Senator Discusses Role of Specialty Pharmacy in Health Care Reform

Price transparency and patient empowerment may represent the next wave in health care reform, according to a session at this year’s National Association of Specialty Pharmacy (NASP) Annual Meeting and Educational Conference, held on September 19, 2017.

Sen Bill Cassidy, MD, (R-LA), a co-author of the Graham-Cassidy-Heller-Johnson amendment, spoke prior to Sen John McCain (R-AZ), and Sen Susan Collins (R-ME) announcing they would not support the legislation, which prevented it from achieving enough votes to pass. Dr Cassidy discussed the shortcomings of the Affordable Care Act (ACA) and the need to reign in escalating health care expenditures that place an undue burden on patients.

“If there is a guiding theme right now in health care, it’s that patients feel like flotsam and jetsam being driven everywhere on a wave,” Dr Cassidy said. “They feel as if there are costs being compounded that they have no clue about.”

Dr Cassidy pointed to Medicaid expansion as a substantial contributor to problems that persist in health care, which has exacerbated existing problems within the individual marketplace.

“[Patients] don’t understand many things about health care. It’s very complicated, but they do understand that price transparency is something that they want,” he said. “That is, if you will, giving the patient the power. They want to have a choice of what they purchase.”

In expressing his admiration for the work performed by specialty pharmacies, Dr Cassidy stated that pharmaceutical costs are of particular concern to voters. He added that many patients feel the system is rigged against them, comparing this issue to the problems surrounding direct and indirect remuneration fees and the impact this has on pharmacies.

With the problems inherent for many patients in health care related to rising drug costs, Dr Cassidy stated it is incumbent upon pharmacists to take a lead role in helping them gain access.

“Pharmacists can direct patients to lower cost options if they have the ability to do so and I think you all do have a unique ability,” Dr Cassidy told the audience. “Pharmacists have the ability to bring that information to a patient. They trust you and they hear that information that will lower their costs. If we speak about the rebate system, it’s not working for a patient and it probably doesn’t work for you as well.”

The Graham-Cassidy-Heller-Johnson amendment would have taken the funding currently in cost-sharing reduction credits, Medicaid expansion, and tax credits, and instead would provide block funding to states for these pools.

“It shouldn’t matter if you’re Democrat or Republican, it should only matter if you’re American and if you have a need,” Dr Cassidy said. “And so, we wrote this—if you will—agnostic as to whether a state was blue or red.”

Despite the failure to garner enough votes in the Senate, Dr Cassidy stated that the problems with the ACA are not going to improve without legislative intervention.

“The Affordable Care Act has many flaws that need to be addressed,” Dr Collins said. “The current state of health insurance, where premiums are skyrocketing, choices are limited, and small businesses are struggling, needs fixing. My focus will remain on remedying these problems.”

He added that with the looming promise of regulation within the health care market, it’s incumbent upon specialty pharmacy stakeholders to become advocates for the industry by remaining in contact with their state legislators.

“They may not know a lot about what you do,” Dr Cassidy said. “It’s incumbent upon you as an American to kind of relay that to those policy makers so they can come up with a wise policy.”