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ACCP Report

Washington Report

Identifying Opportunities to Advance Coverage for Clinical Pharmacy Services in the 118th Congress

Written by John McGlew
Director of Government Affairs


Capitol

The 118th Congress convened January 3, 2023, with a new Republican majority in the House of Representatives, the first female president pro tempore (Patty Murray) in the Senate, the first Black party leader (Hakeem Jeffries) in congressional history, and the longest-serving party leader (Mitch McConnell) in Senate history.

ACCP approaches the new Congress with an assertive agenda aimed at targeting key leaders on congressional committees with jurisdiction over health care issues. In the House of Representatives, ACCP will reach out to members of the Ways and Means Committee and the Energy and Commerce Committee. In the Senate, ACCP will primarily focus on members of the Finance Committee and the Health, Education, Labor and Pensions (HELP) Committee.

ACCP’s Washington, D.C. team has identified the following strategic policy areas in which to advance opportunities for clinical pharmacists:

  • Establishing coverage for medication optimization services for chronically ill patients
  • Integrating clinical pharmacists into substance use disorder and mental health care teams
  • Addressing prescription drug reform by getting the medications right on behalf of patients
  • Establishing Medicare coverage for pharmacogenomic consultations provided by clinical pharmacists

Establishing Medicare Coverage for Medication Optimization Services for Patients with Complex Conditions

It is estimated that $528 billion a year,1 equivalent to 16% of total health care spending, is consumed because of inappropriate or otherwise ineffective medication use. Despite the central role that medications play in the care and treatment of chronic conditions and the growing understanding of the genetic and physiologic differences in how people respond to medications, the nation’s health care system consistently fails to deliver on the full promise medications can offer.

ACCP’s top advocacy priority in the new Congress is thus focused on advancing coverage for pharmacists’ clinical services delivered under collaborative, patient-centered payment and delivery structures, aimed at optimizing medications on behalf of chronically ill older adults with complex conditions.

“Getting the medications right” through a team-based approach to medication optimization also contributes to enhanced productivity for the entire health care team, allowing all team members to more fully focus on their own patient care responsibilities. By fully using the clinical pharmacist’s skills and training to coordinate the medication use process as an interdependent team member, physicians and other team members can maintain focus on the patient care activities that align with their respective expertise and scope of practice.

Clinical pharmacists are also uniquely positioned to address health equity by improving access to a standardized process for optimizing medications that facilitates collaboration with other members of the interdisciplinary team to ensure each medication has an appropriate indication, is effective for the condition, can help achieve clinical goals, is safe, and has a regimen the patient can adhere to.

ACCP’s goal for the coming Congress is to facilitate the full integration of clinical pharmacists into the Medicare program by amending the Social Security Act to authorize clinical pharmacists to serve in Medicare-eligible patient care teams, helping to optimize medications for chronically ill patients with complex conditions.

Ensuring Coverage for Clinical Pharmacists as Essential Members of Substance Use Disorder and Mental Health Care Teams

Lawmakers across both political parties remain firmly committed to addressing America’s ongoing mental health and substance use disorder crises by facilitating the full integration of mental health care with physical health care services and expanding access to crisis care and follow-up services to get Americans the longer-term care they need. Proposed legislation in Congress would increase payment rates to help providers integrate behavioral health and primary care and create a Medicare bundled payment for crisis stabilization services, including observation care, screening for suicide risk, screening for violence risk, and assessment of immediate physical health needs.

  • ACCP recently submitted a 1-page statement that calls on Congress to formally recognize and pay for services in evolving payment models that optimize medications on behalf of patients with complex conditions.

Prescription Drug Reform – Addressing Cost and Coverage Issues by Getting the Medications Right on Behalf of Patients

The inexorable rise in health care inflation is a perennial bipartisan priority issue for lawmakers on Capitol Hill. As Congress grapples with 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 benefit.

As far back as 2003, the Centers for Medicare & Medicaid Services (CMS) stated that its medication therapy management (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. To address this, ACCP has been engaged through the “Buy Right Strategy” of the Get the Medications Right Institute to develop a dialogue with America’s major employers, who collectively sponsor health benefits for more than 160 million Americans and pay billions of dollars for prescription drug coverage yet typically have limited insight into the effectiveness of their drug benefit programs and the resulting outcomes on behalf of patients.

Moreover, in recognition of Congress’s growing understanding of the value of clinical pharmacists in therapeutically managing complex conditions, ACCP is dedicated to advancing a quality-focused, patient-centered, team-based improvement in health care delivery that (1) helps ensure medication optimization, (2) enhances patient safety, (3) promotes value-based rather than volume-based care, and (4) contributes to greater affordability and sustainability for the Medicare program.

  • ACCP recently released a statement to the Senate Finance Committee recommending that, to modernize access to and coverage of innovative therapies, the Medicare program should use the unique contributions of clinical pharmacists in the area of medication optimization.

Establishing Medicare Coverage for Pharmacogenomic Consultations by Clinical Pharmacists

ACCP’s legislative strategy recognizes that health policy often evolves incrementally. The Cures 2.0 legislation aimed at modernizing access to and coverage for innovative therapies generated bipartisan support in the last Congress. Of importance, the bill included Section 408: Medicare Coverage for Consultations, which would establish a program to cover pharmacogenomic consultations delivered by qualified clinical pharmacists. ACCP has been working collaboratively with its partner organizations to advance this potentially impactful provision.

  • Click here to send a letter to Congress calling for reintroduction of legislative language that would cover pharmacogenomic consultations by qualified clinical pharmacists.

Get Involved!

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 its impact, ACCP must be strategic in targeting its limited resources on the health policy leaders best placed to advance its agenda. The text that follows explains 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 funds are spent.

  • ACCP-PAC is nonpartisan and 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, it 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.

 

PAC contributions are a constitutionally protected part of the U.S. political system under the First Amendment’s guarantee of free speech. ACCP-PAC is the only means through which the College can provide financial support for candidates for Congress. With its almost 18,000 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 $400,000. All ACCP members should consider contributing at least $25 to ACCP-PAC.

CLICK HERE to support your PAC today.

References

1Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug-related morbidity and mortality. Ann Pharmacother 2018;52:829-37. Available at https://escholarship.org/uc/item/3n76n4z6.