ASHP InterSections ASHP InterSections

April 30, 2020

ASHP Continues to Support Members and the Healthcare Community Through the COVID-19 Pandemic

Dear Colleagues,

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

THE COVID-19 PANDEMIC is changing our country’s healthcare landscape every day. Critical health policy changes are occurring at an unprecedented rate. We continue to engage with state and federal policymakers to ensure that pharmacists’ expertise is fully utilized and that healthcare providers are equipped to safely and effectively respond to the pandemic.

Update on States’ Response Efforts

State governors are issuing executive orders that expand pharmacists’ ability to provide high-quality care to patients during this crisis. For example, Michigan now permits pharmacists within licensed health facilities to contribute to routine health maintenance and manage chronic disease states without physician supervision. This expansion alleviates burdens on primary care providers and expands access to care, especially in rural and underserved communities where pharmacists are the most accessible healthcare professionals.

We are also seeing a positive trend in pharmacists’ ability to manage therapeutic interchange. In Iowa and Kentucky, executive orders grant pharmacists the authority to substitute medications in response to drug shortages.

Point-of-care testing for COVID-19 is critical to the national pandemic response. Some states already permitted pharmacists, under their scope of practice or through collaborative practice agreements, to order and administer these tests. Pennsylvania, which previously allowed pharmacists to order and administer tests, has taken emergency measures to grant pharmacists explicit authority to order and administer COVID-19 tests. States like Florida, Illinois, Kentucky, and, most recently New York, issued executive orders that permit pharmacists to order and administer COVID-19 tests. State-level COVID-19 response is a rapidly changing situation as local healthcare providers respond to patient surges and the demand for testing. Please check with your state’s board of pharmacy for more information about the status of COVID-19 testing in your area. Helpful information on COVID-19 testing can also be found on the National Community Pharmacists Association’s website.

ASHP applauds state governors’ efforts to expand pharmacists’ scope of practice during this state of emergency. However, we are concerned that authorizing the expansion of pharmacists’ services without authorizing payment for those services will limit the delivery of care in some pharmacy practice settings. COVID-19 is already highlighting shortcomings in state Medicaid payment systems and commercial payer policies that prevent qualified pharmacists from fully serving patients. ASHP is working closely with our state affiliates and other organizations to request reimbursement for the new services they are providing under the state of emergency. This advocacy aligns with ASHP’s Pharmacy Readiness for Coronavirus Disease 2019 (COVID-19) Recommendations for State Policymakers. The recommendations address shortages of drugs and medical supplies and reimbursement of pharmacists for patient care services and also provide readiness and resilience resources for clinicians.

Pharmacists are Essential Healthcare Personnel

ASHP continues to voice our support for all pharmacists who are working tirelessly across the continuum of care in response to the COVID-19 pandemic. Yesterday, I sent a letter to the chief executive officer of Novo Nordisk responding to a full-page NovoCare ad that ran last weekend in the Wall Street Journal and other publications. Pharmacists were omitted from a list of individuals, including nurses, doctors, researchers, and other essential workers who were acknowledged for their caring efforts on the front lines of the COVID-19 response.

In the letter, I reinforced that pharmacists are highly skilled, licensed healthcare professionals who play a key role in selecting and optimizing medication therapy for patients. Pharmacists also oversee the entire medication-use process in hospitals and health systems, including the purchasing, distribution, preparation, and administration of pharmaceuticals. I further explained that, as members of interprofessional healthcare teams, pharmacists are providing a broad range of patient care services during the COVID-19 public health emergency, from directly caring for mechanically ventilated patients in critical care settings, to providing point-of-care testing and medication management to patients in community pharmacy settings and beyond.

It is my hope that Novo Nordisk will appropriately recognize pharmacists and the important role they play in future communications.

ASHP’s Response to Disruptions in Residency Training

In last week’s blog, I discussed the COVID-19 pandemic’s impact on residency training. As a result of disruptions in routine or elective procedures and reductions in inpatient hospital stays, some hospitals and health systems are facing the difficult situation of furloughing their PGY1 and PGY2 pharmacy residents. These actions can disrupt patient care and make residents ineligible for board certification and professional positions that require postgraduate pharmacy residency training. We believe that educating future generations of pharmacists is more critical than ever, and ASHP has issued a statement opposing the furlough of residents.

As always, ASHP is here to support residents and residency programs. If you need assistance with a furlough situation, please reach out to Janet Silvester, vice president of Accreditation Services, or Stephen Ford, director of Residency Accreditation Services.

ASHP is Here for You and the Entire Healthcare Community

Over the past several weeks, I have been sharing information about new and timely resources that ASHP has developed and made available to optimize medication use and patient outcomes during this public health emergency. The response to these offerings, which is captured in a new ASHP infographic, has been tremendous. We are immensely proud of our staff and volunteers who have been working tirelessly to deliver highly relevant information across multiple channels. Our COVID-19 Resource Center is updated regularly with new content and I hope you continue to find the tools and information produced by ASHP valuable as needs related to the pandemic response evolve.

Thank you for being a member of ASHP and for everything that you do for your patients and our profession.

Sincerely,

Paul

 

November 16, 2016

ASHP’s Role with the New Congress and Administration

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

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

AS ANOTHER ELECTION SEASON comes to a close and we look ahead to the new administration and the 115th Congress in 2017, ASHP is again positioning itself as a credible resource to policymakers on issues impacting the profession of pharmacy and public health. While elections create change among those in government, ASHP’s public policy priorities remain the same: advancing provider status legislation, protecting the 340B program, and working with both sides of the aisle and with the administration to address the growing problem of skyrocketing drug prices and their impact on our patients and the healthcare system.

Over the last few years ASHP has increased its presence in Washington by spearheading legislative efforts aimed at curbing drug shortages and ensuring safer compounding practices. These are issues that impact all Americans regardless of political affiliation, and ASHP input was instrumental in developing policy solutions.

The new landscape on Capitol Hill and at the White House is an opportunity for ASHP to forge new partnerships, educate new stakeholders, and highlight ASHP’s expertise in public health issues. Healthcare legislation will once again be back on the agenda, and issues related to Medicare and Medicaid are likely to be in play. As we look ahead to advancing provider status, 2017 may provide legislative vehicles that could include pharmacists as providers in the Medicare program.

ASHP remains committed to working with the new administration and the new Congress to address our public policy goals. Currently we are planning outreach efforts to the Trump transition team and will begin educating the freshman congressional class on how ASHP members improve the health and wellness of their patients by ensuring safe and effective medication use and advancing healthcare. Although change in Washington is inevitable, ASHP stands firm on its commitment to its members and the public at large.

We look forward to continuing to engage you and represent your professional interests in 2017 and beyond. Thanks so much for being a member of ASHP, and for everything you do for your patients.

Sincerely,
Paul

July 17, 2013

Novel Missouri MTM Program Benefits Patients, Pharmacists

DC Pro is a feature of the MO HealthNet Medicaid program.

DC Pro is a feature of the MO HealthNet Medicaid program.

A NEW FEATURE OF MISSOURI’S MEDICAID PROGRAM is drawing admiration from health care experts around the country for its ability to bring pharmacists and patients together.

The program in question—Direct Care Pro (DCPro)—provides pharmacists with a database of patients in their area who are eligible for medication therapy management (MTM) and other cognitive therapies.

Gloria Sachdev, Pharm.D., a clinical assistant professor, primary care, at Purdue University, West Lafayette, Ind., and director-at-large of ASHP’s Executive Committee for the Section of Ambulatory Care Practitioners, is one of the program’s admirers.

​“I would love Indiana to one day have the IT infrastructure in place to provide MTM like Missouri does,” she said, calling DCPro “an amazing example of how to operationalize MTM services in a streamlined manner.”

Gloria Sachdev, Pharm.D.

Gloria Sachdev, Pharm.D.

Pharmacists under the Missouri program receive direct reimbursement as health care providers, and a variety of conditions are covered, including asthma, chronic obstructive pulmonary disease, diabetes, gastroesophageal reflux disease, heart failure, hypertension, and hyperlipidemia.

“The number of covered conditions is constantly expanding,” according to Sandra Bollinger, Pharm.D., provider outreach coordinator with Xerox, which manages MO HealthNet. She added that only a handful of states allow pharmacists to bill directly to their Medicaid programs as health care providers.

Helping Patients During Care Transitions

The program is an excellent example of how pharmacists can help patients during transitions of care, according to Justine Coffey, JD, LLM, director of ASHP’s Section of Ambulatory Care Practitioners.

“It’s a great model because it ensures that patients receive the care they need once they leave the hospital and are back in the community setting,” Coffey said, noting that patients receive better care when pharmacists are involved in medication management decisions.

“This program provides both an opportunity for better patient care and new opportunities to advance ambulatory pharmacy practice.”

Opportunities for Intervention

Pharmacists who are registered with MO HealthNet can log into the DCPro system and view a list of all patients who are eligible for cognitive services. The information is based on gaps in Medicaid claims that would have been filed had the patient been keeping up with their care for a particular disease state.

Next, pharmacists select which patients they want to assist and then “reserve” an intervention (many patients are eligible for multiple interventions). They then contact patients and arrange face-to-face consultations. Interventions can take place in outpatient clinics, patients’ homes, or in areas of community pharmacies that are designated for patient care. Once reserved, an intervention must be completed within 30 days or the patient is released back into the database.

For example, consider an MO HealthNet patient who has diabetes, but has not had an A1C blood test for more than 90 days. The MO HealthNet system will detect that a claim for the test has not been filed.

Based on that care gap, the system automatically adds that patient’s name and flags the intervention for which the patient is overdue. A pharmacist seeing the information can provide the test as well as additional counseling.

During an intervention, DCPro guides the pharmacist through questions that must be answered before it allows users to move to the next topic. It also fills in progress notes and submits the billing automatically once an intervention is complete.

Reimbursement (which is based on the amount of time spent with the patient rather than the nature of the intervention) is calculated in 15-minute increments. Payment ranges from $10-$20 per 15-minute period with a one-hour maximum per intervention. There is no limit on the number of intervention hours a pharmacist can bill annually.

“Pharmacists who use the system don’t have to keep their own records regarding which patients are eligible. They can just log in to see a complete list of all eligible patients in their area,” said Dr. Bollinger. The system also handles all recordkeeping and billing.

Justin May, Pharm.D.

Justin May, Pharm.D.

Utilizing Program Results to Increase Pharmacist Reimbursement

Pharmacists at Red Cross Pharmacy’s 15 locations regularly check DCPro for any pending MTM and cognitive therapy claims, said Justin May, Pharm.D., director of pharmacy with the chain, based in Marshall, MO.

“Ideally, we use the system as part of our adherence program,” he explained. “A pharmacist takes a look at a patient’s medications five to seven days before the prescriptions are filled and identifies patients who require cognitive services. Then, they set up intervention times. When patients come in to pick up their prescriptions, we sit down with them to conduct the interventions for whatever health issues are indicated.”

Chuck Termini, B.S. Pharm., RPh, a hospital staff pharmacist and independent clinical pharmacist in Kansas City, MO, connects with many of his MO HealthNet patients through referrals from nursing homes and community pharmacies, who contract with him to provide cognitive services. But he also mines the database for additional interventions.

“I almost always find patients who need help,” Termini said, estimating that he interacts with about 60 MO HealthNet patients each month.

Although pharmacist enrollment in the system has been slow to catch on, Dr. Bollinger is optimistic that the numbers will grow as pharmacists learn of these new opportunities for patient intervention and care.

“My goal is to get every pharmacist in the state enrolled,” she said, adding that growing enrollment will help her make a case to state legislators to increase reimbursement rates. “It may take a little time, but I’m confident they will increase eventually.”

Dr. Bollinger also said that MO HealthNet has been able to demonstrate cost savings resulting from decreased emergency room visits and hospitalizations among patients who participated in the program.

“This is a huge opportunity for health-system pharmacists who can get past the idea that the business comes to them, because it doesn’t,” said Termini. “You have to be proactive in assisting patients.”

–By Steve Frandzel

           

December 1, 2008

ASHP, Member Efforts Secure Delay in Tamper-Resistant Requirement

What happens when a well-intentioned policy has an effective date that could result in patients going without needed medications? You get a groundswell of advocacy that causes Congress and the White House to take notice.

When the Centers for Medicare & Medicaid Services (CMS) announced a new tamper-resistant requirement for prescriptions for Medicaid beneficiaries, ASHP quickly realized that the timeframe for implementation was too short.

“As a fraud-prevention measure, this is a good rule,” said Joseph Hill, director of ASHP’s federal legislative activities. “But we immediately began to hear from members that there was no way that they could be ready to follow through by the rule’s deadline.”

The Society quickly swung into action, working with several other pharmacy organizations to urge CMS to delay the requirement’s implementation, seeking legislative relief by working with key legislators, and enlisting ASHP members to contact their Congressional representatives.

In the span of just one month, Congress passed legislation postponing the rule for six months. President Bush then signed it into law in late September.

“This issue really hit home for a number of our members, and I am thrilled that we were able to give them some breathing room to properly prepare for the new requirements,” said ASHP President Janet A. Silvester, MBA, FASHP .

Check out www.ashp.org/advocacy to see how the Society’s work on this issue evolved.

Powered by WordPress