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Senator Introduces Legislation to Recognize Pharmacists as Health Care Providers

Donna Young

South Dakota Senator Tim Johnson introduced the Medicare Pharmacist Services Coverage Act, S.974, to the Senate on May 25. If passed, the bill will add pharmacists to the list of professionals that are classified under the Social Security Act as health care providers.

The new legislation will permit pharmacists to bill Medicare for high-level drug therapy management services, in accordance with state law. There are 31 states that have collaborative drug therapy management authorization, according to the ASHP Government Affairs Division.

The bill was sent to the Senate Finance Committee.

While Congress is debating a comprehensive and affordable prescription drug benefit for Medicare beneficiaries, access to drug therapy management services provided by pharmacists in collaboration with physicians and other health care professionals is particularly important now, Johnson stated in the Congressional Record.

Johnson noted that pharmacists’ specialized training in drug therapy management has been demonstrated repeatedly to improve the quality of care patients receive and to control health care costs.

"As a precursor to a prescription drug benefit, it makes sense to take this proven initial step to improve the medication use process. This will help Medicare beneficiaries immediately by ensuring that each precious dollar spent out-of-pocket is spent wisely on a streamlined and effective drug therapy regimen," he said.

The Pharmacist Provider Coalition, a joint effort of ASHP and the American College of Clinical Pharmacy (ACCP), worked closely with Johnson on the legislation.

Kathleen M. Cantwell, ASHP’s federal legislative affairs director and government affairs counsel, said ASHP member Brian L. Kaatz was instrumental in the bill’s creation.

Kaatz, head of the department of clinical pharmacy for South Dakota State University’s College of Pharmacy in Brookings, took a sabbatical to work as a staff member researching policy issues in Johnson’s congressional office last year, according to Cantwell.

He used this opportunity, Cantwell said, to demonstrate the types of services pharmacists provide and give the staff an understanding as to why these services are important to Medicare beneficiaries and, therefore, must be accessible.

C. Edwin Webb, ACCP director of government and professional affairs, said it will be a challenge for the legislation to move through Congress as a free-standing bill.

"Ideally, we would like to see it receive the kind of attention a free-standing bill would receive," he said. "The realistic option would be for [S.974] to be part of a comprehensive drug-benefit legislative package. . . . S.974 doesn’t deal with how to pay for medications themselves, but the language and the concepts would be contained in the larger pharmacy bill."

Cantwell said that if a prescription drug benefit does move forward in Congress this year, the pharmacist-services bill could easily be inserted.

"But that is not the only place it will fit," she said. Although the coalition is supportive of the prescription drug benefit, she said, there are many political and economic questions not settled in the prescription drug benefit. "We think that [S.974] would be a good immediate benefit to bring to Medicare beneficiaries. It will help patients make the best use of medications and establish an infrastructure for the prescription drug benefit. It just makes sense to clean up the process before you put in [place] a benefit that is going to increase the utilization of drugs."

Cantwell said that, according to published research, health care costs are decreased when a pharmacist is involved in drug therapy management.

Also, according to a survey conducted by ASHP, about 50% of American seniors take five or more medications daily.

Cantwell said another study, published in the Journal of the American Pharmaceutical Association, reported that $177 billion is spent in the United States each year for medication-related complications.

"The Medicare Pharmacist Services Coverage Act," said ASHP Executive Vice President Henri R. Manasse, Jr., "is vital to patient care and enhanced medication safety because it will allow physicians, nurses, and indeed patients themselves to access the specialized services of pharmacists. Pharmacists, after all, are the health care professionals who have the extensive education and drug therapy management expertise necessary to reduce medication errors, create optimal patient outcomes, and control costs within our nation’s health systems."

Cantwell said the biggest obstacle the bill faces in passing is the current political climate in Washington with a Democrat-controlled Senate and the House and executive branch controlled by the Republicans.

"It will be a while before the Senate will be able to push anything through," she said.

Cantwell said the coalition is encouraging pharmacists nationwide to support the bill by writing and calling members of Congress. Many ASHP state affiliates are also hosting hospital and clinic site visits for legislators, she said.

ASHP sponsored a letter-writing campaign at its annual meeting in California in June, Cantwell added.

ACCP Executive Director Robert M. Elenbaas said the coalition is "rallying our [organizations’] members to encourage their Senate representatives to sign on as a cosponsor or support the bill. The same goes for when...a bill is introduced in the House."