American Journal of Pharmaceutical Education 2004; 68 (1) Article 13.
VIEWPOINTS Potential and Pitfalls in Prescription Coverage Under Medicare Lucinda L. Maine, PhD Executive Vice President, American Association of Colleges of Pharmacy Keywords: medication therapy management, Medicare, pharmaceutical care, regulation
the years ahead. Validation of the decisions of the 1990s to transition to the PharmD as the universal level of preparation for future pharmacy practice comes from the inclusion of medication therapy management services (MTMS) in the legislation. It was deemed insufficient by policymakers, due to the advocacy work of all national pharmacy associations and many committed individual pharmacists/educators, to simply provide coverage for drug products. Those beneficiaries targeted as eligible to receive MTMS include those individuals with multiple chronic diseases, those that take multiple drug products, and those identified as likely to incur annual costs for covered drugs that exceed a specified level of expenditures. This represents a significant segment of the elderly and disabled population. PDPs are required to develop programs collaboratively with licensed and practicing pharmacists and physicians. Defining MTMS and clarifying the “at risk” population has already drawn heavily upon the research and policy analysis of several AACP members. The engagement of researchers who can continue to help define the needy population, lend clarity to the specific nature of services needed, present cost analyses for delivery of such services, and define how they should be evaluated is timely and critically important. AACP staff will continue to work with other national associations and with the regulatory agencies to connect our members’ expertise with the evolution of this critically important program. Equally critical is the incorporation of relevant components of the law, including an analysis of its implications for pharmacy practice, into all professional degree programs and relevant postgraduate education and training activities. Of course it is essential to assure appropriate coverage of the knowledge and skills pharmacists need to effectively deliver MTM services through didactic and experiential components of the curriculum as well. Increasing attention to geriatric pharmacotherapy is timely and essential. Finally, coverage for MTMS represents a potentially important new source of practice plan revenue for pharmacy practice faculty. We must participate in dis-
In December 2003, President Bush signed into law the most significant changes to an entitlement program in decades. By adding some coverage for prescription drugs to the Medicare program, Congress closed a significant gap in health care services for the elderly and disabled. No longer can it be said that Medicare pays for diagnosis but not for treatment of those covered. The program as adopted also provides virtually immediate assistance to seniors with low annual incomes, a compassionate breakthrough in a program that has historically resisted any such means testing. But what does this truly mean for those covered by the new benefits, for their pharmacists, and for pharmacy educators? Given its recent passage, let’s gaze into the crystal ball to see what implementation of the new law might yield for those in the academic pharmacy community. The law is acknowledged to be “imperfect” even by its most ardent supporters. A recent comment from the chief executive of the AARP indicates that over 45,000 AARP members dropped their membership because of the strong endorsement the organization gave the bill, which contributed to its passage. How imperfect it might be has not yet been determined because a significant amount of the most important details will be decided through the drafting and finalization of regulations. Even when regulations have been issued, the “private sector” entities known as prescription drug plan sponsors, or PDPs, will likely have broad latitude in implementing key provisions of the program. So what does this have to do with contemporary pharmacy education? Both in the macro and micro contexts the implications of the legislation for pharmacy education are quite significant. The legislation lends credibility to recent changes in pharmacy curricula, suggests areas for additional education, reinforces the important patient care roles our faculty members model and teach to our students, and issues a clarion call for input and analysis from our scholars, both today and in Corresponding Author: Lucinda L. Maine, PhD. Address: American Association of Colleges of Pharmacy, 1426 Prince St., Alexandria, VA 22314. Tel: 703-739-2330. Fax: 703-8368982. Email:
[email protected].
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American Journal of Pharmaceutical Education 2004; 68 (1) Article 13. In somewhat of a coincidence of timing, President Kerr asked the AACP Argus Commission to examine the roles and responsibilities of AACP and academic pharmacy in enabling the profession to achieve its mission of delivering pharmaceutical care as the standard of pharmacy practice across all settings. A new opportunity to move closer to that vision was enacted in the 2003 Medicare legislation. It is important to recognize that passing the law, which was extraordinarily difficult, was actually the easy part. Now the “heavy lifting” begins through regulation development and full program implementation. Academic pharmacy has extremely important contributions to make as scholars, leaders, and direct contributors to improved care for our nation’s most vulnerable citizens.
cussions related to defining the credentials of those recognized as providers of such service. We must prepare our faculty and preceptors to become providers and stand ready to deliver care when the program launches in 2006. It will also be essential in the days ahead to ensure that meaningful compensation models are presented to regulators to avoid establishing provisions for payment that inadequately cover the cost of delivering services to this exceptionally needy and deserving population. While Medicare is not looked at by any provider group as a generous payer, the large federal program is certainly a precedent setter. Again, the analytical expertise of academic pharmacists who have worked with leading patient care practitioners to help them define the economic components of pharmaceutical care must be brought to the table.
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