ASHP Intersections Summer 2010 - 14

Robert E. Pittman
RADM (Retired) Robert E. Pittman, B.S.Pharm., M.P.H., U.S. Public Health Service (PHS), recently spoke with InterSections about his service with the PHS and the Indian Health Service (IHS). RADM Pittman served as chief pharmacy officer for the PHS from 2006 to his retirement in February. He also served as principal pharmacy consultant for the IHS from 2000 to 2007 and as the IHS director of the Division of Health Professions Support from 2007 until his retirement.

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What does the PHS chief pharmacy officer do?
The chief pharmacy officer works with the Surgeon General and the Secretary of the Department of Health and Human Services to provide advice and consultation on pharmacy issues, including policy review, recruitment, retention, and clinical issues. However, the chief pharmacy officer also holds another fulltime job in addition to that position. For me, that other job was with the IHS.

have not kept up with the training. Pharmacists cannot work to the fullest extent of their training and knowledge without reimbursement, and this is something that should be considered in implementing health care reform.

about the benefits of Part D, and developed information the local sites could use to explain to patients why it was important for them to sign up so the facilities could get reimbursed and continue to provide care.

What did your work with the IHS entail?
While I was the IHS principal pharmacy consultant, I led pharmacy practice for 600 IHS Commissioned Corps, civil service, and tribal pharmacists at 237 pharmacies throughout the United States. I was mostly responsible for performance improvement, risk management, and pharmacy coordination. I was also involved with implementing Medicare Part D for the IHS and in the development of the IHS national core formulary. When I moved to the Division of Health Professions Support in 2007, I primarily dealt with the recruitment and retention of health care professionals for the IHS.

What was involved in developing the IHS national core formulary?
We set out to establish a core formulary similar to the ones at the Department of Veterans Affairs and the Department of Defense. We wanted to ensure that IHS patients would have access to the same core medications at every IHS site, and we worked with the IHS National Pharmacy and Therapeutics Committee to develop the formulary based on the best scientific information.

What’s in store for pharmacy practice as health care reform shapes up?
With 30 million potential new beneficiaries under health care reform and an already existing shortage of family practice physicians, pediatricians, and internists, there is an opportunity for pharmacists to help increase access to care by stepping in as primary care providers where medication is the primary method of therapy. This is especially true in rural areas, where often the pharmacist is the only health care provider who is readily accessible. The frequency with which patients see their pharmacist makes pharmacists a logical choice for things such as monitoring blood pressure and working with physicians to suggest changes to therapies. We’ve been training pharmacy students to do this kind of drug therapy management for the past 25 years, but, unfortunately, the payment systems

How does the formulary process work?
If a drug is clearly superior to other drugs in a class, that drug is added to the formulary. If drug studies show similar outcomes, including adverse effects, for multiple drugs in the same class, the IHS looks at cost factors in making a decision. Pharmaceutical companies propose bids for medications being considered for the formulary. Although price matters, and the process saves the taxpayers money, the most important criteria are the medical benefits for the patients.

How were you involved in implementing Medicare Part D?
As the Centers for Medicare and Medicaid Services developed new regulations and policies related to Medicare Part D, I worked with them on federal pharmacy issues. At the IHS, we knew Medicare Part D would have a substantial impact on our facilities and patients. We went out to the sites and educated staff

The American Society of Health-System Pharmacists

ASHP Intersections Summer 2010

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