The National Association of Chain Drug Stores has opened a new front in the battle to maximize the impact of pharmacy care on the well-being of patients and the efficient operation of the health care system. In an extensive set of comments sent to Department of Health and Human Services’ Office of Inspector General by NACDS president and CEO Steve Anderson, the association lays out a well-documented case for eliminating obstacles that exclude members of the pharmacy profession from some aspects of health care.
The issue at hand is a proposed rule that would update regulations related to the Anti-Kickback Statute, which bars entities from engaging in transactions designed to bring about referrals for products or services funded by federal health care programs. Providers that are deemed instrumental to the coordination of patient care are, however, defined as “value-based enterprise participants” and receive safe harbor protections under the law. OIG will decide if retail pharmacies meet that definition. The pending rule contends that pharmacies “primarily provide items” and, therefore, do not qualify as value-based enterprises.
The NACDS comments make a compelling case to the contrary. Replete with references to research and specific examples, the 23-page document highlights the very real contributions that retail pharmacy is currently making, as well as the benefits that would result from removing barriers to its tighter integration in the health care system.
“To comprehensively advance health care value for the American people, all entities across the continuum of care must be maximized, leveraged and fully utilized to their highest degree and potential to drive care coordination and patient outcomes,” the comments state. “NACDS urges OIG … to consider opportunities to take advantage of the unique positions, roles and value of all players to meaningfully drive HHS’ mission on quality and to improve care coordination. … Hence, instead of excluding community pharmacy, HHS should leverage community pharmacy embedded in neighborhoods across the nation and correspondingly the multiple patient touchpoints to drive outcomes and population health.”
NACDS supports its argument with hard facts, including the extent of the profession’s reach. The association’s retail members operate 40,000 pharmacies; in addition there are some 20,000 independent drug stores in the U.S. That means 90% of Americans live with five miles of one of them, making community pharmacy the most accessible part of the health care system.
“A study of high-risk Medicaid patients found that patients visited pharmacies 35 times per year, compared to seeing their primary care doctors only four times per year, and specialists nine times per year,” NACDS noted, citing third-party research.
“Further, because pharmacies are well integrated into the communities they serve, pharmacists are able to deliver essential clinical interventions to advance quality of care, with an understanding of the regional, social and economic challenges uniquely faced by that population. The important positioning of pharmacists embedded into communities lends well to moving the needle on HHS’ goals and objectives to advance health care value, and, in fact, national and federal agencies, such as the CDC [Centers for Disease Control and Prevention] and the U.S. Surgeon General, have encouraged and recognized the value of pharmacists in efforts to collaboratively improve quality and health care outcomes.”
The foregoing is just a sample of the methodical approach NACDS takes to building a convincing argument about the value that retail pharmacy brings to health care, and why regulators should remove, rather than erect, obstacles for the profession.
Subsequent sections of NACDS’ comments deal with such important topics as the emergence of community pharmacies as a health care destination for more than prescription drugs; their skill at optimizing medication use and, by so doing, limiting overall health care costs; and their ability to help compensate for the growing shortage of primary care physicians.
The input provided by the association to HHS is an impressive piece of work. It should go a long way toward persuading the OIG to categorize retail pharmacies as value-based enterprise participants.
Beyond that, the comments can serve as a valuable resource for industry advocates as they work to convince government regulators and payers that giving pharmacy a bigger role in health care will benefit everyone with a stake in the system.