Last month the U.S. Senate Finance Committee launched a bipartisan working group to consider policy changes in how Medicare treats chronic conditions and requested that stakeholders provide their proposals.
- Include pharmacists as essential health care providers on chronic care teams and as the lead in coordinating safe and effective medication management, especially during care transitions.
- Recognize as providers under Part B of Medicare to fulfill gaps in chronic care, especially in rural, medically underserved areas.
- Expand Medicare Part D MTM eligibility requirements and promote greater consistency through core, chronic disease state qualifications. Allow pharmacists to refer patients to MTM and CMR review, not just the eligible population identified through Plan Sponsor criteria.
- Empower patients through greater face-to-face interactions during MTM, and taking control of medication use through personalized, coordinated refill programs. Plan sponsors should provide appropriate payment for professional pharmacy services related to refill synchronization, not just the dispensing of the medication. This could be billed as a monthly visit.
- Improve coordination by CMS by improving data sharing among Parts A, B, and D; and looking at the total cost of care, rather than individual benefits separately.
NCPA and its members have advocated for these common-sense solutions on many occasions after the launches of Medicare Part D in 2005 and the Affordable Care Act marketplaces in 2013. While there has been some progress, much more could and should be done. Now the Senate Finance Committee should support these ideas, which are not controversial and would benefit Medicare beneficiaries and American taxpayers.
Pharmacist provider status legislation already has buy-in from leading Senate Finance Committee members, as the comments state:
“We are pleased with the bipartisan support from Congress for pharmacists’ services, including members of the Finance committee, who serve as original co-sponsors of S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act, which, if enacted, would permit pharmacists to perform patient care services consistent with their state’s scope of practice if their pharmacy is located in a medically underserved area, health professional shortage area, or medically underserved population. More than any other segment of the pharmacy industry, independent pharmacies are often located in the underserved and rural areas that are home to many Medicare recipients. In fact, independent pharmacies represent 52% of all rural retail pharmacies and there are over 1,800 independent community pharmacies operating as the only retail pharmacy within their rural communities. This could alleviate issues with primary care provider shortages in rural areas, and provide enhanced preventative services as well.”
Hopefully, Senate Finance Committee Chair Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) can turn their shared objectives into tangible legislative results including some of the improvements NCPA proposed. NCPA and its members are more than willing to help.