Extreme partisan dysfunction is often taken for granted in Washington, DC. Thus, it is perhaps surprising that Democrats and Republicans appear to have found common ground on a prescription drug reform initiative that is gaining momentum in Congress with bipartisan support. As leaders on Capitol Hill and in the White House argue over how best to limit drug prices in order to slash the federal deficit and reduce out-of-pocket spending by Medicare beneficiaries, ACCP believes there is also an opportunity to advance a comprehensive medication management (CMM) benefit.

Take Action!

With prescription drug price reform a top priority on Capitol Hill, it is vital that elected officials hear from you as clinical pharmacists delivering direct patient care services in their state or district to learn firsthand about the value you bring to the medication optimization process.

Contacting the offices of your elected officials is simple. We have prepared a letter for you to review and edit. Simply follow the instructions to send this message to Capitol Hill. Please take the time to personalize the letter by providing additional information about your practice and the patients you care for. If appropriate, highlight what the COVID pandemic has meant for your practice and your patients. Click here to take action today!

Background to Medicare Prescription Drug Coverage

Historically, Medicare prescription drug reform has been an issue on which ideologically opposing sides had difficulty reaching a consensus. In 2020, for example, President Donald Trump alarmed many of his allies in the business community by announcing an initiative to reduce the price of medications for American consumers that was widely criticized by pharmaceutical manufacturers.

Back in 2003, with the George W. Bush administration focused on the aftermath of the attacks of 9/11, the Medicare Modernization Act (MMA) passed Congress by a razor-thin margin and resulted in the largest Medicare overhaul in the program’s 38-year history. To steer this landmark legislation through a bitterly divided Congress, the final law included a provision that expressly prohibited Medicare from negotiating bulk prescription drug prices and required that only the private insurance entities administering the Medicare prescription drug program – not the federal government – have the legal right to negotiate drug prices directly from drug manufacturers.

The Bush administration touted that Part D private health plans would compete for seniors’ business and help control the costs of Medicare by using marketplace competition, not government price setting. The result was the rapid expansion of prescription drug plans (PDPs) that had been established to administer the newly created drug benefit. With almost 40 million Medicare beneficiaries in private PDPs and an increasing share also integrated within Medicare Advantage programs, this private-market approach to Medicare expansion is considered highly successful. Of importance, the 2003 MMA also included the requirement that participating PDPs establish medication therapy management (MTM) programs that:

• Ensure optimum therapeutic outcomes for targeted beneficiaries through improved medication use
• Reduce the risk of adverse events
• Are developed in cooperation with licensed and practicing pharmacists and physicians

In comments related to the Part D final rule, CMS stated its belief that the MTM program would be a “cornerstone of the Medicare prescription drug benefit.” MTM was intended to be to be a “patient-centric and comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.” However, CMS has acknowledged that it has not been possible to fully demonstrate the value and success of the Part D MTM program.

Medicare Prescription Drug Act

Fast forward to 2022, and the Medicare prescription drug program is subject to intense political speculation. Legislation in Congress would fundamentally alter the domestic pharmaceutical market by establishing a federal Drug Price Negotiation Program. Under the proposal, Medicare could start the new pricing procedures next year, with the secretary of Health & Human Services identifying up to 10 drugs subject to bargaining. The resulting prices would go into effect in 2026. As many as 10 additional drugs would follow by 2029.

The highly partisan Democratic Congressional Campaign Committee released a pre-recess memo warning that a Republican majority would “protect Big Pharma profits over people’s lives.” In response, House Republican leaders distributed communications kits warning that “Democrat Socialist drug takeover could lead to 135 fewer drugs and cures.” Rep. Brad Wenstrup (R-OH), a physician, said the Democrats’ bill would “limit production” and be a “crushing blow to research and development in the pharmaceutical industry.”

Advancing Coverage for Team-Based Services That Optimize Medication Use

Notwithstanding concerns regarding prescription drug pricing, the cost of suboptimal medication therapy should command even more attention from lawmakers. The impact of our health care enterprise’s inability to achieve medication optimization for the patients we serve is profound – a lower cost drug used sub-optimally or inappropriately not only fails to benefit the patient but can result in negative health outcomes and increased health care expenditures.  ACCP is fully committed to advancing Medicare coverage for team-based clinical pharmacists delivering services that help optimize medications on behalf of patients. In recognition of the growing momentum around prescription drug reform on Capitol Hill, in March 2022, ACCP submitted comments to the Senate Finance Committee urging Congress to advance a patient-centered, team-based, and evidence-driven approach to medication management that would better ensure that the rational and economical use of specialty drugs is optimized for both patients and the health care system. ACCP called on Congress to enact coverage for CMM services that would guarantee access to interprofessional, patient-centered care and better ensure optimized, economical specialty drug use.

ACCP also urged Congress to pursue specialty drug pricing models that would ensure patients and health systems receive commensurate value from the appropriate use of specialty drugs, employ rational and transparent pricing practices, and enable pharmaceutical manufacturers to sufficiently recoup research and development investments. Value-based pricing models might include indication-specific pricing, bundled payments, and explicit investigations of cost, value, comparative effectiveness, and safety of specialty drugs.

Click here to view read ACCP’s comments, and don’t forget to write to your elected officials on Capitol Hill!