As discussions of health care reform took shape on Capitol Hill and on the campaign trail throughout 2008, pharmacy organizations representing the entire spectrum of the profession came together to create a comprehensive set of principles for the future of the profession of pharmacy and the role of the pharmacist within the context of national health care reform.

These principles were developed in collaboration with 12 pharmacy organizations: Academy of Managed Care Pharmacy, American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, Food Marketing Institute, National Association of Chain Drug Stores, National Alliance of State Pharmacy Associations, National Community Pharmacists Association, Rite Aid Corporation, and Walgreen Co.

This effort is notable not only for uniting almost the entire pharmacy profession around a comprehensive policy proposal, but also for reaching a consensus on the principles themselves, which are almost entirely focused on patient care and the developing role of the pharmacist on the health care delivery team. Click here to review the principles in full.

Principles Overview

According to the Institute of Medicine, “because of the immense variety and complexity of medications now available … the pharmacist has become an essential resource … and this access to his or her expertise must be possible at all times.”¹

The pharmacy principles for health care reform are centered on the basic premise that pharmacists improve patient care. The principles urge that pharmacists play a vital role in ensuring that medication therapy is safe, equitable, and patient centered as well as that medication therapy results in quality outcomes and that pharmacists be recognized in this capacity.

The principles highlight that the proper use of prescription medications helps improve patient quality of life and health outcomes. Yet the health care system incurs more than $177 billion annually in mostly avoidable health care costs to treat adverse events resulting from patients who do not take their medications as prescribed.

Pharmacists can help lower such costs through pharmacist-provided patient care services that include medication therapy management (MTM) practices such as educating patients on how to take their prescription medications properly and safely, as well as administering health screenings and immunizations. With current costs to the health care system to treat chronic diseases at $1.3 trillion annually, taking medications properly now can help prevent the need for emergency or catastrophic care later.

Reform Principle I—Improve the Quality and Safety of Medication Use

This section outlines the role that pharmacists can and should play to help achieve the best possible medical outcomes from the use of prescription medications. The principles specifically highlight collaborative practice with physicians and other health care providers – including making recommendations on specific medications or changes in medications—and how pharmacists can help prevent drug interactions and adverse effects.

The principles also discuss the role of the pharmacist in public health prevention and education strategies—from weight management and immunization administration to smoking cessation programs. The specific principles under the quality and safety section are as follows.

Health Care Reform Principles—Quality and Safety

• Principle I (A): Incorporate coverage for pharmacist-provided patient care services into public and private health care programs. These programs could include medication therapy reviews for patients entering Medicare and for other patients with documented medical need; in addition, these programs could include MTM services, as well as pharmacist-delivered immunizations.
• Principle I (B): Provide appropriate payment for pharmacist-provided patient care services. These payments could be based on pay-for-performance programs connected to specific evidence-based measures.

Reform Principle II—Ensure Patient Access to Needed Medications and Pharmacy Services

The second of our three reform principles focuses on pharmacy infrastructure and workforce issues. The principles state that, given the impending retirement of approximately 80 million “baby boomers” and the corresponding increased burden on our health care delivery system, we must ensure ready access to medications and the services of pharmacists. The specific principles under the infrastructure section are as follows.

Health Care Reform Principles—Infrastructure

• Principle II (A): Ensure that all Americans have access to the services of well-educated and trained pharmacists competent to meet specific health care needs of patients by establishing and financing a comprehensive federal health professions workforce strategy.
• Principle II (B): Within the context of their prescription plan coverage, allow patients to choose the provider of prescription medications as well as MTM and other pharmacist-provided patient care services.
• Principle II (C): Provide appropriate reimbursement to pharmacists and pharmacies for costs associated with obtaining medications and for dispensing and administration services to ensure accurate medication delivery to patients. Payment for dispensing should reflect the costs to dispense.
• Principle II (D): Ensure that pharmacists can provide patients access to the most appropriate, cost-effective medications, including generic medications and biologicals, without any artificial impediments or barriers.

Reform Principle III—Promote Pharmacy and Health Information Technology Interoperability

The third of our health care reform principles refers to the rapidly changing role of health information technology in health care delivery, including the use of electronic health records and electronic prescribing. Our principles call for the continued development of an electronic, interoperable health care system that will help pharmacists ensure patient adherence to their medication regimens, reduce medication-related errors, and enhance medical decision-making. The specific principles under the Health Information Technology section follow.

Health Care Reform Principles—Health Information Technology

• Principle III (A): Provide pharmacists electronic access to critical patient health care information, including diagnosis and laboratory values. This information must be provided through an interoperable electronic health record system, including electronic prescribing, that supports multidirectional communications among various health care providers and settings.
• Principle III (B): Establish federal and state grants to health care providers, including pharmacists, which support the continued growth of an interoperable health care system.
• Principle III (C): Ensure the appropriate flow of critical information within and among health care providers, including pharmacists, that is needed to make decisions regarding the best possible treatment for patients, while protecting patient information.

Health Care Reform—Political Strategy

The development of the health care reform principles represents a starting point in a long and laborious political process. These principles provide an important starting point for more technical discussions with policy-makers about how to implement this vision through legislation.

After the November 2008 elections, health care reform stakeholders began an outreach to key Congressional leaders as well as the Obama administration transition team to begin early discussions around our proposal and reinforce the importance of the pharmacy profession to the health care reform debate.

Obama Transition Team Meeting

Representatives from the member organizations, including ACCP, were invited to present our materials and discuss our proposal with the Obama transition team on December 16, 2008. The meeting focused on outlining the potential contributions of pharmacists’ services to overall patient health, quality of care, and the health care delivery system and opportunities in the health care reform process to incorporate pharmacists’ services to help improve health care quality, better manage chronic disease, and maximize the outcomes of medication use.

In addition, there was discussion about the potential cost savings pharmacists could generate for the health care system through the improved use of medications and reduced incidence of adverse reactions and other medication-related events.

Even though our proposal and materials were well received and resulted in an engaging discussion during this 1-hour meeting, neither the administration nor the members of the 111th Congress are in a position to make any guarantees at this early stage in the health care reform debate.

Key Congressional Offices

Since the swearing in of the 111th Congress, the pharmacy health care reform stakeholders have held meetings with a number of key Congressional offices, including:

• Community Pharmacy Coalition Co-Chairs: Reps. Marion Berry (D-Ark.), Cathy McMorris Rodgers (R-Wash.), Jerry Moran (R-Kan.), and Anthony Weiner (D-N.Y.)
• Senate Finance Committee staff
• Sen. Edward Kennedy (D-Mass.)
• Sen. Orin Hatch (R-Utah)
• Rep. John Boehner (R-Ohio)

As in the meeting with the Obama transition team, the proposal was well received by both Democrats and Republicans, but given the uncertainty about the direction health care reform will take this early in the process, no promises have been made.

Next Steps

Press Conference: Pharmacy health care reform stakeholders have scheduled a press conference for February 12 at the National Press Club in Washington, DC. The CEOs from three member organizations will make remarks on the vision of the pharmacy profession for the future of health care delivery and will respond to questions about our proposal.

Congressional Briefing: Members of Congress and staff members have been invited to a Congressional briefing on Capitol Hill on February 18, 2009, to learn more about the health care reform principles and discuss legislative strategy for moving these principles forward as legislation.

Health Care Reform and the Leadership for Medication Management

Most ACCP members are already aware of the work of the Leadership for Medication Management (LMM)—a coalition of nine national pharmacy organizations—to develop legislation that would expand access to MTM for Medicare beneficiaries by covering pharmacists’ services under Medicare Part B.

Although the LMM’s efforts are focused on specific changes to the Medicare program, their work is clearly in line with the broader health care reform principle that calls for appropriate payment for pharmacist-provided patient care services.

As the LMM finalizes legislative language to provide coverage on Part B, we are exploring ways to incorporate this legislation into the stakeholder’s proposal and put the full weight of the pharmacy stakeholder’s group behind the LMM efforts.

How Can You Get Involved?

As you know, ACCP’s Legislative Action Center contains a wealth of information about your elected officials and allows you to communicate with your members of Congress. For your convenience, we have prepared letters you can send directly to Congress, introducing the LMM principles or inviting your elected officials to learn more about the practice of clinical pharmacy. Remember, to maximize your impact, you are encouraged to edit and personalize the letter, providing background on your practice and professional experience. In addition, you are strongly encouraged to make the following requests in your letter:

• Ask for a list of the dates your members of Congress will be available for meetings in his/her district or state.
• Ask about any “Town Hall” meetings your members of Congress have scheduled, particularly those focused on health issues.
• Request an in-person meeting with your members of Congress and/or staff while they are home for the recess.
• Invite your members of Congress and/or staff to tour your clinical pharmacy practice site. (Click here for more information on hosting your members of Congress.)

Reach out to incoming lawmakers now! Contacting freshman lawmakers to congratulate them on their victory and discussing issues of concern to the clinical pharmacist community is an excellent way to establish or develop a relationship. Freshmen lawmakers often actively seek important issues to support; they are not yet overwhelmed by the range of issues and interests competing for their attention or stifled by the political allegiances that a more established lawmaker will have built up over a career.

If you are planning to contact a new or returning member of Congress, let ACCP help you. Contact John McGlew at (202) 756-2227 or [email protected] to discuss how to conduct a successful meeting with a lawmaker and how to maximize your political impact with that lawmaker.

References

1. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.