With new push, pharmacy groups seek inclusion in health reform’s ACOs

NCPA, NACDS appeal to CMS

ALEXANDRIA, Va. — Independent and chain pharmacy groups are making a new push to stake a firm claim to the new healthcare system emerging with the health-reform law enacted earlier this year.

Weighing in on a major aspect of the new law, the independent pharmacy lobby is urging federal health officials to untangle government red tape that could prevent pharmacies from fully participating in newly created health-provider organizations.

In a letter to the Centers for Medicare and Medicaid Services, the National Community Pharmacists Association staked out its position on the shifting healthcare landscape that will take shape over the next few years. The letter was authored by John Coster, NCPA’s SVP government affairs.

Noting that “the Affordable Care Act establishes a new category of healthcare structure: the accountable care organization within the Medicare program,” Coster called on CMS to assure pharmacists a full stake in the new health-delivery model. That means allowing independent pharmacies to collaborate with other health entities without fear of antitrust regulations.

Community pharmacists, he added, provide such services as medication therapy management and medication adherence that can play a “critical role” in ACOs, “as well as in similar entities, such as ‘medical homes,’ ‘transition of care’ teams and ‘medication reconciliation activities.’ These services,” Coster reminded CMS officials in his letter, “have been offered for years by pharmacists in such models as the Asheville Project ... as well as other integrated healthcare teams.”

What’s more, noted the group’s government affairs chief, “pharmacists are increasingly gaining recognition for the integral role that they play in encouraging preventative care and promoting wellness, given their subject matter expertise and access to patients in the communities in which they are located. To help fulfill the intent of the new healthcare law to improve medication use, pharmacists should be allowed to collaborate with other providers and negotiate with insurers to deliver patient care services and serve as patient advocates in ACOs.”

That kind of collaborative care model involving pharmacists as part of healthcare teams, Coster told CMS, “will ensure that a greater number of patients will have access to this type of innovative care, resulting in a potential reduction in overall healthcare costs through improved medication use." He called “the inclusion of pharmacists in these collaborative care models” a “natural fit given the profession’s growing utilization of electronic prescribing and electronic health records.”

Coster urged the agency to assure that independent pharmacists — many of which practice in “very rural and/or very urban areas not typically served by chain pharmacies” — are able to compete on a level playing field. Among other things, that means assuring that pharmacists and “allied healthcare providers” are assured a “safe harbor” to shield them from antitrust laws, he pointed out.

“In order for independent community pharmacists to be able to actively participate in the envisioned ACOs and other collaborative care models,” Coster told CMS, “these practitioners need to be able to collaborate with one another in order to form provider networks that can realistically compete on an equal footing with pharmacy networks made up of chain pharmacies.” Both Congress and the Federal Trade Commission may have to get involved, he pointed out, to provide pharmacies with “an antitrust exemption in order to collectively negotiate.”

Also making its voice heard Tuesday was the National Association of Chain Drug Stores. In a letter to CMS administrator Donald Berwick, NACDS VP public policy Julie Khani urged the agency to consider the role pharmacy plays in delivering patient-centered care as it develops rules for ACOs. To that end, she noted, MTM should be a core element in the new health accountability framework.

“A critical factor in the success of an ACO is improving health outcomes and reducing healthcare costs related to chronic conditions through better medication adherence and medication therapy management,” Khani stated. “MTM is one solution that has been proven to improve patient medication adherence by leveraging face-to-face consultation with community pharmacists.”

NACDS also highlighted the importance of provider-pharmacy partnerships in providing patient-centered care. “By partnering with community pharmacies, solo and small practice providers will be able to ensure that their patients receive assistance in medication management from qualified pharmacies, leading to better medication adherence, which will lead to better health outcomes, enhancing the ability of the provider to effectively treat the patient,” Khani told Berwick.

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