Ex-Governors to Pharmacists: Engage in Your State’s Political Process to Shape Medicaid, Health Reform

By Kevin Schweers

Two respected, former Governors spoke fondly this week of their first-hand experience with the services of independent community pharmacists and urged pharmacists to take an active, solution-oriented role in the political process to help preserve patient access to community pharmacies.

NCPA’s Government Affairs and Advocacy Center chief, John Coster, PhD, RPh, moderated the insightful discussion between former Governors Phil Bredesen (D-Tenn.) and Jim Douglas (R-Vt.) – part of NCPA’s 113th Annual Convention and Trade Exposition that brought a few thousand community pharmacists to Nashville. In the prior two years, the series featured former Health and Human Services Secretaries Mike Leavitt and Donna Shalala and earlier former Senate Majority Leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.).

Former Gov. Bredesen’s first job in the world was working in a local Rexall pharmacy in his small hometown. It taught me a lot about community pharmacy and what an integral part of the healthcare system it plays, particularly in rural areas.

Engage with the state government, former Gov. Bredesen told the 3,000 community pharmacists in attendance. “The world is changing and the [Affordable Care Act] is accelerating both change and costs. Rather than resist these changes, grab hold of them and bring your expertise to ensure that change is done in a way that protects the interests of your patients.”

Former Gov. Douglas recalled how community pharmacists responded to flooding in Vermont – the second-oldest state in the nation in terms of its senior population. To traverse high flood waters and deliver prescriptions, pharmacists took to National Guard helicopters, all-terrain-vehicles and even horseback. “We’re very proud of the pharmacists in Vermont,” said Douglas. “They did a great job.”

Both Bredesen and Douglas agreed that the two major healthcare issues the states will deal with over the next few years are Medicaid costs and the implementation of the state-by-state health insurance exchanges set forth in the Affordable Care Act.

Bredesen lamented the lack of flexibility with which Governors must grapple in seeking to reform Medicaid to lower costs without sacrificing access to needed medical treatment. Recalling his experience in Tennessee, he described having an innovative cost-saving proposal rejected by federal Medicaid officials and instead having to adopt an arbitrary monthly limit on recipients’ prescription drug access.

“So what you end up with instead of a scalpel is a much blunter instrument,” said Bredesen, asserting that, with flexibility, it could have been done in a better way for patients.

“Governors are desperate for some answers to these costs questions,” Bredesen continued. “To the extent to which community pharmacies can help with that as opposed to saying, ‘No, we’re going to draw a line in the sand,’ governors will be more receptive to that.”

He then stressed the need for short-term savings proposals as governors often face year-to-year budget crises as opposed to being able to focus on long-term cost reduction.

The big, underreported story in health care reform, Bredesen predicted, will ultimately prove to be that the enrollment figures in the health insurance exchanges will far exceed any predictions, driving the budget cost of the program beyond the official Congressional Budget Office’s prediction. He cited the generous federal subsidies for middle-class Americans participating in an exchange.

Douglas urged pharmacists to know how their state government is divvying up decisions regarding ACA implementation; and to focus their greatest efforts where the most important decisions are going to be made.

Both Bredesen and Douglas expressed concern regarding the growing wave of health care industry consolidation, among both the provider community and in the insurance community, as with the proposed mega-merger of pharmacy benefit manager (PBM) giants Express Scripts and Medco.

“There is nothing like going down to the community pharmacy where I live where they know me and give me the medications to help my homebound father,” Douglas said. “So I hope this consolidation does not affect that dynamic.”

Bredesen referred to the Medicaid cost crises now and in the future as an opportunity for community pharmacy to make a very good argument why it makes sense to continue to provide drugs through a local pharmacy.

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