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5/21/2001

Pharmacy Presents Congress With Core Principles for Devising Medicare Pharmacy Benefit

Cheryl A. Thompson

National pharmacy organizations today continued their delivery of a unified message regarding the core principles that pharmacy would like included in any Medicare pharmacy benefit to be proposed by Congress or the Bush administration. As follow-up to a meeting last month with Health and Human Services Secretary Tommy G. Thompson, the pharmacy coalition presented members of Congress with "A Unified Agenda for American Pharmacy."

The document emphasizes the importance of pharmacists' role in ensuring patients' safe and effective use of medications and strongly advocates for a new reimbursement structure that would adequately pay pharmacists for providing such medication management services. In addition, the pharmacy organizations collectively called for a benefit design that would allow patients to freely choose and contact the pharmacist and pharmacy that best meet their health care needs.

Dear Senator:

Policymakers continue to discuss the best approach to establishing a comprehensive outpatient pharmacy benefit for seniors. We believe that all seniors should have access to the important medications that they need to maintain their life and health.

The "Pharmacy Benefits All" Coalition—representing pharmacists and pharmacies that provide health care in a wide range of practice settings—are pleased to provide to you our perspectives on what we believe are the important components of a comprehensive pharmacy benefit for seniors. We believe that a senior pharmacy benefit should:

  • Assure that seniors have access to both the prescription drugs that they need, and the important medication therapy management programs and services that help assure that medications are used appropriately.  
  • Provide payment to pharmacists and pharmacies consistent with the time and intensity required to provide special medication education and counseling to the senior population, which takes more medications than the non-senior population.  
  • Vest pharmacists and pharmacies with the responsibility of providing these important patient care services to seniors.

We describe these components more fully in the enclosed document. We urge you to consider the views of the nation’s pharmacists and pharmacies—one of our nation’s largest, most accessible, and consistently most trusted group of health professionals—as these important discussions continue. We look forward to working with you on this important health care initiative, and ask you to call on us if we can be of further assistance. Thank you.


Sincerely,

Academy of Managed Care Pharmacy (AMCP)
American College of Clinical Pharmacy (ACCP)
American Pharmaceutical Association (APhA)
American Society of Consultant Pharmacists (ASCP)
American Society of Health-System Pharmacists (ASHP)
National Association of Chain Drug Stores (NACDS)
National Community Pharmacists Association (NCPA)
National Council of State Pharmaceutical Association Executives (NCSPAE)

"Pharmacy Benefits All" Coalition 

A Unified Agenda for American Pharmacy—Spring 2001
Academy of Managed Care Pharmacy (AMCP)
American College of Clinical Pharmacy (ACCP)
American Pharmaceutical Association (APhA)
American Society of Consultant Pharmacists (ASCP)
American Society of Health-System Pharmacists (ASHP)
National Association of Chain Drug Stores (NACDS)
National Community Pharmacists Association (NCPA)
National Council of State Pharmaceutical Association Executives (NCSPAE) 


As policymakers discuss a comprehensive outpatient pharmacy benefit for seniors, the "Pharmacy Benefits All" Coalition encourages Congress and the Bush Administration to carefully consider the views of the nation’s pharmacists and pharmacies—one of our nation’s largest, most accessible, and consistently most trusted group of health professionals. 

Pharmacy Organizations: Who We Represent

Our organizations represent the spectrum of American pharmacy practice—independent and chain community pharmacists and pharmacies; hospital and health-system pharmacists; clinical pharmacists in academic health centers, medical group practices, and clinics; pharmacists practicing in managed care organizations; consultant pharmacists in long-term and senior care facilities; home health care pharmacists; and virtually every other type of pharmacist and setting where patient care and medication use occur. We are unified in our core beliefs concerning the development of an outpatient pharmacy benefit for seniors. 

Outpatient Pharmacy Benefit For Seniors: What We Believe

  • Seniors Should Have Access to a "Pharmacy Benefit" – Not Just a "Drug Benefit" 

We believe that seniors should have access to a comprehensive pharmacy benefit. This includes coverage for the most appropriate medication for the senior, as well as the professional services of pharmacists and pharmacies that assure effective outcomes from medication use. 

Pharmacists can work together with the patient and their physicians to help assure that medications are clinically appropriate and cost effective. As a result, preventable drug-related problems, such as side effects and drug interactions, can be avoided. For these reasons, we believe that seniors should have access to a "pharmacy benefit," not simply a "drug benefit." In addition to providing the medication, a meaningful pharmacy benefit would include important components such as collaborative medication therapy management (MTM) services for seniors with chronic medical conditions, refill reminders, extended pharmacist counseling, and outcomes monitoring and evaluation.

Some proposals do not meet these important tests. For example, "prescription drug discount card" programs do not provide adequate pharmacy coverage for seniors, and represent price controls on pharmacies, which are private-sector businesses. Moreover, simply providing coverage for medications is only part of the answer to assuring that seniors have access to a comprehensive pharmacy benefit. Medications are safe and effective only when they are used appropriately. Inappropriate medication use leads to hospitalizations, emergency room visits, and other unnecessary medical costs for which Medicare is already paying a substantial price. 

Seniors recognize that pharmacists are the most qualified health professional to provide this level of care and service. Seniors should have the choice of and access to the pharmacist and pharmacy that best meet their specific health care needs. 

  • An Outpatient Pharmacy Benefit Should Pay Pharmacists and Pharmacies for the Services that Meet the Special Needs of the Senior Population. 

Any outpatient pharmacy benefit must recognize that the nation’s pharmacists and pharmacies are the individuals and entities that actually provide the medications and professional services that are essential to assure that medications are optimally used. 

Payment to pharmacists and pharmacies for providing these products and services must recognize the important health care needs of the senior population, including such services as medication compliance packaging, prescription compounding, and patient education and counseling. Payments should be reasonable and adequate to cover the professional, administrative, and business costs of providing these products and services—as well as a reasonable return on investment—in all pharmacy practice settings in which the care and services are provided. 

  • Pharmacists and Pharmacies Should Deliver Care to Seniors under the Outpatient Pharmacy Benefit. 

Most of the senior outpatient pharmacy proposals introduced to date turn the administration, management, and delivery of services over to "private sector" entities sometimes referred to as prescription benefits managers (PBMs). For example, under several existing proposals, PBM’s are charged with "managing care," "developing drug formularies," "increasing generic drug use," "negotiating discounts with pharmaceutical manufacturers", "placing price controls on pharmacies," and "providing medication therapy management programs to seniors." 

PBMs can and do have an important role in performing many of the administrative tasks associated with providing the pharmacy benefit to seniors. We believe that the nature and scope of "patient care and cost management" tasks that these proposals would assign to PBMs needs further thorough discussion. Pharmacists and pharmacies are the real "private sector" providers of care and service to patients. Pharmacists and pharmacies provide services and work with patients at their point of care to help assure appropriate medication use and accurate dispensing. Senior citizens will ultimately rely on pharmacists and pharmacies to achieve the outcomes we all seek for a successful outpatient pharmacy benefit. 

What We Pledge 

Our organizations are jointly committed, prepared, and able to work with the 107th Congress, the Bush Administration, the pharmaceutical industry, HCFA, physician organizations, senior advocacy groups, and other interested parties to help design an outpatient pharmacy benefit for seniors that improves medication use, helps control overall health care costs, and enhances the quality of life. 

An outpatient pharmacy benefit for seniors will be the single most substantial and important addition to the program since its inception 35 years ago. We must assure that any new program established provides the most cost effective pharmacy benefit to seniors and the Medicare program. Seniors, taxpayers, and the public at large deserve nothing less than our best effort.