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Monday, September 21, 2009

Pharmacies, Rx in Overhaul

By Dale Tinker And Steven C. Anderson
N.M. Pharmacists Association National Association of Chain Drug Stores
          When it comes to health care, President Obama and members of Congress would do well to take an example from the American people: when faced with a problem with nowhere to turn, trust the pharmacy. The same pharmacy qualities that appeal to patients offer promise to policymakers searching for truly nonpartisan solutions amid one of the more heated debates in recent history.
        Politically charged issues are grabbing the headlines. Yet one of the areas most in need of reform is that our current health care delivery system does not function as systematically as it could or should. There is not sufficient focus on the relationship between physicians and non-physician providers, like pharmacists, in providing high-quality, cost-effective patient care.
        This problem is exposed by the declining supply of primary care physicians. According to the American Academy of Family Physicians, the number of U.S. medical students entering primary care has dropped by more than 50 percent over the past decade. At the same time, a July 2009 report by PricewaterhouseCoopers reinforced the accessibility of pharmacists, with respondents reporting the least amount of difficulty in accessing care from pharmacists.
        Most Americans live within five miles of a pharmacy. The point should not be lost on policymakers that health care solutions remain as close as pharmacy's geographic proximity implies. In reform efforts, it is essential to advance, and prevent harm to, the health care providers who deliver practical and professional services and products including health screenings, medication reviews, immunizations, and access to prescription and over-the-counter medications.
        The importance of access to medications, and help in taking them correctly, cannot be overstated. The New England Health Institute recently estimated that the overall cost of poor medication adherence, measured in otherwise avoidable medical spending (i.e. emergency room visits and extended hospital stays), is as much as $290 billion per year, or 13 percent of total health care expenditures.
        To merge popular health care practices with popular health care policies, and to capitalize on the expertise and access of the 250 community pharmacies and nearly 1,200 community pharmacists in New Mexico and across the nation, we propose at least three steps in the right direction.
        First, customers and patients deserve access to pharmacy care and services. But a 2005 federal law, and its regulations, would reimburse pharmacies at below cost for Medicaid prescriptions and put many pharmacies in a Catch-22 — forced to decide whether to close their doors or reduce services. Congress needs to reform the pharmacy Medicaid reimbursement system for the good of patients.
        Second, Congress should enhance the emphasis on pharmacist-provided medication therapy management. MTM includes services to help ensure patients use drugs appropriately to maximize health and to reduce the risk of adverse events. Examples of services include a consultation between a pharmacist and a patient, development of a comprehensive personal medication record, development of a medication action plan, coordination with a physician to help resolve medication problems, and documentation and follow-up. In one study, every $1 invested in pharmacist-provided medication therapy management resulted in overall health care savings of $12.
        Third, Congress should exempt pharmacies, just as it has exempted other providers, from bureaucratic red tape to ensure they remain able to provide durable medical equipment such as diabetic testing supplies, canes and crutches, and other products without being subject to duplicative and prohibitive regulations.
        Health care reform is a laudable goal for President Obama and Congress and we hope pharmacy and the pharmacy professionals in New Mexico can work with our elected officials, like Sen. Jeff Bingaman, to achieve comprehensive reform. Pharmacies are the face of neighborhood health care in this country, and they can be the face of health care reform as well.
        Dale Tinker is executive director of the New Mexico Pharmacists Association. Steven C. Anderson is president and CEO of the National Association of Chain Drug Stores.