Pharmacists termed innovators, leaders for improving healthcare quality

May 5, 2010

The American Pharmacists Association annual meeting opened in Washington just days before the big March vote on healthcare reform, and a number of people from the political realm were there to praise pharmacists and ask for their support.

Key Points

The American Pharmacists Association annual meeting opened in Washington just days before the big March vote on healthcare reform, and a number of people from the political realm were there to praise pharmacists and ask for their support.

Pharmacists in the lead

Sebelius said inspectors had found "egregious violations of Medicare policy, including denying enrollees coverage for HIV, cancer, and seizure medications they needed not only to stay healthy, but to stay alive."

Begin with medication

Speaking live at the session, Congresswoman Eleanor Holmes Norton, (D-D.C.) told the pharmacists that the only way to "bend the curve" in healthcare costs is "to begin with medication and with how medications and pharmaceuticals are priced."

Among other things, she said, "You have got to free the pharmacists, so that the pharmacist is not virtually forbidden, in some circumstances, to speak about generics, which we regard as key to driving down the costs of pharmaceuticals."

Transparency for PBMs

Another "huge issue" is the system's reliance on pharmacy benefits managers (PBMs), who, she said, "operate in an amazing fashion in a society that prides itself on transparency, hidden behind a veil where many factors that could help the pharmacist and help those he serves simply are not known."

She cited as an example the bill she co-sponsored calling for more restrictions on PBMs that serve federal employees, saying, "We found that the PBMs that served federal employees, huge PBMs, were largely in secret and unregulated, even though we regulate the carriers that in fact deal with the PBMs."

"How troubling it was to sit in hearing and learn of an independent study, just a couple of years ago, of one of the largest PBMs, that managed, the study found, to keep 44% of the rebates" it processed in a given year, Norton said.

She asserted, "Our goal is transparency. We understand the roles of the PBMs. We can't play that role. Somebody has to play that role for us. We do want to know what they are doing and where the money is going."

Innovations in delivery of care

Mark McClellan, MD, PhD, who was head of CMS when Part D passed, said that he keeps coming back to pharmacists, because, among other things, they are engendering some of the most innovative healthcare ideas, including medication therapy management.

Among other hopeful signs, the Pharmacy Quality Alliance, created four years ago at the behest of CMS and others, has made quality improvements in pharmacy care happen, said McClellan, who is also former head of FDA and is now head of the Brookings Institution's Center for Health Care Reform.

Indeed, McClellan asserted, the promising alternative to simply squeezing down healthcare payments is moving payment to accountable care.

"Because pharmacists have so many good ideas for delivering care and because it is less costly than the traditional ways of delivering healthcare, this kind of reform, accountable care payments, provides a direct and stronger channel for supporting effective pharmacy care," McClellan asserted.

Noting that half of a set of physician-quality demonstrations started by CMS have cut spending by more than two percentage points per year, he said that reductions on that scale would be enough to pay for the coverage expansions that have been so controversial in the healthcare reform bill.

"And this is something that is going to be part of the future of Medicare reimbursement," he said.