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Health care reform still has long way to go

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So far community pharmacy has come out reasonably well in the battle over the reform of the nation’s health care system.

The landmark $940 billion legislation that was passed by the House on a narrow, partisan vote and signed into law by President Obama last month includes several favorable provisions for the profession.

The measure gradually eliminates the notorious “doughnut hole” in Medicare Part D coverage; makes changes in the definition and method of calculating average manufacturer prices, a critical component in determining pharmacy reimbursements under Medicaid, and ensures that federal upper limits for the program will be set using a multiplier of 175% or higher; grants a conditional exemption for pharmacies from new durable medical equipment accreditation regulations; and puts in place pilot programs to foster greater use of medication therapy management.

Those points closely coincide with the agenda established by the National Association of Chain Drug Stores and its allies.

After more than a year of intense debate about health care reform, pharmacy advocates might be tempted to declare victory and let down their guard. That would be a mistake. The contest hasn’t ended; in many important respects, it’s just begun.

At presstime the Senate was debating a package of revisions to the reform bill that House leaders crafted to ensure passage of the original legislation. While Democrats in the Senate vowed to pass the measure without amendment, the best-laid plans often go awry.

United in their opposition to the reform package, Republicans have started a movement to repeal and replace the new law. And the attorneys general of 14 states have initiated legal challenges to it.

Assuming that all those hurdles are overcome, there’s still the regulatory process, where, as NACDS president and chief executive officer Steve Anderson likes to say, the rubber really meets the road. How officials in the executive branch interpret and implement the reform act could have as much to do with its ultimate impact on retail pharmacy as the legislative process.

Beyond those concerns, the gap between the vision and reality of health care reform will almost certainly create the need for further action. At the beginning of the process, proponents of reform had two broad goals — expand access to all Americans and contain costs. The law goes a long way toward achieving the first objective, but leaves much to be desired in relation to the second.

By the time all of the legislation’s provisions are in effect in 2014, 32 million people who now lack health insurance should be covered. Among other things, that will greatly expand the number of patients who can afford to have prescriptions filled.

On the other hand, the failure to make a serious attempt to control surging health care expenditures, which already account for 17% of GDP and continue to rise faster than inflation, will spark new conflicts over insurance rates, government funding and allocation of economic resources. (President Obama and Democratic congressional leaders say reform will actually reduce the federal budget deficit by $143 billion over 10 years, but that projection, which the Republicans contest, is based on the assumption that Congress will sustain future cuts in Medicare funding.)

Those dynamics, together with demographic trends, will keep health care at the center of the national debate for years to come. To maintain the gains it has made and win a bigger role in the health care system, retail pharmacy must sustain, if not elevate, the level of involvement it has displayed as the process has unfolded over the past year.


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