Internal Medicine, and Health Affairs. Her research has been featured in the main media outlets, including The New York Times, The Washington Post, NPR, CNN, Forbes, BBC, ABC, CNBC, and Bloomberg.

Hernandez is the principal investigator of a K01 and an R01 award on anticoagulation use in atrial fibrillation. Her drug pricing research is funded by West Health Policy Center. In 2021, she became the first pharmacist to be recognized with the AcademyHealth Alice S. Hersh Emerging Leader Award. In 2018, she was named one of the “30 Under 30” young leaders in health care research by Forbes. She is a fellow of the American College of Cardiology and the American Heart Association Academic Achievements.

The NAM Fellowship in Pharmacy program enables talented, early-career health policy or health science clinicians and scholars to participate actively in the work of NAM and to further their careers as future leaders in the field. When asked what she hopes to gain from this unique experience, Hernandez stated:

I am hoping to engage with policy-makers and academic leaders to disseminate the results of my research studies, particularly those that demonstrate the value of the pharmacist in providing equitable access to care. The NAM fellowship will enable me to guide my future investigations toward the areas that can most benefit the pharmacy profession and society.

Former NAM Pharmacy Fellows:

2012–2014      Samuel Johnson, Pharm.D., FCCP, BCPS*

2014–2016      Steven Smith, Pharm.D., MPH, BCPS*

2016–2018      Jonathan Watanabe, Pharm.D., M.S., Ph.D., BCGP

2018–2020      Dima Qato, Pharm.D., MPH, Ph.D.

2020–2022      Adam Bress, Pharm.D., M.S.*

*ACCP member

For more information on the NAM Fellowship in Pharmacy, visit https://nam.edu/programs/health-policy-educational-programs-and-fellowships/nam-fellowship-program/nam-fellowship-in-pharmacy/.

ACCP Members Lead Response to CDC on COVID-19 Vaccine Recommendation in Children 6 Months and Older

ACCP members led a joint advocacy effort with the Pediatric Pharmacy Association (PPA) in response to the CDC approval of both the Moderna and Pfizer-BioNTech vaccines for children 6 months and older.

Representatives from the ACCP Pediatrics PRN and the PPA Immunizations Committee developed the written comment to the ACIP Notice of Meeting (June 17 and 18) on behalf of their respective organizations. We thank these authors for their diligent and timely contributions: Lea S. Eiland, Pharm.D., FASHP, FPPA, BCPS, BCPPS; Jennifer Girotto, Pharm.D., BCPPS, BCIDP; Amanda Cavness, Pharm.D., BCPPS; Tracy M. Hagemann, Pharm.D., FCCP, FPPA; and Kathy Pham, Pharm.D., FPPA, BCPPS.

In the written comment, both ACCP and PPA encourage the CDC to provide resources to help clinicians engage with parents and caregivers to address their concerns on vaccines. The letter also highlights our members’ clinical experience and expertise in vaccine advocacy, and we ask for future opportunities to remain engaged in our nation’s efforts to build vaccine confidence for young children. Read the letter submitted to the CDC in full here.

ACCP-PAC: Building Strategic Alliances in Congress

ACCP’s political action committee (PAC) allows the College to participate in political campaign activities that strengthen its relationships with key policy-makers on Capitol Hill. Providing financial support to influential leaders helps raise the profile of clinical pharmacy and demonstrates ACCP’s ideological commitment to its core mission.

To maximize this impact, ACCP must be strategic in targeting its limited resources on the health policy leaders best placed to advance its agenda. Here’s how ACCP’s leaders decide who should receive financial support.

Consistent with all of ACCP’s initiatives, ACCP-PAC is member driven and managed by a Governing Council, which is responsible for decisions related to how PAC money is spent.

• ACCP-PAC is nonpartisan – it is committed to working with health policy leaders across all political parties and ideologies.
• ACCP-PAC supports candidates on the basis of their alignment with ACCP’s mission to advance the profession and improve human health through research, training, and education.
• ACCP-PAC strategically targets members of Congress who sit on committees with jurisdiction over health care. In the Senate, ACCP-PAC primarily supports members on the Finance Committee and the Health, Education, Labor and Pensions (HELP) Committee. In the House, ACCP-PAC focuses on those who sit on the Ways and Means Committee and the Energy and Commerce Committee.
• ACCP-PAC is committed to transparency – all contributions are reported to the Federal Election Commission, and the information is available to the public.

Outlook for ACCP-PAC in 2022

Despite frustration with the well-documented political dysfunction in Washington, ACCP is confident that there is solid, fundamental support on Capitol Hill for the core policy driving its effort to establish Medicare coverage for clinical pharmacists’ services that optimize medication use for patients.

Looking ahead to the remainder of the 117th Congress and the 2022 mid-term elections, ACCP sees a clear opportunity to raise its profile on Capitol Hill by providing financial support for policy-makers who work with the College to advance its issues. It is vital that ACCP provide support for these friends on Capitol Hill in order to ensure that leaders remain in Washington to advance policies that meaningfully address the health care issues the nation currently faces.

PAC contributions are a constitutionally protected part of the political system under the First Amendment’s guarantee of free speech. ACCP-PAC is the only means by which the College can provide financial support for candidates for Congress. With its more than 17,000 members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, ACCP needs the widespread support of its membership. If each ACCP member contributed just $25, ACCP-PAC would raise over $425,000. All ACCP members should consider contributing least $25 to ACCP-PAC. CLICK HERE to support your PAC today!

GTMRx Responds to HHS on Initiative to Strengthen Primary Care

The Get the Medications Right (GTMRx) Institute has submitted a comment letter in response to the request for information (RFI) issued by the Department of Health & Human Services (HHS). Leaders of the GTMRx Payment and Policy Solutions Workgroup, including Kathy Pham from ACCP and Tom Kraus from ASHP, provided input on this comment submission that concisely summarized the successful and innovative models providing comprehensive medication management (CMM) as well as actionable steps to addressing the barriers to implementing CMM models to strengthen primary care.

In the RFI issued by HHS, the agency sought information on (1) successful models or innovations that help achieve the goal state for primary health care, (2) barriers to implementing successful models or innovations, (3) successful strategies to engage communities, and (4) proposed actions HHS could take. GTMRx responded to this request by highlighting successful CMM models and identifying payment as the primary barrier to CMM implementation. The letter also included key payment and policy recommendations extrapolated from the GTMRx document Optimizing Medication Use Through Comprehensive Medication Management in Practice: Strategic Recommendations for Implementing CMM into the Care Team with Sustainable Payment and Practice Structures:

                        1. Public medical benefit plans (Medicare, Medicaid, VA, Marketplace) should preferentially promote and compensate interprofessional care teams through value-based payment models.

                        2. Under fee-for-service models, physicians should be allowed to bill for complex evaluation and management services provided by members of the interprofessional team working in a collaborative practice with the physician.

                        3. The AMA Prior Authorization and Utilization Management Reform Principles should be implemented, and federal regulation in support of a gold-card approach to eliminating prior authorization requirements for medications should be introduced when clinical pharmacists are providing CMM services as part of an interprofessional team.

                        4. Federal and state agencies should support training programs to ensure a sufficient workforce of qualified interprofessional team members, including clinical pharmacists credentialed and privileged to provide CMM services to meet patient and population needs.

For more information about the advocacy efforts and letters of GTMRx together with policy recommendation documents, visit this link on the GTMRx website.

ACCP Joins Multistakeholder Advocacy Effort to Strengthen Nation’s Public Health Preparedness

ACCP has joined a diverse and influential group of health care professionals and other key stakeholders in support of the PREVENT Pandemics Act (S. 3799), bipartisan legislation to strengthen the nation’s public health and medical preparedness and response systems in wake of the COVID-19 pandemic.

The PREVENT Pandemics Act would improve the nation’s testing and treatment capabilities and address the disparities that make public health care challenges more difficult for vulnerable populations.

The legislation includes provisions that would:

• Establish a White House office to oversee pandemic preparedness and response; modernize and strengthen the medical supply chain
• Improve safety and security and address foreign influence in biomedical research; bolster public health and allied health workforces; strengthen blood supply collaboration
• Reauthorize two grant programs to improve trauma care, including in rural areas
• Update the ability of the CDC director to appoint and review the agency’s leadership

Click here to read the Stakeholder Letter. Click here learn more about S. 3799.