Health Care Reform Pharmacy Stakeholders February 12, 2009

Health Care Reform Pharmacy Stakeholders February 12, 2009 Press Briefing National Press Club John Coster, Senior Vice President of Government Affairs, National Community Pharmacists Association Thank you all for coming today to this press briefing on pharmacy’s principles for health care reform. I am John Coster, Senior Vice President of Government Affairs for the National Community Pharmacists Association. We are here today to discuss with you a common set of principles that all segments of the profession have developed over the past 6 months that will guide our actions and activities as policymakers embark on reforming our health care system during this year - and maybe into next. Why is this newsworthy and significant? Just look at the sign behind me. Pharmacy is an incredibly diverse health profession. Pharmacists practice in community settings, hospitals, long term care facilities, and managed care organizations, among others. But, while we certainly have diversity in practice, we all share a common interest: helping to assure the appropriate use of prescription medications. Pharmacists are trained as the health care system’s medication use experts. No other health profession receives as much training in the appropriate use of medications as does the pharmacist. From the local neighborhood pharmacy to the floors of a hospital’s intensive care unit, pharmacists help to assure that medications are prescribed and used correctly. Pharmacists’ services help assure the maximum benefit from medications can be obtained and their risks can be minimized. Pharmacists have always had an important role in safely preparing and dispensing medications. But over the 25 last years or so, their role in assuring the proper use of medications has increased significantly. The health care system is increasingly recognizing that placing a potent medication in the hands of a patient is only half the equation of assuring that it is being used correctly. The intervention, services, and consultation provided by the pharmacist is as critical to achieving the prescriber’s drug therapy goals as the medication itself. Federal health care programs have increasingly recognized the important role that pharmacists have in assuring appropriate medication use. In the late 1970s, Medicaid started requiring that pharmacists perform monthly drug regimen reviews in nursing homes; in 1990, Federal law specified that Medicaid patients be counseled on their prescription medications; in 2003, the new Medicare prescription drug benefit specified that medication therapy management services would be offered to Medicare beneficiaries, and pharmacists are playing an important role in delivering those services. And just in 2006, CMS announced the formation of the Pharmacy Quality Alliance, whose goal is to develop a series of standardized measures to determine how pharmacists contribute to improving patient outcomes. Now as we stand on the cusp of the health care reform debate, we will be working with policymakers to try and further integrate pharmacists’ services into the fabric of the reformed health care system. Here to describe our vision of how pharmacists fit into the health care reform puzzle are three of the profession’s leaders. Thomas E. Menighan was named the new Executive Vice President and Chief Executive Officer Designate of the American Pharmacists Association (APhA) in November, 2008. Menighan began his transition into the role of APhA CEO-designate in February of 2009 and will assume the position of CEO on July 1. Menighan received his Bachelor of Science in Pharmacy (BSPharm) in 1974 from West Virginia University School of Pharmacy. Prior to joining APhA Menighan was President of SynTegra Solutions Inc., in Germantown, Maryland. The company provides supply chain and chargeback auditing and consulting in risk management, 340B Systems, anti-counterfeiting, and the technology of medication information. Bruce Roberts is the founder and owner of three pharmacies and a home health care company, in Loudon County, Virginia. He was named NCPA’s Executive Vice President and CEO in 2002. He serves as the co-chair of the SureScripts-RxHub board of directors. He is a graduate of the West Virginia University School of Pharmacy. He also led the formation of Mirixa, a technology company owned by NCPA focused on connecting the community pharmacist with those that want to engage them to provide clinical services. Steve Anderson is the President and CEO of the National Association of Chain Drug Stores, a position he assumed in 2007. He was President and Chief Executive Officer of the National Restaurant Association for eight years. Prior to that Anderson held management positions at the American Frozen Food Institute for 20 years, having served as President and Chief Executive Officer for 10 years. I would like to also recognize the CEOs and representatives of many of the other groups who are part of this Coalition. Judith A. Cahill, Executive Director, Academy of Managed Care Pharmacy C. Edwin Webb, Associate Executive Director, American College of Clinical Pharmacy John Feather, Executive Director and CEO, American Society of Consultant Pharmacy Kasey Thompson, Vice President, Policy, Planning, and Communications, American Society of Health- System Pharmacists Cathy Polley, Vice President of Pharmacy Services, Food Marketing Institute Rebecca Snead, Executive Vice President & CEO, National Alliance of State Pharmacy Associations Special thanks to Kristina Lunner of APhA for all the hard work she has done in helping to lead this Coalition and implement the action steps needed to make these principles come to fruition. Now I would like to call on the CEOs to each describe one of the three pharmacy principles for health care reform. Tom Menighan, EVP and CEO-Designate, American Pharmacists Association Thank you John, I am Tom Menighan, EVP and CEO Designate for the American Pharmacists Association, representing more than 62,000 members. We are honored to play a role in this important stakeholders group. The Stakeholders have developed three principles for reform – Quality and Safety, Access, and IT Interoperability. In cooperation with my colleagues, I will focus my remarks on Reform Principle I - Improving Quality & Safety of Medication Use. Access to healthcare is an often cited principle in broad discussions of reform. However, the benefit of access to pharmaceuticals is greatly diminished without access to corresponding care. Unfortunately, even those with prescription coverage often continue to have difficulty paying for and using medications as prescribed. This is especially true for those with chronic illnesses and in today’s economic times. Health care reform provides the opportunity to address access together with support for effective use. Today’s pharmacists have proven their value in facilitating effective medication use and we are ready to play that role in any new health care model. Medication use is growing and is a key component of preventing, treating, and managing disease. We know, for example: that among adults over 55 years of age, 28% use five or more chronic medications each month. Data suggest that patients taking multiple medications are more likely to suffer from adverse drug events and medication errors. These folks are precisely the ones who would benefit most from pharmacist services. For example, the inappropriate use of medications contributes to more than 1.5 million preventable, medication-related adverse events each year and accounts for an excess of $177 billion dollars in morbidity and mortality. We also know that adverse drug reactions and noncompliance are responsible for 28% of hospitalizations in the elderly. The evidence is clear that patients need our help if they are to safely achieve the full benefit of their medications. In the examples just cited, adverse events and costs could be avoided with enhanced support from pharmacists. We cannot afford to ignore the problem any longer. These system failings can be minimized through the use of pharmacist provided programs known as Medication Therapy Management. MTM is a distinct set of services in which pharmacists work in collaboration with patients, physician and other providers to optimize care. The profession has articulated and published the scope of these services for use in any practice setting. We improve patient care and empowerment with MTM by identifying, prioritizing, communicating and resolving medication related problems. This system supported coaching by pharmacists has been proven to optimize therapeutic outcomes, reduce errors and adverse events, provide more effective coordination of care, and improve quality of life. We can cite many successes. In public sector programs, several federal and state health programs recognize the value of pharmacists on the clinical health care team. VA pharmacists often manage patients’ hypertension, high cholesterol, anticoagulation and other conditions, as do pharmacists in Indian Health facilities and the uniformed services. In the private sector, the APhA Foundation is responsible for one of the most successful and innovative private sector projects in the nation. The city of Asheville, NC’s self-insured plan began a program with the Foundation in 1996 that enrolled patients suffering from diabetes. These employees received focused attention from participating community pharmacists after being referred by their physician. The results were remarkable! Hundreds of patients achieved their goals through collaboration, resulting in

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