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Care Reform Stakeholders

February 12, 2009 Press Briefing

National Press Club

John Coster, Senior Vice President of Government Affairs, National Community Association

Thank you all for coming today to this press briefing on pharmacy’s principles for 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, , long term care facilities, and 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 . From the local neighborhood pharmacy to the floors of a ’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 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 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, started requiring that pharmacists perform monthly drug regimen reviews in homes; in 1990, Federal law specified that Medicaid 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 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 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 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

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 . 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, 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 . 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’ , 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 from . 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 reduced overall healthcare costs and more days on the job for employees. Patients’ health outcomes exceeded national goals; and all involved — patients, pharmacists, and payers — were extremely pleased with results.

Since the Asheville project, the model has been proven in other settings as well and the collaborating organizations here today can describe those successes. We recognize the future of improved health care lies with empowered individuals in charge of their health. Any new system must insure QUALITY and SAFETY by providing patients with the tools and support needed to self-manage their care. MTM services provided by pharmacists are an essential part of that reform.

Thank you.

Now, I’d like to turn the podium over to my colleague from the National Community Pharmacists Association, pharmacist Bruce Roberts.

Bruce Roberts, CEO, National Community Pharmacists Association

My name is Bruce Roberts and I am the CEO for the National Community Pharmacists Association. Our association represents the approximately 23,000 owners and operators of independent retail pharmacies across the United States. Our organization is pleased to be part of this historic effort to improve patient care by promoting an expanded role for the pharmacist in our health care delivery system.

The fact is that 95 percent of the population of the United States lives within 5 miles of a community retail pharmacy. We are among the most accessible health care providers, especially in rural and urban areas where many people rely on their pharmacist for their needs. That is why the second leg of our three-leg "principles" set discusses the need to assure that our pharmacy delivery system is strong and viable in all communities across the country.

We believe that our nation's medication delivery system is among the most efficient and effective part of the health care system. It is literally the case that in almost any community across this nation, a patient or prescriber can order any medication - and there are thousands of medications - and it can be available that day or the very next day at the local pharmacy. Pharmacists are also providers of other vital health care products and services, such as and durable medical equipment, such as diabetes testing supplies. Many pharmacies have become wellness centers for their communities, and some pharmacists are specializing in helping to treat certain chronic medical conditions, such as diabetes and obesity. For these reasons, our coalition intends to promote policies as part of health care reform that will assure that the infrastructure that provides these products and services to millions of Americans every day remains strong and viable. Our efficiency is hard to match - most pharmacies operate on less than a net 2 percent profit margin. We view ourselves as part of the solution to the health care cost crisis, not as part of the problem.

Continued community-based access to these products and services is critical especially for the increasing number of older Americans that our health care system will be serving. As baby boomers advance in age, and become increasingly reliant on medication and the adherence to medication therapy, and as prescription drugs continue as the solution to many health care problems -- we, as an industry, must do everything in our power to assure that access remains intact -- and we rely on the federal government to help in this charge.

So, as you will note, our second principle calls for policies that assures that our nation has an adequate supply of pharmacists to treat the growing demand for pharmacy services; that patients be able to choose their provider of medications as well as pharmacists within the context of their insurance coverage; that pharmacists are reimbursed adequately for these products and services; and that pharmacists continue to be allowed to promote the use of generic medications where appropriate to assure the best patient care at the lowest cost.

We believe that our patients will support these principles because, at least in my experience, most people want to know that their pharmacist is there and available for them. In fact, our association, NCPA, launched a new online community just last week -- called Fight 4 Rx -- to give our patients a louder, stronger voice in the health care debate. It's an online community where patients will have regular access to user-friendly information and will provide an opportunity for patients to reach out to their elected officials when the health care debate ensues.

Steven C. Anderson, President and Chief Executive Officer, National Association of Chain Drug Stores

Good morning. I’m Steve Anderson, president and CEO of the National Association of Chain Drug Stores. NACDS represents traditional drug stores, supermarkets, and mass merchants with pharmacies – from chains with four stores to national companies. Chains operate more than 39,000 pharmacies, employing more than 2.5 million employees, including 118,000 pharmacists.

Some of you may question the form that healthcare reform will take: will it be comprehensive reform, or incremental reform? We are enthusiastic about comprehensive reform. But it is pretty clear that some incremental reform is already here. The stimulus bill includes important measures to advance health information technology – or HIT.

Really, HIT deploys today’s resources to advance the classic and highly respected role of pharmacists and pharmacies, the face of neighborhood healthcare. Through HIT and electronic prescribing, pharmacists have additional resources to help patients take medications as prescribed … to further reduce errors … to empower better decisions based on patients’ health information … to implement medication therapy management … and to help reduce costs.

That’s why NACDS and NCPA in 2001 formed the e-prescribing network SureScripts – now SureScripts- RxHub. And that’s why HIT and e-prescribing comprise one of three pillars in these principles.

We call on Congress and the Obama Administration to consider this important reform principle: Promote pharmacy and health information technology interoperability. In short, the promise of HIT will not be realized if electronic silos simply replace paper silos. Patient care will not be maximized, and financial resources will be wasted, if systems do not talk with each other, and do not provide the right information.

Getting healthcare reform right in this area means several things.

• First, pharmacists should have electronic access to patient health information such as diagnosis and laboratory values. This information must be shared among healthcare providers through an interoperable system. • Second, federal and state grants to healthcare providers should support the growth of an interoperable healthcare system. • Third, protect patient information, while assuring that these protections also allow information- flow among healthcare providers to enhance treatment decisions. Pharmacies and pharmacists are committed to protecting patient information – and to saving lives and improving lives. Their views on how to accomplish these objectives reasonably – and simultaneously – are worth serious consideration. Interoperable HIT is an important part of our principles because it relates directly to helping patients take the right medications, and take them correctly. We consistently emphasize that when people don’t take their prescriptions, they end up causing themselves and their families more trauma, and fall into more costly forms of care.

You have heard that failure to take medications as prescribed costs, by one estimate, $177 billion per year. At a recent NACDS conference, Doug Long of IMS Health presented some numbers that help us understand this problem. In what he called the “leaky bucket,” he described what happens to every 100 new prescriptions:

• Between 50 and 70 percent are actually relayed to a pharmacy. • Between 48 and 66 percent are picked up from a pharmacy by the patient. • Only 25 to 30 percent are taken properly. • And only 15 to 20 percent are refilled as prescribed. Pharmacists – with HIT as a tool – can do even more to help fix that leaky bucket.

So, the work of Congress to this point to advance HIT is appreciated. We encourage Congress and the Obama Administration to remain consistent with our recommendations for promoting pharmacy and HIT interoperability.

John Coster, Senior Vice President of Government Affairs, National Community Pharmacists Association

Thank you, Tom, Bruce and Steve

Before we open it up for questions, let me give you some insight into the steps we are taking with policymakers to try and bring these principles to life.

First, we have been meeting as a group with staff of key Members of Congress to let them know that pharmacy organizations are united on a single set of health care reform principles and to ask them to work with us to look for ways that pharmacists’ services can play a role in a reformed health care system. They seem to appreciate our combined efforts to present a common set of principles.

Today we are sending to each Congressional office a copy of the principles, and we will also be seeking meetings with key players in the Obama Administration that will be crafting and leading health reform initiatives.

We will also be providing legislation options to policymakers to enhance medication therapy management programs under Medicare, as well as incorporate pharmacist services into new health care delivery systems, such as the medical home model.

We believe we are at an important cross road in pharmacy and look forward to working with policymakers, patient groups, and other health professionals who believe in an expanded role for pharmacists in a reformed health care system.

Thank you.