Re: Pharmacists’ Contributions to Reducing Drug Pricing, Addressing Drug Shortages, and Combatting the Opioid Epidemic, and Serving as Direct Patient Care Providers to Improve Adherence, Safety, and Medication Therapy Outcomes
Dear Moderators and Candidates:
The United States is not effectively utilizing its existing clinician resources – particularly pharmacists – to address our nation’s greatest healthcare challenges. The American Society of Health-System Pharmacists (ASHP) urges policymakers to fully and effectively engage pharmacists in patient care.
ASHP is a national professional organization representing nearly 50,000 members including pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians, who provide patient care services in acute care and ambulatory settings, including hospitals, health systems, and clinics. For more than 75 years, ASHP has been on the forefront of efforts to improve medication use and enhance patient safety.
Pharmacists are integral members of the healthcare team, practicing across the continuum of care. Pharmacists’ medication expertise is invaluable, and their education prepares them for patient care that extends far beyond dispensing medications. Nevertheless, pharmacists continue to face both regulatory and reimbursement barriers to practicing at the top of their scopes of practice. As a result, our healthcare system fails to use its available clinical resources effectively. Numerous innovative pharmacist-led care models and population health initiatives are already in place in communities across the country and could easily be scaled to other areas.
Pharmacists can assist policymakers in addressing several of our nation’s most pressing healthcare issues, including drug pricing, drug shortages, and substance abuse identification, treatment, and prevention. ASHP encourages policymakers to focus their efforts on engaging pharmacists to ensure that patients receive the full value of drugs through adherence and effective management of co-morbid chronic conditions.
Reducing Drug Spend through Better Medication Management
Medications are the first line of therapy to treat patients with chronic diseases and complex acute diseases, such as cancer. Nearly 70 percent of Medicare beneficiaries have one or more chronic conditions, and many of these beneficiaries take multiple medications. Lack of proper medication oversight and management can result in suboptimal outcomes and patient harm. For example, too many patients are unnecessarily readmitted to the hospital or visit the emergency department due to medication-related issues. The Institute of Medicine estimates that 1.5 million preventable adverse drug events (ADEs) occur annually in the United States, resulting in an estimated 7,000 deaths. The New England Healthcare Institute has estimated the cost of ADEs and non-adherence to total $290 billion annually. Addressing these costs would contribute substantially to improving the price tag for health care while benefitting patients.
Pharmacists are uniquely qualified to provide the type of medication and disease management needed not only to address waste and patient harm due to ADEs and non-adherence, but also to enhance patient outcomes through improved medication use. Pharmacists offer an in-depth knowledge of medications that is unmatched in the healthcare arena. Pharmacists today receive clinically-based doctor of pharmacy degrees (Pharm.D.), and many also complete postgraduate residencies and become board certified in a variety of specialties. Advancements in medical science and evolution in care delivery models have made postgraduate residencies essential to performing certain patient care services, and they are now prerequisites for positions within specialties such as solid organ transplantation, psychiatry, infectious diseases, critical care, cardiology, oncology, and neonatology, among others.
Pharmacists in hospitals and ambulatory clinics work with physicians, nurses, and other providers on interprofessional teams and perform healthcare tests, provide preventative care, manage patients’ medication, including improving medication adherence and modifying drug therapy regimens, and ensure appropriate care transitions. Patients often receive little information regarding perhaps the most essential part of treatment — the medication prescribed to cure or manage their condition. To avoid overspending on drugs and to maximize the value of the drugs patients purchase, pharmacists must play a more prominent role in medication selection and modification, patient education, follow-up and monitoring of medication, and overall medication and chronic disease management.
Studies indicate that the inclusion of pharmacists on the healthcare team results in a significant return on investment in both patient outcomes and real dollars. For every dollar invested in clinical pharmacy services in all types of practice settings (hospital, clinics, government, etc.), health systems realize an average savings of $4. Numerous studies attest to the benefits of fully engaging and integrating pharmacists into community health systems.
Despite this evidence, pharmacists are neither eligible to participate in Medicare Part B, nor are they required providers within accountable care organizations (ACOs). As a result, pharmacists are not directly reimbursed for patient care, making it more difficult for them to fully integrate into certain practice settings. We urge policymakers to provide reimbursement for comprehensive medication management so that pharmacists’ skills can be better leveraged to improve patient outcomes, reduce healthcare costs, and avoid patient harm due to ADEs.
Combatting the Opioid Epidemic
Pharmacists can play an integral part in combatting opioid use using a variety of approaches and tools. For instance, pharmacists can assist physicians in creating patient-specific pain plans that reduce the risk of opioid addiction.
As noted above, due to regulatory barriers, pharmacists are not always effectively engaged in patient care, including treatment of mental health disorders and opioid abuse. For example, the Drug Enforcement Agency (DEA) recently expanded prescribing authority for buprenorphine to physician assistants and nurse practitioners, but not to pharmacists. Pharmacists are clinicians directly engaging patients struggling with opioid addiction, but federal regulation prevents them from intervening to provide treatment. As our nation struggles with an opioid epidemic, we urge policymakers to better utilize pharmacists’ services for pain management and substance abuse treatment by allowing them to prescribe and dispense medication-assisted treatments, such as buprenorphine, to patients in need.
Protecting Patients from Drug Shortages
Recent shortages of critical intravenous solutions — from basic products like saline and amino acids to injectable medications — placed unsustainable burdens on patient care. In some cases, there was no alternative therapy available, and patients suffered. There are currently well over 100 drugs in shortage. Healthcare providers, including hospitals, health systems, and clinics, continue to struggle to obtain supplies of medications, some of which are essential to maintain basic levels of patient care.
Pharmacists are the frontline defense against drug shortages. They identify alternative drugs for many conditions as well as develop and manage providers' shortage contingency plans. Hospital pharmacists regularly report that they must spend considerable time locating supplies of medications. This significant reallocation of staff time results in both financial and personnel challenges and jeopardizes patient care.
Drug shortages place our nation’s healthcare system at risk and contribute to price increases. This critical issue demands policy action that prevents new shortages and mitigates existing shortages. Specifically, new legislation should require extensive manufacturer reporting on products in shortage, establish manufacturing quality metrics for manufacturers to reduce the frequency of shortages due to quality challenges, and direct the Department of Health & Human Services and the Department of Homeland Security to assess the potential national security risks of drug shortages.
ASHP and its members are committed to working with policymakers to improve medication use and enhance patient safety. We urge you to view ASHP as a resource. Please do not hesitate to contact me if we can ever be of assistance.
Vice President, Government Relations