ASHP InterSections ASHP InterSections

February 27, 2017

ASHP Continues Working on Solutions to Rising Drug Prices

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

RISING DRUG PRICES have affected virtually every segment of healthcare. From consumers to hospitals to third-party payers, all have been forced to make difficult decisions regarding healthcare choices. Patients and ASHP members’ organizations are feeling the impact of escalating drug prices, as is the entire healthcare system. ASHP is well aware of this alarming trend and is diligently working with a wide array of stakeholders and bipartisan policymakers to explore practical and sustainable solutions.

This problem is about public health and the downstream effects that high drug costs have on the health of patients and the ability of our healthcare institutions to care for them. For example, we know that when patients face higher costs they are more likely to not fill their prescriptions and may even ration their medications. Nonadherence often leads to more expensive therapies or hospital stays due to complications resulting from untreated or undertreated conditions. Payers have also had to make difficult choices in the face of spiraling drug costs, including challenging formulary decisions. Hospitals and health systems may be forced to make difficult decisions to offset rapidly rising drug costs.

Even generic drugs widely used to manage the cost burden on individual patients and our hospitals and clinics are now experiencing dramatic price increases. Instead of a robust marketplace flush with competition that drives prices lower, sometimes there appears to be little or no competition, resulting in a single company producing a generic product. Without competition, manufacturers can raise their prices as high as the market will bear. In 2016, a study commissioned by the American Hospital Association and the Federation of American Hospitals noted that drug spending increased 8.5% in 2015, while inflation increased only 0.7%. This trend cannot be sustained. The study provided an example of one hospital where “the price increases for just four common drugs, which ranged between 479 and 1,261 percent, cost the same amount as the salaries of 55 full-time nurses.” Unfortunately, while this may be an extreme example, the typical drug price increases in a hospital or health system place a heavy burden on the healthcare team and its organization to ensure their patients have access to medication therapies.

In 2016, ASHP joined the Steering Committee of the Campaign for Sustainable Rx Pricing (CSRxP), a coalition consisting of physicians, consumers, payers, hospitals, health systems, and patient advocacy groups. We believe that CSRxP, as a coalition of nationally prominent organizations, has the best chance of effecting change at the national level regarding drug price increases. With ASHP’s input, CSRxP developed a policy platform that seeks to address this problem through market-based solutions, focusing particularly on competition, value, and transparency. ASHP and other members of the Steering Committee have begun conducting joint meetings with congressional staff to discuss bipartisan policy solutions. CSRxP has also been implementing an ongoing media strategy to call attention to drug pricing and place this issue on the national agenda.

Efforts to address the problem through legislation are already underway. For example, S. 297 and H.R. 749 would require the Food and Drug Administration (FDA) to expedite approval of an Abbreviated New Drug Application (ANDA) when a drug is in short supply or little or no competition exists. Another bill, S. 124, would prohibit brand companies from paying generic manufacturers to delay introduction of a generic version, otherwise known as “pay for delay.” ASHP believes these are steps in the right direction, but more can and should be done to promote competition and limit marketplace manipulation through pay-for-delay or restricted distribution.

Also under consideration in Congress is legislation (S. 92, S. 183) that would allow drugs to be imported from other countries, such as Canada, where prices are significantly lower. This approach, however, is not one that ASHP supports, due to safety concerns over the origin of the drug and the disconnect of the pharmacist-patient relationship. Another policy option would be to allow the government to negotiate drug prices directly with manufacturers for drugs covered by Medicare Part D. However, this legislation (S. 348, H.R. 242, S. 41) does not have bipartisan support.

Finally, the Prescription Drug User Fee Act (PDUFA) is up for reauthorization this year and may serve as a legislative vehicle to address this problem. This reauthorization is considered must-pass legislation, and we have already begun discussions with key congressional staff about the policy goals of CSRxP and their potential fit within PDUFA.

ASHP remains an active leader in CSRxP and will continue pushing for solutions to the problem of rising prescription drug prices. As the only national pharmacy organization on the Steering Committee, we will continue to work collaboratively with our partners to provide the perspective of our members and to help ensure that affordable medications are accessible to those who need them.

Thank you for all that you do on behalf of your patients and for being members of ASHP.

Paul

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February 23, 2017

Career and Family: Mary Ann Kliethermes Proves You Can Have It All

ASHP President Lisa M. Gersema, Pharm.D., presents Kliethermes with the ASHP Distinguished Leadership Award at the 2016 Midyear Clinical Meeting in Las Vegas.

“YOU CAN BE SUCCESSFUL and be a mom.” This is the heart of Dr. Mary Ann Kliethermes’ message to female pharmacists concerned about balancing a career and a family. She should know. The mother of four recently received ASHP’s Award for Distinguished Leadership, recognizing her dedication and work in expanding patient care roles for pharmacists in current and emerging healthcare models.

For Dr. Kliethermes, however, success isn’t about winning awards. “Awards are very nice, and I truly appreciate them,” she said, “but for me, it is about connecting with people.” Whether those people are patients, other pharmacists, or physicians, Dr. Kliethermes’ connections with them result in better care, better communication, and better outcomes.

Mentoring with a Mother’s Touch

Dr. Kliethermes, Pharm.D., is the Vice Chair of Ambulatory Care and a Professor at the Chicago College of Pharmacy. Mentoring young faculty is her favorite part of her job. “I love mentoring!” she said in a recent interview. “Other than the dean and myself, [the faculty] is fairly young, so they are just starting to have kids and deal with the balancing act that comes with it.”

Mary Ann Kliethermes

Dr. Kliethermes’ passion for mentorship began in the late 1970s and early 1980s during pharmacy school. Many of her mentors were physicians, and one in particular left a lasting impression. “He was kind to patients, incredibly smart … patients came from around the world to see him … and he took an interest in me along with everyone else, not just the medical students,” recalled Dr. Kliethermes. “He wouldn’t leave a patient’s room on rounds until I heard the heart sounds, too.”

Dr. Kliethermes believes that motherhood has enabled her to be a better mentor. “When you’re mentoring young people, it’s like what you did with your kids to make them successful. Caring, and dealing with the challenges of growth — just like with children. It’s my natural approach,” she said.

Part-Time Success

Dr. Kliethermes credits working part time as an important step in balancing career and family. Sixteen months after having her first child, she gave birth to a set of twins who arrived two months premature. Life with three children under the age of 2 was complicated. “There were no daycare options,” Kliethermes explained. “Just getting them all in the car was a challenge. We couldn’t afford a nanny. I realized I needed to go part time.”

When she proposed reducing her work hours to the Director of Pharmacy at the hospital where she worked, he said he had never heard of a part-time Pharm.D. “He told me that if I wanted to come back part time after maternity leave, I could staff,” she said. But Dr. Kliethermes wanted to do clinical work. “I was the only clinical pharmacist at that hospital,” she explained. “I was doing a lot of work with the nutritional support team and with medical residents.”

Luckily, the physician in charge of nutritional support also had twins and convinced the Medical Education Department to hire her part time. After that, and while she was still on maternity leave, the Pharmacy Department relented and agreed to let her work fewer hours.

The Kliethermes family: Mary Ann, daughter Stephanie, son Chris, husband Mark, son Cody, and son Mark Jr.

In total, Dr. Kliethermes worked a pared down schedule for 23 years. Eight years after having her twins, she had her fourth child. She continued working as a clinical coordinator at the hospital while her children were in grade school — training residents about dosing, helping nurses, assisting in the ICU, and even taking calls at home when necessary. Eventually, Dr. Kliethermes and her husband, who is also a pharmacist, became co-owners of two home-infusion companies. She worked part time for the infusion companies until they were sold.

When her three older children were in high school, Dr. Kliethermes began working with the University of Illinois College of Pharmacy’s “Refill Ten” program, for patients with 10 or more prescriptions. She worked from 9 a.m. to 2 p.m., building the program from 21 patients to about 150. “Basically what I did was medication therapy management,” she said. Her proudest moment came when a particularly curmudgeonly physician told her, “I’ve been taking care of this patient for five years, and I’ve never seen her blood pressure so well controlled. The program must be working.”

Advice for Pharmacist Moms

Dr. Kliethermes draws on her motherhood experience to help her be a better pharmacist. “My way of dealing with patients is very maternal. It’s like dealing with kids. How do I get them to do what they are supposed to do? [Counseling patients] blends with motherhood,” she said.

Kliethermes and her pharmacy practice colleagues at Midwestern University, Donna Cutro, Kathleen M. Vest, Pharm.D., Christie Schumacher, Pharm.D., and Jennifer Mazan, Pharm.D., wear pink to support breast cancer research.

Dr. Kliethermes tells women she mentors the same thing she tells her children. “Do what interests you. Follow your heart, follow your passion,” she said. “I never set my sights on advancement. I did the things that I was passionate about. I don’t know that I did anything in particular to be a leader, but I was always willing to do whatever needed to be done.”

Dr. Kliethermes encourages female pharmacists to “fight to practice at the level that you want to.” She noted that often it was physicians who helped her to do that, rather than fellow pharmacists. “Don’t accept ‘we’ve always done it that way.’ Fight for what you need,” she added.
Dr. Kliethermes believes that working part time can help mothers balance career and family life. “You don’t want to miss your children’s childhood,” she said. “Don’t miss events. Be there at games. Coach them. Be there for concerts when they can’t play the tuba very well. Be the driver — some of the best conversations with your children take place in the car.”

Dr. Kliethermes could not be prouder of her own four children and the paths they have chosen. They have all become “successful, independent, happy, well-adjusted people,” she said. “None went into pharmacy — they all chose what they should be.”

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By: Ann W. Latner, JD

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