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Three bills in Congress address freedom of choice, provider status, and pharmacist shortage
As the second session of the 107th Congress moved into full swing, pharmacy lawmakers were intent on keeping up the momentum to propel some proposed bills through the legislature that they say hit the "high-water mark" in recognizing the expanded role of pharmacists and the value of pharmacy services.
Topping the listand backed by strong lobbying efforts from national pharmacy groupsis the highly lauded Medicare Drug and Service Coverage Act of 2002, which would offer comprehensive prescription drug benefits to seniors.
Also high on the agenda: the provider status bill, which is expected to bring pharmacists in line with the other healthcare professionals by making them providers under Medicare; and the Pharmacy Education Aid Act of 2001, which takes aim at easing the critical shortage of pharmacists by increasing support for pharmacy education.
And while there's probably little likelihood that all of these bills will be passed into law this year, there's strong consensus among pharmacy leaders that on the table now is legislation that represents a step in the right direction for the profession.
"Some of the key initiatives in Congress this year are well in line with our highest priority of redefining the pharmacist's job description to include securing payments for pharmacy services such as medication therapy management," explained Susan Winckler, group director of policy and advocacy for the American Pharmaceutical Association.
Indeed, said Winckler, APhA's ringing endorsement of the Medicare Drug and Service Coverage Act, drafted by the Pharmacy Benefits All Coalition (PBA) and introduced recently by Rep. Jo Ann Emerson (R-Mo.) and Rep. Mike Ross (D-Ark.), hinged in part on the legislation's emphasis on pharmacy services and not just the provision of medication.
Under this bill, seniors would be responsible for a 20% copayment for their medications, along with a monthly insurance benefit yet to be determined and an annual deductible of $250half of the $500 deductible other Medicare legislation would require.
Unlike earlier plans, choice of drugs, with the exception of certain lifestyle drugs, would not be limited, and beneficiaries would have access to pharmacy-based medication management services to improve the effectiveness of their drugs and reduce errors. By allowing seniors to access these benefits at the pharmacy of their choice, the legislation goes a long way in recognizing the importance of a strong patient-pharma-cist relationship.
Yet another provision will provide for benefit cards to help streamline the administrative process at the store level. To ensure lower drug costs, manufacturers would provide larger rebates.
"The Emerson/Ross bill clearly reflects the kinds of issues that any pharmacy group would like to see in a comprehensive Medicare reform package," said John Rector, general counsel for the National Community Pharmacists Association (NCPA). Among the key attractions for his group, he said, is the legislation's "more traditional role" for pharmacy benefit managers.
"The bill guarantees seniors complete freedom to select the drugs and pharmacist providers that best meet their needs and rejects the unbridled delegation of authority to PBMs to steer patients to their highly profitable mail-order businesses, which radically limit the choice of drugs for seniors," maintained Rector.
Ross/Emerson also spells good news for the National Association of Chain Drug Stores. "This comes closest to providing a real benefit, as opposed to the discount bills that have surfaced," said Larry Kocot, NACD's general counsel. Indeed, NACDS, NCPA, and APhA have vociferously opposed the prescription drug discount card program now being touted as the "Bush" card and which targets about 40 million Medicare beneficiaries. "The card is a nonstarter in that it doesn't answer anyone's real concerns," contended Kocot.
APhA's position is clearly that seniors need coverage, not discounts, declared Winckler, adding that under the proposal first advanced last July, the "discounts that have been promised varied widely." In fact, a recent General Accounting Office report showed discounts in the 10% range. "For a senior who can't afford a $100 medication, a $90 one is not that much more affordable," Winckler said. One interpretation of the Bush card is that it would disrupt consumers' choice by directing them to mail-order pharmacies.
The Emerson/Ross bill "has undoubtedly raised the bar for other drug benefits that are introduced in the future," noted Kathleen Cantwell, director, federal legislative affairs and government affairs counsel of ASHP. While strongly endorsing the bill, Cantwell suggests that the clear signal from government indicating a lack of funding for comprehensive programs is steering some groups to more reachable goals, such as pushing through the provider status legislation.
"It's clearly our top legislative and policy issue right now," said Edwin Webb, director of government and professional services for the American College of Clinical Pharmacy, in describing a bill that would amend the Social Security Act to include pharmacists as providers under the Medicare program. At the heart of the proposal is the recognition that pharmacists provide a range of services that are currently not taken into account and are not reimbursable under Medicare because the pharmacist is not recognized as a provider eligible for payment.
"Recognition of pharmacists as providers not only aligns pharmacists with other healthcare professions but allows them to establish a practice that could theoretically be based exclusively on these kinds of collaborative practice and patient care services that are not necessarily tied to the dispensing of a product," explained Webb.
All eyes, too, are on the Pharmacy Education Aid Act of 2001. If passed, it would give grants to colleges of pharmacy to expand class size and expand faculty. Also, by making pharmacists eligible for scholarships and loan repayment programs under the National Health Services Corps, the legislation could lead to the supply of more pharmacists in medically underserviced areas.
Other issues on the watch list for pharmacy include a consumer medicine initiative launched last year to restore some deductibility for prescriptions, OTCs, and prescription services as well as a bill that would allow independent practitioners to negotiate contracts with health plans. And independent pharmacy groups are stepping up the pressure to implement a bill passed in 2000 to allow pharmacists to import Food & Drug Administration-approved drugs from a number of countries.
Tina Kyriakos. These three bills top pharmacists' agenda in Congress this year.