Advocating for provider status legislation on Capitol Hill
LOREN BONNER The Pharmacy and Medically Underserved Areas Enhancement Act (H.R 592/S. 314) continues to gain support in Congress. At press time, the legislation, which would provide access to and coverage of pharmacists’ patient care services, had 275 cosponsors in the House and 42 cosponsors in the Senate.
Champions of the legislation are continuing to do their part. In a column that appeared in the Iowa newspaper the Gazette on April 8, Sen. Chuck Grassley (R-IA) voiced further support for Medicare beneficiaries to have access to pharmacists’ patient care services.
Pharmacists are taking every opportunity to gain support from more Members of Congress. Recent advocacy efforts included 20 pharmacists and student pharmacists meeting with 30 offices on Capitol Hill about the legislation during the 2016 APhA Academies Leadership Meeting (ALM), which took place April 7–8, 2016, in Washington, DC.
“Pharmacists should put every resource into this effort because the chance will not come again,” said Michael Schuh, PharmD, MBA, assistant professor of pharmacy at the Mayo Clinic in Jacksonville, FL. “Every pharmacist should continually advocate for this endeavor every day until the goal is achieved.”
Schuh, who is an ALM executive committee officer, met with staff for Sens. Bill Nelson (D-FL) and Marco Rubio (R-FL).
‘Your interests align with theirs’
E. Michael Murphy, PharmD candidate at Ohio State University College of Pharmacy in Columbus and APhA Academy of Student Pharmacists (APhA–ASP) National President-elect, said he had a productive meeting with Sen. Rob Portman’s (R-OH) staffer.
“I was impressed with how familiar [he] was with how important pharmacist-provided care is. This seems to be becoming a recurring theme during Hill visits,” said Murphy.
Ali Jo Shipman, PharmD candidate at Mercer University College of Pharmacy in Atlanta and member engagement standing committee chair for APhA–ASP, said that advocacy is a constant necessity in the pharmacy profession, and meeting with Members of Congress does not have to be intimidating.
“Your main interest is taking care of your patients, and their main interest is taking care of their constituents. When you are meeting with your senator or representative, your patients and their constituents are the same people, so really your interests align with theirs,” Shipman said.
“If you keep that in mind as you speak to them and explain how pharmacists are working to help the people in their communities, they are generally very receptive and understanding. It is also important to remember that building relationships with Members of Congress and their staff is just as important as getting them to agree to cosponsor a bill.”
Shipman met with staff for Sens. Lindsey Graham (R-SC) and Tim Scott (R-SC) during ALM.
During their Hill visits, pharmacists and student pharmacists also discussed the Comprehensive Addiction and Recovery Act (CARA) of 2015 that would put programs in place to curb prescription drug misuse and abuse.
Although the pharmacy community is committed to this fight, there is concern related to one of the provisions of the legislation that would mandate pharmacists to consult their state prescription drug monitoring program database prior to dispensing a Schedule II, III, or IV controlled substance.
Loren Bonner, MA, Reporter
Photo Caption:APhA–ASP National President-elect E. Michael Murphy met with Jack Dolan, (L–R) staff for Sen. Rob Portman (R-OH).
Pharmacists manage anticoagulant therapy at FQHC in Florida
S0NYA COLLINS Eighty-year-old Eva Romero might be in an assisted living facility if it weren’t for the pharmacist who helped her maintain her independence. When Romero fainted during a routine test at the hospital, her doctors thought she might be having a stroke. Her daughter immediately feared that her mother’s days of independent living were numbered.
“Renee” had been going to the Coumadin Clinic at Azalea Health, a federally qualified health center (FQHC) in Palatka, FL, for more than a year. Her physician continued to refill her prescription, and Renee went to the clinic every few weeks to let pharmacists test her international normalized ratio (INR).
“After analyzing her current therapy and indication for treatment, we realized that she was no longer a candidate for anticoagulation,” said Matt Timmers, PharmD, who manages anticoagulant therapy with his colleague, Ashton T. Cobb, PharmD. Both are postgraduate year 1 community pharmacy residents at Azalea Health.
Renee had had a blood clot more than a year before, for which a medical provider prescribed 6 months of anticoagulant therapy. “We asked her if there was any reason that she knew of that she was still taking this, and she said she was just taking it because her primary care provider kept renewing the prescription,” Timmers recalled.
Timmers and Cobb contacted Renee’s primary care provider (PCP )to suggest that the therapy be discontinued. “This patient was coming in, getting her INR checked every few weeks, paying for the visits, [and] paying for medication that she might not even need. And she was constantly on antibiotics that were affecting her INR, so she was at increased bleed risk almost every week,” Timmers said. Renee went for a follow-up visit with her PCP, who then stopped the medication.
This pharmacist-driven intervention cut costs, eliminated an unnecessary medication, and reduced the risk of bleeding for an already vulnerable patient, all without putting unnecessary burden on an overtaxed physician workforce.
Easing the burden
As medication experts, pharmacists are uniquely qualified to manage patients like Renee who take chronic medications. But most fee-for-service models of care don’t allow for it. As a result, regardless of the value they bring to patient care, many clinics simply can’t afford to add a pharmacist’s salary to their overhead.
If pharmacists—like their colleagues in virtually all other health care disciplines—could bill for their services, more of them could provide services as Cobb and Timmers do. They could see more patients with more conditions in a wider variety of settings, including community pharmacies and primary care practices.
“Pharmacists are extremely underutilized,” Timmers said. “Providers in our health center do not have enough time to successfully and safely manage these complex conditions. We want to step in and try to ease that burden and assist in certain disease states.”
In the short time allotted for a patient visit, PCPs simply don’t have time—after addressing the acute problem that brought the patient in—to review long lists of medications and ensure the patient still needs them and is taking them correctly. Without that intervention, patients like Renee may end up taking unnecessary medications for months or years.
“Sometimes we identify gaps in care or errors in a prescription,” said Cobb. “We’re able to clarify things for a patient or answer additional questions they might have about their medication or disease state. It’s a great service that we provide.”
Pharmacists can correct medication errors, identify gaps in care, and empower patients with information, saving patients and payers money.
“Provider status would take pharmacists off the bench and put them on the health care team,” said Cobb, “where they could make sound recommendations, manage medications, improve patient outcomes, and lower health care costs.””
Sonya Collins, MA, MFA, contributing writer Photo Caption:Ashton T. Cobb