Health Care Reform: Has Pharmacy's Message Been Heard?

Pharmacy has a united voice during the health care reform debate, and now that HR 3590 has passed, pharmacy groups must continue to be heard.

I was daydreaming the other day that the president of the United States called to ask my advice about health care reform. Actually, it was more of a nightmare than a dream, because I was not sure what to say.

Suppose you were given the power to implement the ideal health care system for the United States. What would you do? As I contemplated that opportunity, I became overwhelmed with the options that could work. I was further challenged as I tried to decide whether I should approach the answer as a pharmacist and focus on elements of health care reform that would allow pharmacists to better serve patients. Of course, as a taxpayer, maybe I should focus on cost-saving approaches, even if they restricted access to some services because I or my children will be responsible for paying for services that some may not be able to afford. Since I can expect to use more health care services in the not-so-distant years, my answer might make sure that I personally have access to all the health care services I think I may need—even if my children or future generations might end up being responsible for the bill.

I also began wrestling with a fundamental question. Is health care a right or a privilege? Just the other day, a colleague (who had been my student in the early 1970s) reminded me that I had asked his class that very question, and he told me how often he has been reflecting on it recently. Who or what confers “rights” to American citizens? If health care is a right, is there a limit on some aspects of health care, such as cosmetic surgery, that is not a right? If all aspects of health care should not be considered a right, how do you determine what procedures are necessary and which ones are elective?

Now you can see why my daydream turned into a nightmare. I may have my own personal feelings, but I decided that my answer to the president would be based on my insights as a pharmacist, where I think I have some expertise, and suggest that he include a strong pharmacy focus in any health care plan, such as appropriate reimbursement for the drug product cost, the cost of dispensing, plus professional services; inclusion of medication therapy management (MTM) services to promote patient adherence, improve quality of life, and reduce costs; and continue to allow pharmacists to immunize patients and promote transparency in the drug use system.

In fact, that is precisely what pharmacy’s national organizations have done. Pharmacy Health Care Reform Stakeholders includes 15 national pharmacy organizations and other interested entities. This group developed pharmacy health care reform principles that they have articulated to Congress. All participating organizations agreed on the elements, although each organization focused their efforts on the principles of most interest to their members. This strategy allowed pharmacy to have many voices with a single message.

Has pharmacy’s message been heard? Most participants say “yes.” When reform discussions started, policymakers were unaware of our nation’s medication use crisis. They did not know the contributions pharmacists could offer. Through pharmacists’ efforts, policymakers have become aware of the various public and private programs that demonstrate the value of pharmacists in improving patient care. So now, the health care reform bill has passed, and it does include opportunities for pharmacists to provide and be compensated for MTM services. Pharmacists are being included in the discussions about the medical home concept. Appropriate reimbursement for dispensing-related services is included. As health information technology is discussed, pharmacists’ need for access to patient information is now recognized.

I do acknowledge that the current pharmacy components included in the health care reform bill are not perfect. Most would agree, however, that pharmacists’ needs are now understood more and more in the public eye. And, if these pharmacy elements are included in the final implication of health care legislation, pharmacy will have a good platform to work from and patients will benefit from pharmacist services. â– 

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

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