Pharmacists Have Right Prescription for Health Care Reform

August 27, 2009

As Appeared in the Charlotte Observer

By George Brookins, RPh, Drug Store Lincolnton owner (Lincolnton, NC) 
National Community Pharmacists Association Executive Vice President and CEO Bruce T. Roberts 

The World Health Organization ranks America 1st in health care spending and 37th in health care outcomes. This statistical paradox is a prime motivator behind Congressional and White House efforts to enact comprehensive health care reform. The focus has mostly been on doctors, insurance companies, drug makers and hospitals, but policy makers shouldn't overlook the vital role of independent community pharmacists. Evidence suggests that, when pharmacists are fully utilized, they help lower costs and make patients healthier. 

The so-called Asheville Project is a perfect example that warrants nationwide consideration. In 1997, the city of Asheville, North Carolina implemented a program targeting employees, dependents and retirees with chronic health conditions like diabetes, asthma, hypertension, and high cholesterol. The participants were educated by the Mission-St. Joseph's Diabetes and Health Education Center at the outset, and monitored by community pharmacists for the duration of the program. 

The clinical expertise of pharmacists ensured medication adherence, which reduces the rate of health complications that cause expensive emergency room and doctor office visits or worse. City leaders enlisted pharmacists to design patient care programs to help participants maximize the benefits from their medications. This included eliminating unnecessary medications; preventing bad medication interactions; making recommendations to change the dosage or medication based on evaluations; and maintaining a strict medication regimen that participants follow. 

The results after one year were impressive. Participants with diabetes achieved the trifecta of improved blood glucose control levels, reduced total health care costs (from $7,042 per patient to $4,000), and fewer sick days (from 12.6 a year to 6). The success continues, because the program is both payer-driven and patient-centered. In addition, participants' cardiovascular costs were cut by $628 and asthma costs cut by $725 per year. Of course, the improved quality of life for patients exceeds even these impressive financial benefits. 

If imitation is the sincerest form of flattery, then the creators of the Ashville Project should be blushing. Versions of their program have been employed in other communities with similar results. A peer-reviewed study published in the Journal of American Pharmacists Association estimates that enhanced utilization of pharmacists' patient care services, like medication therapy management and disease state management contained in the Ashville Project, could reduce health care spending nationwide by $177.4 billion a year. 

There are several versions of health care reform winding their way through the House and Senate. Some of these proposals include provisions to further incorporate pharmacists' clinical skills into health care. The challenge is to make those provisions more robust and ensure they survive any potential reconciliation between the House and Senate. 

However, we can't get to this appealing picture of "tomorrow's health care" without also addressing some of today's challenges facing pharmacists. Medicaid cuts that would reimburse pharmacies providing generic prescription drugs at well below even the cost of acquiring the drug must be rescinded. Pharmacies, already licensed by the state, should be exempted from expensive, duplicative compliance requirements so they can continue selling durable medical equipment, such as diabetes testing supplies. Creating greater transparency and accountability for the pharmacy benefit managers, who administer prescription drug plans, will produce greater efficiency and uncover potential savings. In each case the current policies, if left unchanged, endanger patient access to their pharmacists. 

Effective pharmacist-to-patient interactions can help ensure America relinquishes its dubious crown as the world's leader in health care spending without a commensurate high ranking in patient health care outcomes. Pharmacists are ready to do their part. Hopefully, Congress and the White House will enact legislation that allows this to happen.

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