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ACCP Report - June 2013

Washington Report: ACCP’s Medicare Initiative Advocacy Resources Are Now Available

Written by John McGlew
Associate Director, Government Affairs



ACCP has released two important resources 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.

1. 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”
  • The action needed from Congress

Click here to access the Medicare Initiative Congressional Issue Brief.

2. 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, freestanding medical clinics, and health systems. In all cases, a consistent and comprehensive process of care was used in service provision. Data reflect 11,804 patients (older than age 65) with 21,213 documented encounters.

Based on these data, ACCP projects that providing Part B 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 two 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 CMM coverage.

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 you can get more involved.

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

As ACCP proceeds with a schedule of meetings with congressional offices aimed at generating support for our initiative and identifying champions to introduce legislation that would recognize CMM as a covered Medicare Part B benefit, elected officials need to 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.

Simply 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 jmcglew@accp.com or (202) 621-1820.

Legislative Strategy

ACCP’s Washington, DC, office 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. Staff are conducting meetings with congressional offices to familiarize lawmakers with the Medicare initiative concept and explain why it constitutes good policy. Through this process, we hope to identify a champion to introduce the bill as well as develop a list of potential original cosponsors. Ideally, our goal is to secure a bipartisan introduction of legislation, with a Republican lead sponsor and a Democratic original cosponsor in the House and 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 is to identify legislative champions in the House and Senate who sit on these influential committees and who will accordingly be best placed to advance our initiative.

ACCP is also working to identify legislative vehicles that are likely to move through Congress this session, to which we might attach language advancing our Medicare initiative. For example, the House Energy and Commerce Committee recently released for discussion a draft bill that would reform the process by which Medicare reimburses physicians and replace the sustainable growth rate that would otherwise require significant cuts to Medicare physician payments. This discussion draft explores payment models that measure and reward value and quality, rather than volume. More information on the Energy and Commerce discussion draft is available here.

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

ACCP’s Medicare initiative represents a legislative proposal that is fundamentally different from previous attempts 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 provided by clinical pharmacists delivering care as members of interprofessional teams, with established collaborative drug therapy management agreements or formal clinical privileges granted using local credentialing processes.

From both a professional and political standpoint, we believe this is the correct approach, but our task is now to help Congress understand why this approach is different from previous efforts in this area and why our initiative can help Medicare achieve its goals of better care, better quality, and lower costs.

Contributions from ACCP-PAC to members of Congress 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 support 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, allowing 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 were to contribute just $25, ACCP-PAC would raise $350,000. All ACCP members should consider donating at least $25 to ACCP-PAC. CLICK HERE to support your PAC today!

CMS Launches Health Insurance Marketplace Toolkit

As part of the process of implementing the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) developed a toolkit to help interested stakeholders educate the public about Health Insurance Marketplaces and encourage consumers to sign up. The CMS Office of Public Engagement has reached out to a range of potential partners and stakeholders, including ACCP, and requested that we alert our members to the availability of this Health Insurance Marketplace toolkit. Health Insurance Marketplaces are state-based competitive marketplaces where individuals and small businesses can shop for and buy private health insurance. These marketplaces are not private insurance companies or government-run health plans.

With one application, consumers can find out whether they qualify for health plans in the Health Insurance Marketplace and other programs like Medicaid and the Children’s Health Insurance Program (CHIP), tax credits, and cost-sharing reductions. Consumers can apply for coverage and enroll in a health plan through the marketplace starting October 1, 2013; coverage begins January 1, 2014.

Useful Links to Health Insurance Marketplace Sites:

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
Telephone: (202) 621-1820
E-mail: jmcglew@accp.com