March 24, 2017
The American Health Care Act (AHCA), introduced in the House of Representatives on March 6, 2017, would repeal and replace certain provisions within the Affordable Care Act (ACA). Specifically, AHCA replaces subsidies for the purchase of insurance with refundable tax credits based on age and income level, and it phases out Medicaid expansion under the ACA. ASHP’s mission statement notes that “the mission of pharmacists is to help people achieve optimal health outcomes.” Pharmacists can achieve this aim only if patients have access to healthcare.
ASHP’s nearly 45,000 members are committed to providing patient care that helps patients achieve optimal health outcomes. ASHP helps its members achieve this goal by advocating and supporting the professional practice of pharmacists in hospitals, health systems, ambulatory care clinics, and other settings spanning the full spectrum of patient care. ASHP serves its members as their collective voice on issues related to medication use and public health. Thus, as Congress evaluates healthcare reform options, we strongly encourage them to work within certain guiding principles. Specifically, in order to safeguard patient health through the provision of robust coverage, we believe legislators should focus reform efforts on legislation that:
- Promotes Access to Healthcare. ASHP advocates insurance coverage for all residents of the United States, including coverage of medications and related pharmacist patient-care services. Reforms should be crafted to protect patient access to the full continuum of care, from preventive services to acute and long-term care. This includes services such as substance abuse and mental health coverage, which are vital to combating the nation’s opioid epidemic.
- Supports Provision of Affordable Medications. ASHP believes that safe and effective medication use should be a component of all proposed solutions to the central healthcare reform issues of access, cost, and quality. Under the ACA, medications are an essential health benefit – we strongly urge Congress to protect patient health by maintaining this benefit. Patients who cannot afford their medications do not take their medications. Medication nonadherence costs our healthcare system in both financial terms and in the form of suboptimal outcomes. As Congress moves forward, we suggest that any healthcare reform proposals include methods to reduce medication costs for patients, such as the adoption of the hospital formulary model that helps control costs by promoting the use of less-expensive generic medications and the expansion of therapeutic interchange of drugs through collaborative pharmacist – prescriber arrangements.
- Preserves the Safety Net Program Serving Vulnerable Patients. The safety net program, otherwise known as the 340B drug discount program, enables qualified hospitals and community health centers to purchase outpatient prescription drugs at a reduced price. The discounts are used by the covered entity to provide care for low-income and uninsured patients, and offset the impact of care that is often uncompensated. In some cases, a hospital’s ability to remain solvent is dependent upon their participation in the program. Reductions in program size or changes in eligibility could devastate these providers, who are already confronting significant market challenges, and severely impact patient access.
- Utilizes the Medication-Use Expertise of Pharmacists. ASHP supports pharmacists as non-physician patient care providers, and we believe that all healthcare programs, both public and private, should fully incorporate pharmacists as full providers of care as it relates to medication use. Current and evolving care delivery models are team-based approaches that rely on the unique expertise of each team member. Pharmacists, as the medication-use experts, are a vital component of these care models, and they work collaboratively with physicians, nurses, and other healthcare professionals to ensure that medication use is safe and effective. Further, as the most accessible of all healthcare practitioners, pharmacists can provide basic access to care, especially in areas that are underserved.
- Maximizes Existing Resources. ASHP encourages Congress to address potential access issues associated with the looming physician shortage by maximizing integration and utilization of all members of the healthcare team. Policymakers must support efforts to shore up the provider pipeline by investing in critical residency training programs, including programs dedicated to training pharmacists in managing the most complex therapies, such as oncology, organ transplantation, critical care, cardiology, infectious diseases, and geriatrics.
- Supports Public Health Initiatives. ASHP strongly recommends the preservation of all existing funding for opioid abuse treatment and prevention, vaccination, antimicrobial stewardship, and other critical public health services. In particular, reductions in funding to the U.S. Centers for Disease Control and Prevention could cripple ongoing efforts to address these public health crises, threatening health outcomes on a national level.
All Americans need access to prescription medications and to pharmacist-provided patient care services to help them optimize therapeutic outcomes and reduce the risk of adverse events from medication therapy. Healthcare reform provides an opportunity to advance these goals. Pharmacists are a highly trained and valuable resource, yet they are currently underutilized. Healthcare reform discussions should focus on strategies to maximize efficiency and safety while providing patients with access to the full benefit of pharmacist-provided patient care services to achieve better healthcare.