Pharmacy & Therapeutics - February 2009 - (Page 78)

COMMENTARY Pushing an Expanded Role for Pharmacists Medicare, SCHIP, and Health Insurance Debates Present Ample Opportunities Stephen Barlas The pharmaceutical industry will be facing a radically differtwo seats still in doubt—58 votes in the Senate, including those ent political environment in Washington in 2009 compared of two independents, Senators Joe Lieberman (D-Conn.) and with any time in the recent past, but opportunities and threats Bernie Sanders (D-Vt.), who caucus with the Democrats. In differ from sector to sector. Barack Obama’s ascension to the addition, a couple of Senate Republicans remaining in ConWhite House, the fattening of the Democratic majority in Congress voted for the Medicare Part D reform bill in 2007. The gress, and the shift in leadership of at least one key commitquestion for that bill—as with the State Children’s Health tee signals the acceleration of three trends: an emphasis away Insurance Program (SCHIP), which is a “must pass” because from the treatment of disease to one of disease prevention, a of the impending expiration of the program’s authorization in switch from brand-name drugs to generics, and a movement March—is just how many pharmaceutical amendments will be toward comparative research that will address the attached to those legislative vehicles. question of which brand-name drugs really work. As with the potential expansion of the role of These trends are likely to highlight the value of pharmacists, the tightening or loosening of repharmacists, for example, and to undercut the strictions on Medicare formulary policies is probappeal of brand-name drugs, just to mention two ably also up for grabs in the form of amendments of the sectors likely to be affected. to either a Part D or a SCHIP bill. The issue What will be a new emphasis on prevention and cropped up in 2008 because of the passage of the better-informed patients presents the opportunity Medicare Improvement for Patients and Providers for pharmacists to receive federal backing to eleAct of 2008 (MIPPA) last summer. The main purvate their role to health care advisors. John M. pose of that bill was to eliminate a big cut in Coster, Vice President of Federal Affairs and PubMedicare pay for physicians in the second half of Stephen Barlas lic Policy at Rite Aid, says: 2008 and for calendar year 2009 and to replace the Medicare pay cut with a minimal increase. The bill was introduced in June and passed within weeks, without any hearings There is going to be an emphasis on prevention in any legislation being held, because of a June 30 deadline for a precipitous detargeting the uninsured and that means there will be opportunities cline in physicians’ pay. The frenzy surrounding the bill made for advancing the health care role of pharmacists. There will be a it an appealing target for all sorts of amendments that Conconcerted effort in 2009 among pharmacy groups to push for direct gress—had it acted in a more purposeful manner—might not payment of pharmacists for medication therapy management have considered, much less passed. [MTM] and immunization services, including by Medicare. Drug manufacturers, aligned with patients’ and some physicians’ advocacy groups, used the chaotic environment to get But the health insurance industry is expected to lobby hard an amendment attached to the MIPPA, which has the potenagainst new, discrete payments to pharmacists, because, with tial to expand the Part D formular y program. Currently, Medicare, the insurance industry receives payments directly Medicare has a limited “mandated” formulary, established by for MTM services that any health care professional, not just a way of guidance issued by the Centers for Medicare and Medpharmacist, can provide. icaid Services (CMS), which says that every Part D drug plan There will be numerous legislative opportunities for pharmais required to provide “all or substantially all” medications cists to expand their roles in both private and federal health within six classifications: immunosuppressants, antidepresprograms. A Medicare Part D “reform” bill will probably move sants, antipsychotics, anticonvulsants, antiretrovirals, and much more quickly than an “uninsured” bill. The House did pass antineoplastics. such a bill in 2007, only to see it derailed in the Senate by That guidance was issued at the beginning of 2006, when the Republican opposition and a veto threat by President George W. Medicare outpatient drug benefit kicked in. The guidance was Bush. Its main feature had allowed the federal government to established to protect the stream of fragile Medicaid recipients negotiate Medicare drug prices directly with drug companies. who were being transferred to the Part D program; these At this writing, the Democrats have—with the occupants of recipients were the so-called “dual eligibles,” so that even if they were being treated for depression, psychosis, or any of the Mr. Barlas is a freelance writer based in Washington, DC. He other four conditions, they would not be required to stop takcovers issues inside the Beltway and writes P&T’s Prescription: ing their current medication. Washington column. Patients’ groups and drug manufacturers wanted a more permanent, and potentially broader, Medicare formulary proAccepted for publication December 3, 2008 78 P&T® • February 2009 • Vol. 34 No. 2

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - February 2009

Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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