On June 12, 2023, Senator Mike Crapo (R-ID) and Representative Cathy McMorris Rodgers (R-WA) issued a bicameral Request for Information (RFI) seeking input on policy solutions to the increase in drug shortages. The RFI followed a U.S. Senate Committee on Homeland Security report that showed a 30% increase nationwide in drug shortages between 2021 and 2022.

The bicameral RFI cited a May 2023 study from the Office of the Assistant Secretary for Planning and Evaluation indicating that drug shortages not only force those living with even the most serious medical conditions to seek out alternatives or experience debilitating lapses in care, but also trigger a variety of direct and indirect detrimental costs for both patients and frontline health care providers.

The RFI requested input on two areas of particular interest to ACCP:

• How can federal agencies, such as the Centers for Medicare & Medicaid Services (CMS), better address the economic forces driving the shortages? Are these agencies using their current authorities effectively?
• Are there any guardrails that Congress should consider related to demonstration projects, including through the CMS Innovation Center, that would help protect against drug shortages? Are there any proactive demonstrations that would prevent drug shortages?

ACCP Member Engagement
Like all of its initiatives, ACCP’s work in Washington, DC, is driven by its members. ACCP leaders have been integral in supporting the Government and Professional Affairs team in its efforts to secure key meetings with leaders on Capitol Hill. Because of the lobbying efforts of Rex W. Force, Pharm.D., FCCP, BCPS, at Idaho State University, ACCP staff secured a meeting with senior policy advisers to Senator Crapo, who serves as the ranking member on the powerful Senate Finance Committee with jurisdiction over Medicare. Thanks also to the following ACCP members who have been instrumental in helping ACCP secure meetings on Capitol Hill with leading Senate offices:

• Jerry L. Bauman, Pharm.D., FCCP, FACC, Journal of the American College of Clinical Pharmacy
• Marie A. Chisholm-Burns, Pharm.D., Ph.D., MPH, MBA, FCCP, FASHP, FAST, FACHE, Oregon Health & Science University
• Vicki Ellingrod, Pharm.D., FCCP, FACNP, University of Michigan College of Pharmacy
• Linda Gore Martin, Pharm.D., MBA, FASHP, BCPS, University of Wyoming
• Suzanne Amato Nesbit, Pharm.D., FCCP, FASHP, The Johns Hopkins Hospital
• Glen T. Schumock, Pharm.D., MBA, Ph.D., UIC College of Pharmacy

ACCP Drug Shortages Response
ACCP used this occcasion to urge Congress and CMS to consider opportunities to integrate coordinated, team-based comprehensive medication management (CMM) provided by clinical pharmacists into Medicare coverage and payment models. Problems related to medication misuse generally fall under three major categories: overuse of medications that don’t improve health and may cause harm, underuse of critical drugs needed for acute or chronic health problems, and misuse of medications such as opioids.

All three are contributing to the growing issue of drug shortages as well as driving higher costs and adversely affecting patient health. According to the Get the Medications Right (GTMRx) Institute, “to prevent overuse of medications, health care providers shouldn’t start or continue medications without a comprehensive evaluation of the patient’s health issues and medications.”

ACCP highlighted the fact that many of the Medicare Merit-Based Incentive Payment System performance measures established under the Medicare Access and CHIP Reauthorization Act already directly pertain to medication use. The Comprehensive Primary Care Plus (CPC+) Program Year 2 Care Delivery Requirements administered by the Medicare Innovation Center (CMMI) included access to CMM services for patients discharged from the hospital and those receiving longitudinal care management that would involve the development of an individualized action plan addressing a patient’s medication problem list and a review of the plan with the primary care team.

Clinical pharmacists are also included as integrated team members in CMMI’s Making Care Primary (MCP) Model – a 10½-year CMMI multi-payer model with three participation tracks that build on previous primary care models, such as the CPC, CPC+, and Primary Care First models as well as the Maryland Primary Care Program.

ACCP also highlighted the growing importance of pharmacogenomics (PGx) and precision medicine to ensure safe and effective therapy for each patient. When integrated into CMM, PGx testing allows for targeted treatment decisions on the basis of the characteristics of each patient’s unique genetic profile. Integration of PGx within CMM reduces costs, improves outcomes and access to care, and enhances patient and provider quality of life and satisfaction. To ensure medication optimization, ACCP calls for PGx to be integrated into CMM coverage. Click here to read ACCP’s response in full.