Get Involved in Public Policy, Says 2015 Zellmer Lecturer
The old rallying call of independent pharmacies—“Get into politics or get out of pharmacy”—still holds true today and applies to all segments of the profession, said John M. Coster, the 2015 William A. Zellmer Lecturer.
Coster offered his advice while delivering the Zellmer Lecture on September 17 in Arlington, Virginia, as part of ASHP’s Policy Week activities.
Coster called on practitioners to build relationships with their elected officials, keep abreast of what policymakers are considering, and tell them what pharmacists can and want to do to improve patient care.
“Tell them . . . how what you do is good for your patients,” Coster said. “Talk about how what you are proposing . . . is good for constituents, good for healthcare, and how it saves money.”
And he emphasized that pharmacy associations need help from individual pharmacists to succeed at advocacy efforts.
“We are all in this together,” he told the audience.
The Zellmer Lecture has been presented annually since 2010 by a pharmacist who has demonstrated exceptional leadership in national healthcare policy to improve the safety and effectiveness of medication use. During the lecture, presenters express their personal views on the interface between public policy and pharmacy practice.
Coster currently serves as director of the division of pharmacy for the Centers for Medicare and Medicaid Services (CMS) Center for Medicaid and Children’s Health Insurance Program Services. Before joining CMS, he held leadership positions at the National Community Pharmacists Association, the National Association of Chain Drug Stores, and Rite Aid Corp.
Coster served as ASHP’s 1984–85 executive resident in association management. He told Zellmer Lecture attendees that the residency program, one of his early forays into public policy, helped set him on the path to work in and around the nation’s capital for the past 30 years.
Coster said federal policies that don’t seem to affect pharmacy practice or reimbursement for medications or pharmacists’ services can indirectly affect the profession because the government’s healthcare actions drive policy decisions for insurers and other nongovernmental organizations.
“Government is the 800-pound gorilla,” Coster said. “Ignore government-based healthcare programs, and the changes being made to them, at your own peril.”
Coster said his inside view of federal healthcare policymaking has shown him that the system, though sometimes slow, is thoughtful and deliberative and works toward positive goals for both patients and the healthcare delivery system.
He said pharmacists should take advantage of opportunities to meet with policymakers to help shape the value-based, accountable, and integrated care models that the federal government is supporting.
“I urge all of pharmacy to look at the opportunities in the [Affordable Care Act] that are positioning healthcare for the future,” he said. “Get in early. Talk with people, because if you aren’t, others are.”
Noting that it took Congress decades to add an outpatient prescription drug benefit to Medicare coverage, Coster urged pharmacists to take the “long-haul approach” to advancing public policy.
Even before the Medicare Part D drug benefit was enacted, he said, educational outreach by pharmacists helped policymakers understand the important role that the profession must have in administering the benefit. In particular, he said, pharmacists persuaded Congress that adding a medication therapy management benefit to the program “was the right thing to do.”
Coster noted that while attaining provider status for pharmacists under Medicare “will be a great achievement for the profession,“ pharmacists need to continue to show their value outside of fee-for-service healthcare delivery.
As he speculated about the future of healthcare, Coster reminded the audience that ideas in healthcare are cyclical and that “if you have been around long enough, everything old is new again.”
One current hot topic in pharmacy—the escalating cost of medications—was a major policy issue 25 years ago and resulted in the creation of the Medicaid drug rebate program, Coster said.
He also said policymakers today are struggling with how to pay for personalized medications. Pharmacists, Coster said, can have an important role to play in delivering this type of care—if the profession prepares for that role.
But he urged the audience members not to forget their roots even as they explore the possibilities within the changing healthcare landscape.
“It is important to remember where we came from because . . . it keeps us grounded,” Coster said. “It . . . reminds us of the reason we do what we do every day: to make a difference in the lives of patients.”
[This news story appears in the November 1, 2015, issue of AJHP.]