NEW YORK — As health care reform gets deeper into the implementation phase, pharmacy advocates have mixed feelings about how the new dynamics will impact community pharmacies and the companies that supply them.

More of the provisions of last year’s health care reform bill are slated to go into effect this year, while other parts of the law remain up in the air after newly elected lawmakers promised to scrutinize the legislation and rework parts of the reforms that they felt were inadequate.

In the meantime, as the health reform effort unfolds, millions more patients across the country are expected to have access to affordable prescription drugs, and community pharmacist are likely to continue to expand their role by becoming more involved in managing patients’ health — a scenario that many in the industry see as promoting improved health outcomes and reduced expenditures for care.

Chain Drug Review asked leaders from 14 industry organizations what they see on tap for 2011. Here are excerpts of their comments on a range of topics:

MEDICATION THERAPY MANAGEMENT (MTM) & ADHERENCE

"NACDS has utilized medication adherence to position pharmacists as problem solvers and as an integral part of the health care solution. MTM continues to show great promise in improving patient health as well as in reducing overall health care costs — a win-win for patients and government officials. … Pharmacy must continue to weigh in with its unique position in health care delivery. Pharmacy is uniquely positioned to be part of the solution: improving health and reducing costs by providing affordable and accessible care to patients." — Steve Anderson, president and chief executive officer, National Association of Chain Drug Stores (NACDS)

"Demand for MTM is on the verge of exploding. The pioneers have established the parameters of a new way for pharmacists to practice. The early adopters among us have attracted the attention of policy makers, payers and the media. Many (but not yet enough!) are convinced that when pharmacists get involved, quality goes up and costs go down. … For this new way of practicing to work, we as pharmacists have to put ourselves in places where we are available to patients for more in-depth consultations and extended interactions. Thirty seconds at the point of dispensing will not do. MTM will mean reorganizing the work flow in pharmacies around tasks that can be completed by certified pharmacy technicians, assisted by automated dispensing machines." — Tom Menighan, executive vice president and CEO, American Pharmacists Association (APhA)

FLEXIBLE SPENDING ACCOUNTS (FSAs)

"At a time when consumers are taking on greater control of their personal health care, over-the-counter medicines and dietary supplements play an even more important role in the nation’s health care system. Millions of Americans rely on these products every day to feel well, get well and stay well. And they do so for good reason. These products offer consistently convenient and affordable options in the face of increasing health care costs and barriers to accessing health care providers. … That is one of the many reasons why CHPA is working to reverse the provision in the health care reform law that would prohibit the use of flexible spending accounts to purchase OTCs without a prescription. The availability of OTC medicines through an employer-sponsored FSA provides valuable cost savings to 35 million consumers, increases worker productivity, helps prevent unnecessary doctor visits, and encourages smart health decisions by both employers and employees." — Scott Melville, president and CEO, Consumer Healthcare Products Association (CHPA)

"Requiring a prescription for the purchase of an OTC medicine injects extra costs into the health care system and disadvantages customers who have come to rely upon FSAs for the purchase of OTC medicines for the prevention, treatment and symptomatic relief of minor ailments. During the 112th Congress, FMI will support repeal of these provisions of the Patient Protection and Affordable Care Act." — Leslie Sarasin, president and CEO, Food Marketing Institute (FMI)

TECHNOLOGY

"For years, the ability of pharmacies to electronically communicate and collaborate with physicians and hospitals has been restricted by the lack of real-time connectivity and electronic health records (EHRs) interoperability as well as low adoption of EHRs, e-prescribing and standards by health care providers and vendors of clinical information systems. Starting this year, however, pharmacy efficiency, communication and collaboration with other key health care stakeholders will take a major leap forward because of the $19 billion that the government will spend over the next four years to promote ‘meaningful use’ of certified EHRs. The money will bring health care interoperability closer to reality, enabling pharmacies and clinicians to exchange information." — Lee Ann Stember, president, National Council for Prescription Drug Programs (NCPDP)

STEVE ANDERSON, NACDS CEO: "Pharmacy is uniquely positioned to be part of the solution: improving health and reducing costs."

HEALTH CARE REFORM

"Certainly, the health care reform law — like all laws — has its flaws. We are particularly concerned by the provision that would create an Independent Payment Advisory Board (IPAB), or as I like to call it, a ‘Medicare Cutting Board.’ This board will have unprecedented authority to restrict seniors’ access to certain health care services or treatments. … Another implementation matter that we’re keeping a close eye on is how individual states constitute and propose to manage the state-based insurance exchanges called for under the health care reform law. We believe that state-based exchanges must maximize consumer choice and improve access to health care services and needed medicines. " — John Castellani, president and CEO, Pharmaceutical Research and Manufacturers of America (PhRMA)

"Among its many provisions, the [health care reform] legislation created a new nonprofit entity called the Patient-Centered Outcomes Research Institute, or PCORI. PCORI will support and coordinate research to generate scientific evidence comparing the effectiveness of medical treatments and strategies to achieve the best clinical outcomes for patients. … Why should pharmacists and patients care about comparative effectiveness research and the activities of this new institute? … Patients and their caregivers need reliable and trusted guidance in determining the best available treatment options. And it’s important to ensure that the research is high-quality and the findings are interpreted and translated in a way that end users can easily understand how to use those results." — Dan Leonard, president, National Pharmaceutical Council (NPC)

DRUG SAFETY

"While the U.S. drug supply remains among the safest in the world, it is being challenged by 21st century realities. The now truly global nature of the pharmaceutical industry, in which a majority of active pharmaceutical ingredients contained in finished products are produced overseas (mainly in China and India), opens up the system to the vulnerabilities inherent in long and complicated supply chains that may also be far afield from American regulators. … Smart and active management by the FDA, as well as adequate funding, is absolutely critical in this environment." — Roger Williams, executive VP and CEO, U.S. Pharmacopeia (USP)

PHARMACY REIMBURSEMENT

"During the past year, HDMA has expanded its focus on traditional pharmaceuticals to the specialty field to continue to adapt to changes in the health care delivery system. The specialty expansion also has included a heightened awareness of the importance of adequate reimbursement methodologies and the impact of federal and state programs on our customers, particularly pharmacies and physicians. Health care distribution customers face a variety of reimbursement rates and methodologies for prescription drugs under Medicare and Medicaid, some of which are currently undergoing change as a result of the recent health care reform initiative. HDMA firmly believes that the reimbursement our customers receive must be fairly and accurately determined to ensure that health care providers are able to continue providing lifesaving and life-improving medications to patients in their communities." — John Gray, president and CEO, Healthcare Distribution Management Association (HDMA)

EXPANDED SCOPE OF PHARMACY

"The continued proliferation of niche services offered by independents is part of what is attracting patients in search of more personalized care. These services include diabetes education and training programs; disease state management programs for smoking cessation, weight management, asthma management and HIV/AIDS; immunizations; durable medical equipment, including diabetes testing supplies; compounded drugs such as hormone replacement therapy; and home delivery, which often is free. … We must capitalize on every opportunity to ensure that the care independent community pharmacies provide continues to be the cornerstone of patient-focused health care." — Kathleen Jaeger, executive VP and CEO, National Community Pharmacists Association (NCPA)

"Community pharmacy is poised to show public and private payers — and the patients they serve — the value of their interventions on health care outcomes and cost-effective use of system funding. Doing so will require focused efforts to ensure timely completion of regulatory amendments to expand pharmacists’ scope of practice; training programs and change management strategies for providers; allied health care providers such as nurses and physicians; and technology enablers to promote collaboration among health care professionals." — Nadine Saby, president and CEO, Canadian Association of Chain Drug Stores (CACDS)

REGULATION

"The approaching age of biogeneric and biosimilar medicines in the United States presents magnificent growth opportunities for the generic pharmaceutical industry. And because of the established link between growth in generic use and increased health care savings, the advent of these more affordable versions of some of the world’s most promising — yet expensive — medical treatments brings the expectation of new savings for American patients. … For that reason, it is incumbent on the FDA to create an approval system that will set in motion a vibrant and robust generic biologics industry." — Robert Billings, vice president of policy, Generic Pharmaceutical Association (GPhA)

"The implementation of the new health care reform law by the Department of Health and Human Services (HHS), FDA and other agencies will have a large impact on whether incentives for innovation are enhanced or harmed. … The law authorized the creation of a pathway for the approval of biosimilars (also called follow-on biologics) by the FDA. Implementation must align with the intent of the original law by protecting patient safety and balancing the need to increase access with the imperative to promote continued innovation. " — James Greenwood, president and CEO, Biotechnology Industry Organization (BIO)

"Almost every health care provider in the marketplace today is measured on quality, with the exception of pharmacy. Hospitals, nursing homes, home health care agencies, physicians … and the list is growing. Pharmacy should recognize that quality measurement and quality improvement activities will be a marketplace reality in the very near future." — Laura Cranston, executive director, and David Nau, director of research and performance measurement, Pharmacy Quality Alliance (PQA)

*Editor’s Note: To read the full 2011 Pharmacy Outlook and more executive comments, please see the January 3, 2011, print issue of Chain Drug Review.

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