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Carey Potter, GA Consultant

CPNP and its members, who perform highly skilled clinical pharmacy services and practice under collaborative agreements, continue to work on recognition as healthcare providers and for payment for their services. Thanks to the Affordable Care Act, payment reform is now the goal of both pharmacy organizations and Congress. The familiar fee for service models will never be completely erased. However, more streamlined, team-based care with measurable outcomes, and identifiable standards of care that involve patients directly, will become the new age of patient care and the guidelines for payers. 

In 2013, CPNP joined forces with ACCP to pursue a new benefit, under Medicare Part B. Future legislation would recognize comprehensive medication management (CMM) and under collaborative practice agreements, qualified clinical pharmacists who are willing to practice at the top of their license, would receive reimbursement as a member of the healthcare team. Throughout 2014, CPNP consulted with ACCP and the government affairs consultant in Washington, D.C., contributed to lobbying strategies, white papers and issue briefs, and provided educational outreach. Nearly forty visits to members of Congress ensued throughout the year and CPNP and ACCP co-authored several letters to members of Congress explaining the need for a more comprehensive approach to patient care and/or a more defined process for Medication Therapy Management. The goal of our initiative is not simply to identify pharmacists as providers or to seek payment for undefined MTM services, but to get Medicare to recognize the unique abilities and contributions by pharmacists to healthcare teams as a reimbursable benefit, while improving patient care.

Based on our coalition goals of a comprehensive, team-based approach, leaders within the Senate Finance Committee delegated staff to begin drafting future legislation. As a result of ongoing discussions, the CPNP Government Affairs Council (GAC) discussed two separate drafts and worked with the coalition to provide comments and pursue further revisions. While no formal legislation was introduced on our behalf by the end of 2014, a legislative draft resembling much of the coalition’s recommendations remains with Committee leadership awaiting the 2015 Congressional session. Positive and affirming comments from Congressional staff indicate to CPNP and the coalition that the focus on comprehensive, team-based care and identifiable practices will become a part of the standards for payment reform.

The coalition will continue meetings and communications with Senate and House leadership as Congress gears up for 2015 business. As majority leaders shift and committee leadership transfers, we continue outreach and education about the need for a recognized benefit under Medicare, and the need for qualified pharmacists to be compensated as a part of a comprehensive team. The group also continues developing a relationship with primary care physicians and the American Academy of Family Physicians with a request for a meeting with the President of AAFP extended.

At the state level, CPNP reached out to several possible future allies, including payers, physicians, special interest groups, state Medicaid and Medicare officials, and pharmaceutical companies who are all interested in CMM and pursuing the issue at the state level. In 2015, CPNP anticipates reviewing and commenting on a second CMM legislative proposal being promoted on Capitol Hill and we will continue working to foster coalition efforts and build support.

CPNP also worked throughout the year with the Pharmacy Stakeholder’s group on various issues and discussed and monitored HR 4190, introduced by the Patient’s Access to Pharmacist’s CCoalition (PAPCC), proposing to give pharmacists provider status. HR 4190 received more than one hundred co-sponsors for the provider status effort, but supporters failed to secure a companion bill in the Senate or a committee hearing. Recall that membership in the PAPPC and the ACCP coalition was not possible. The PAPCC is expected to revive efforts and to seek a Senate companion bill in 2015. It is likely that, as the CPNP coalition effort takes form in legislation, that the two will be amended and negotiated into one single piece of legislation. The content and whether CPNP members can support the effort remains to be seen.

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