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House and Senate Pass Versions of Medicare Reform Legislation

Cheryl Thompson

ASHP and the entire pharmacy community played a significant role in shaping historic bills passed by both chambers of the U.S. Congress early today, constituting the largest change to the Medicare program since its inception in 1965.

The legislation creates a drug benefit, effective in 2006, which would be delivered by private entities, such as pharmacy benefits managers, health maintenance organizations, pharmacy networks, and insurance companies.

ASHP, as part of the Pharmacy Benefits All Coalition, worked closely with members of Congress to ensure that the bills addressed many of pharmacy's core principles for a Medicare prescription drug benefit. Both the Senate and the House bills, to different degrees, include coverage of pharmacists' medication therapy management services, access to local pharmacies, and transparence for rebates and other incentives provided to pharmacy benefit managers.

ASHP is particularly enthusiastic that both bills include medication therapy management services as a core quality-enhancing program to be offered by all prescription drug plans. In addition, ASHP, as a founding member of the Pharmacist Provider Coalition, was successful in securing a provision in the Senate bill that would allow national pharmacy organizations, in the period before implementation of drug coverage, to work directly with the Centers for Medicare and Medicaid Services to assess how pharmacists' services can best be incorporated into the Medicare program and to develop appropriate payment methodologies. This assessment would allow for the comparison of medication therapy management programs in six geographic areas.

"Pharmacists are a critical element in protecting the health of seniors whose medical care increasingly depends on medications and who are at high risk for complications," said Henri R. Manasse Jr., Ph.D., Sc.D., ASHP executive vice president and chief executive officer. "Access to pharmacists to help patients manage their medication therapy is an essential provision in Medicare reform and can significantly improve the health of our nation's seniors."

Congress's next step is to convene a conference committee of House and Senate members who will be charged with working out differences between the two chambers' bills. The conference committee is tentatively scheduled to begin shortly after the Fourth of July holiday, with a goal of sending a bill to the President before the August recess.

Once ASHP has thoroughly reviewed both bills, the Society will send an "action alert" to members asking them to urge conferees to retain several key features, including the assessment program provided in the Senate bill, as well as medication therapy management services and appropriate recognition for pharmacists.

"ASHP greatly appreciates all the work our members have done to make sure that health-system pharmacy's voice was heard in this debate," said Manasse. "Members of Congress will need to continue to hear from pharmacists during the conference period as they decide how to blend the two bills."

For more information about the bills and Congress's recent actions, read the following material:

"Medicare Bills Would Add Drug Benefits," Washington Post, (free through July 10)

"House and Senate Pass Measures for Broad Overhaul of Medicare," New York Times, (free, registration required)

"Prescription Drug Coverage for Medicare Beneficiaries: A Side-by-Side Comparison of Selected Proposals," by Health Policy Alternatives Inc.,