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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

 

April 9, 2020

Important Wins on the Advocacy Front in the Fight Against COVID-19

Dear Colleagues,

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

AS THE IMPACT OF THE COVID-19 PANDEMIC CONTINUES TO ESCALATE ACROSS THE COUNTRY, there is increased urgency to ensure that frontline pharmacists, pharmacy technicians, and our healthcare partners have the medications and equipment they need to successfully treat their patients. ASHP continues to spearhead multiple advocacy efforts that support your ability to provide the best care possible for those in need.

Mitigating shortages of critical medications like propofol, fentanyl, midazolam, paralytics, and others remains a high priority. We continue to engage with relevant federal agencies to improve access to medications. I am pleased to report that the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) have taken critical actions in direct response to ASHP’s advocacy efforts.

ASHP, in coordination with the American Medical Association, the American Hospital Association, the Association for Clinical Oncology, and the American Society of Anesthesiologists, sent a letter last week to the DEA requesting an immediate increase in the annual production quota allocations for Schedule II controlled substances. This would enable manufacturers and 503B outsourcing facilities to increase the supply of opioids critical to the care of COVID-19 patients on ventilators. As a direct result of this collaborative advocacy effort, the DEA announced yesterday that it is taking immediate actions to address this critical issue. These actions include increasing the annual production quota for controlled substances, including fentanyl, morphine, and hydromorphone, that are used for the treatment of mechanically ventilated COVID-19 patients, and increasing the amount of ketamine, diazepam, and other controlled substances that can be imported into the United States.

We also sent a letter to the FDA advocating for regulatory flexibility in compounding drugs in shortage and compounding in hospitals. ASHP’s advocacy efforts, including significant staff engagement on the issue, directly triggered the FDA to clarify existing compounding guidance, including the removal of the one-mile radius requirement for hospitals compounding medications. FDA’s quick action to reduce regulatory hurdles for health systems is an important step to help clarify compounding guidance during this crisis.

ASHP will continue to advocate for additional compounding flexibility, including the expansion of FDA’s drug shortage list to include products ASHP has identified as in shortage. We will also continue to seek 503B outsourcing facility flexibility, particularly for hospital-owned or affiliated 503B operations, to help ensure they can meet hospitals’ medication needs.

Yesterday, we were pleased to see that the Department of Health and Human Services (HHS) authorized pharmacists to order and administer COVID-19 tests pursuant to the Public Readiness and Emergency Preparedness (PREP) Act. The authorization is responsive to the joint COVID-19 recommendations we created with other national organizations. While this authorization does not address pharmacist reimbursement, we are encouraged to see HHS providing pharmacists with a greater role in supporting the COVID-19 response, and we continue to work on that issue.

We also continue to actively advocate for Congress to recognize pharmacists as providers in the Medicare program to further support the COVID-19 response and beyond. Yesterday, ASHP and 11 other national organizations sent a letter requesting that Congress immediately support legislation that would establish pharmacists as providers in Medicare Part B on an emergency basis to provide COVID-19 and flu testing. This authority is an important step in being able to rapidly expand access to testing across our country to support the national response to this crisis. We also see this as a step toward expanded recognition of pharmacists by payers, including Medicare.

Finally, ASHP is also working with our members and other stakeholders to gain access to medications from the Strategic National Stockpile (SNS). Most recently, we joined with several organizations to request that FEMA immediately release all available quantities of a number of critical drugs from the SNS to the New York and New Jersey Departments of Health to address urgent patient care needs. We are also working to support other state affiliates and members across the country with these important requests.

ASHP and its government relations team will continue to work tirelessly with our collaborating partners to ensure that U.S. regulatory authorities are responding to the current needs of pharmacists and healthcare providers.

While our collective attention is on the needs of frontline practitioners, I wanted to take an opportunity to highlight some positive news about the newest members of our profession. ASHP’s 2020 Residency Match concluded this week, and I want to congratulate the 5,269 future pharmacists who matched with 2,551 PGY1 and PGY2 pharmacy residency programs across the country. This number represents a 46% increase in the number of available positions over the past five years – a remarkable rate of growth. I am pleased that our accredited residency programs have demonstrated an outstanding commitment to training during the pandemic. While managing multiple critical priorities, these programs continued to interview applicants virtually. This undoubtedly will be a unique time during which to begin a residency program regardless of its focus. ASHP is committed to ensuring that these young practitioners and their programs have the needed resources to successfully conduct critically important resident training this year and beyond.

In the same vein, please know that ASHP stands ready to offer you and your healthcare colleagues that same level of steadfast support. In addition to advocating to give you access to critical medications, ASHP continues to update and create new resources and tools that can be found on our COVID-19 Resource Center. We have also opened access to many evidence-based online resources and tools on ashp.org, making them widely available to all pharmacists and the broader healthcare community.

Over the last few weeks, I have heard countless stories from members and others about the challenges they are facing, but I’ve also heard many stories of hope and heroism. I, and David Chen, ASHP assistant vice president for Pharmacy Leadership and Planning, have listened in on calls from pharmacy leaders at major health systems in New York City, the pandemic’s current epicenter. We are incredibly impressed by how these leaders have shared their information and experiences and how they support each other and their frontline staff. This is a tremendous example of how peer-to-peer connection and communication can aid in the pandemic response. Their experiences and willingness to share their stories will undoubtedly help others in responding to COVID-19 in facilities across the country. We applaud them for these efforts.

Please also know that ASHP is here to support your well-being, which should remain a priority for all healthcare personnel during this challenging time. Please make sure that you are taking care of yourself and your family.

“ASHP has our backs.” These are the words of a member who recently reached out to us. This really resonated with me, and I can assure you that we will continue to work across all fronts, leveraging our talented staff, our valued partners, and our amazing members to provide you with the information, connections, and resources you need today and in the future.

Thank you for everything you do for your patients and the profession.

Sincerely,

Paul

February 21, 2020

New Mexico Legislation Expands Access to Pharmacist Care

Dear Colleagues,

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

A concerted and highly organized effort has resulted in a significant step forward for pharmacists and patients in New Mexico. Pharmaceutical Services Reimbursement Parity (House Bill 42), passed by the New Mexico Senate on February 20, will expand access to healthcare by enabling pharmacist clinicians and other pharmacists with prescriptive authority to be reimbursed for clinical services.

ASHP’s Government Relations team worked closely with the New Mexico Society of Health-System Pharmacists (NMSHP), the New Mexico Pharmacy Association, the UNM College of Pharmacy SSHP, and others to mobilize grassroots support urging Gov. Michelle Lujan Grisham and members of the New Mexico legislature to pass the bill.

This is a wonderful achievement for pharmacists and their patients in New Mexico. It also serves as a strong building block as we work toward achieving pharmacy provider status nationally. Supporting states in expanding access to pharmacist care is a key part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time.

Multiple studies have shown that pharmacist-provided clinical services expand access to care, improve chronic disease outcomes, and help decrease the cost of care with research estimating that every $1 invested in clinical services by pharmacists reduces overall healthcare costs by $4.[1] We are working hard to make sure that policymakers across the country recognize that value and the impact you bring to patient care.

I would like to express my thanks to all of the individuals and organizations that worked so hard to support the passage of the bill, including Keenan Ryan, NMSHP president, Dale Tinker, executive director of the New Mexico Pharmacists Association, and the students at UNM College of Pharmacy who worked to make sure every legislator in New Mexico understood the importance of this legislation.

We have great momentum on this critical issue and look forward to continuing our advocacy efforts on expanding access to pharmacist care in other states to help improve patient health for all.

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

Sincerely,

Paul

 

[1] Avalere. Exploring Pharmacists’ Role in a Changing Healthcare Environment. May 21, 2014, available at https://avalere.com/insights/exploring-pharmacists-role-in-a-changing-healthcare-environment

 

 

 

June 18, 2018

Underserved Patients Rely on Pharmacists to Fill Care Gap

Nazia S. Babul, Pharm.D., BCACP, Clinical Pharmacist and Clinical Assistant Professor at the University of Illinois College of Pharmacy, counsels patients at CommunityHealth, a free clinic in Chicago.

PROVIDING HEALTHCARE TO UNINSURED AND UNDERINSURED INDIVIDUALS is a challenge that continues to grow. With rising premium costs, the threat of major insurers on the verge of withdrawing from health exchanges, and the potential for reductions in coverage, three health systems — Yale-New Haven Health, Ascension, and the University of Illinois Hospital and Health Sciences System — are calling on clinical pharmacists to help address gaps in care.

Ambulatory Care at Yale-New Haven Health
“Our pharmacists teach underserved patients about their medications, optimize their dose, determine if they’re really receiving the best medication given their particular situation, and find the lowest-cost options for them,” explained Lee Ann Miller, Pharm.D., Director of Clinical Pharmacy Services at Yale-New Haven Health in Connecticut. “These are all steps that can improve adherence and outcomes while also reducing healthcare resource utilization and lowering the overall cost of care.”

Although pharmacists at Yale-New Haven Health provide beneficial care to patients, funding is a concern. Dr. Miller explained that, although pharmacists at ambulatory care clinics often spend up to an hour with a patient, a lack of provider status means they bill Medicaid and Medicare at the lowest-level evaluation and management incident-to code, which reimburses $20 on average.

This financial picture makes it difficult to make a case for expanding the clinical pharmacist workforce beyond the eleven pharmacists who are embedded across the health system’s roughly 200 ambulatory care offices and clinics, explained Dr. Miller. “Moving to value-based payment structures and having provider status would certainly give us the help we need to offer this same level of service at other clinics,” she added.

Ascension’s Social Mission
Despite the low level of reimbursement currently available, pharmacists continue to provide important care. Ascension, the largest nonprofit health system in the country, with facilities in 22 states, offers free medications to those who can’t afford them through one of 45 Dispensary of Hope locations. The Dispensary of Hope program collects medications donated by pharmaceutical manufacturers and distributes them to certain pharmacies and safety-net clinics. At some Dispensary of Hope locations, health leadership may purchase additional medications as part of a safety net formulary for their institutions.

The pharmacy team at the Medical Mission at Home provides medications and counseling to underserved patients.

“In the fourth fiscal quarter of 2017, our Dispensary of Hope pharmacies served 6,460 unique patients,” said Lynn Eschenbacher, Pharm.D., FASHP, National Director of Pharmacy Operations at the Resource Group, which is part of Ascension.

Another Ascension initiative, the Medical Mission at Home project, features daylong community health events that provide patients with primary and speciality care services. As part of the initiative, underserved individuals also receive medications and counseling about their medications, explained David Neu, Pharm.D., MSHSA, Vice President of Pharmacy at Saint Thomas Health, a member of the Ascension network in Nashville, Tenn. According to Dr. Neu, Nashville is host to the largest of the four annual Medical Mission at Home days and recently provided care to more than 750 patients during a single day.

“We see a lot of people with untreated hypertension, diabetes, asthma, or chronic obstructive pulmonary disease — or people who are not adherent to their medication regimen — so pharmacists have an opportunity to make an important impact on their care,” Dr. Neu explained.

Patients are assessed by a nurse and triaged to the appropriate health caregiver, whether that is a physician, pharmacist, or nurse practitioner. Prescriptions can be written and filled onsite using both Dispensary of Hope medications and subsidized medications purchased by the participating Saint Thomas Health hospital, noted Dr. Neu. All medications are provided at no cost to patients during the event.

“Pharmacists also provide counseling and patient education such as inhaler training,” he explained. They assist individuals who need help paying for medications, whether that means obtaining a coupon voucher, connecting with a patient assistance program, or pointing patients to a Dispensary of Hope location. “There’s an aspect of social work to the care our pharmacists provide during these events, which is important as uninsured and underinsured patients have a hard time navigating our health care system to meet their medication needs,” reflected Dr. Neu.

Caring for Chicago’s Poor
At the University of Illinois Hospital and Health Sciences System (UI Health), ambulatory care pharmacists help some of the poorest and most vulnerable communities in Chicago,” said ASHP member Sandra Durley, Pharm.D., Senior Associate Director of Ambulatory Care Pharmacy and Clinical Assistant Professor at the University of Illinois College of Pharmacy, Chicago. “Many of these individuals lack insurance and convenient access to healthcare services and are considered to be medically underserved.” Care is available at UI Health’s on-campus pharmacies and at 20 outpatient clinics and four pharmacy-based clinics staffed with 38 full-time clinical pharmacists.

At Mile Square Health Center, a federally qualified health center that is also part of UI Health, a clinical pharmacist works alongside physicians and nurse practitioners to care for patients with diabetes and other illnesses, many of whom are underinsured or uninsured, explained Dr. Durley. And in an institutional collaboration, two University of Illinois College of Pharmacy clinical pharmacists work four days each week at CommunityHealth, the largest volunteer-based free clinic in the country, she added.

Like Dr. Eschenbacher, Dr. Durley is concerned about the future of underinsured and uninsured patients. Although pharmacy services help improve health outcomes among the underserved, pharmacists are not always compensated. However, she also struck an optimistic note, pointing to the Pharmacy and Medically Underserved Areas Enhancement Act, which, if passed, would recognize pharmacists as healthcare providers under Medicare Part B in medically underserved areas. “That is an important first step in getting compensation for pharmacist services,” Dr. Durley said.

 

By David Wild

# # #

May 7, 2018

Provider Status and Opioids Legislation Update

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

I WOULD LIKE TO UPDATE YOU on ASHP’s ongoing efforts to advocate for passage of legislation that would recognize pharmacists as patient care providers in the Medicare program, as well as legislative efforts related to the opioid epidemic.

As the 115th Congress begins to shift focus to the November elections, opportunities for healthcare legislation are limited. We anticipate that any healthcare-related legislation will be mainly focused on the opioid epidemic. As a lead member of the Patient Access to Pharmacists’ Care Coalition, ASHP is working to determine ways in which provider status language might be addressed in the pending opioid bills. However, given that the focus of these bills is mainly on opioids, our efforts for now may need to shift to articulating how pharmacists can play important roles in helping to solve this major public health problem.

Efforts to obtain provider status are part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time. Our intent is to enhance our members’ ability to provide care as part of the interprofessional patient care team.

As states look to expand their scope of practice laws to promote the direct patient care roles of pharmacists, ASHP is supporting state-level efforts of our members and working at the federal level to include these direct patient care roles in Medicare. We also want to make sure our members are well-positioned to align their efforts with Medicare modernization, which is now focused on moving toward value-based models that align payment with quality and outcomes. ASHP members are in an excellent position to lead efforts to optimize medication therapy through value-based models, and ASHP will be there to make sure that Congress, Medicare and Medicaid, states, and others understand the many advanced practice models our members are engaged in as well as the direct patient care roles they play.

As we continue to work with Congress, states, and public and private payers to recognize pharmacists as patient care providers, we will keep you apprised of these activities and our many advocacy efforts on your behalf — addressing persistent drug shortages, rising drug costs, and threats to the 340B Drug Pricing Program, as a few examples.

Thank you for your support and your continued engagement as we work together to help our patients achieve optimal medication therapy outcomes and to advance pharmacy practice.

Sincerely,

Paul

August 21, 2017

Happy 75th Anniversary, ASHP!

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

I AM HONORED to have the privilege of writing this message to you in celebration of ASHP’s 75th anniversary. On this day in 1942, ASHP was founded by an exceptional group of leaders who envisioned a future where pharmacists would be the medication therapy experts on what we now refer to as the interprofessional patient care team. In reflecting on the past 75 years, it is clear that ASHP and its exceptional members created a future that far exceeded the expectations of our visionary founders.

Over the course of 75 years, ASHP has been a leader in:

  • Conceptualizing and advancing pharmacy as a clinical profession.
  • Establishing standards of practice.
  • Creating accredited residency training.
  • Supporting pharmacist specialization.
  • Advancing the roles of pharmacists in ambulatory clinic settings.
  • Advocating for the effective utilization of pharmacy technicians.
  • Creating the modern drug formulary system.
  • Developing evidence-based drug information.
  • Advocating for the entry-level doctor of pharmacy degree.
  • Being the first organization to hold a national conference dedicated to high-level clinical education — the ASHP Midyear Clinical Meeting.

These are just a few of the many areas where ASHP has been the leader in helping to move pharmacists closer to the patient in the interest of improving patient care and medication safety.

ASHP is proud of these accomplishments; however, we are now focused on creating a future where all patients have access to and receive the appropriate level of comprehensive medication therapy management in all care settings. ASHP’s vision is that medication use will be optimal, safe, and effective for all people all of the time, and we are steadfast in our resolve to achieving this bold vision.

Being a member of ASHP has always been about being part of something much bigger. It’s been about working collectively to help pharmacists achieve their full potential and, in doing so, improving the lives of the patients we serve.

I hope you will join me in December at the ASHP Midyear Clinical Meeting in Orlando for the grand finale of our 75th anniversary year celebration. We’ve planned a great event that includes the best educational program, opportunities to network with over 25,000 colleagues, an anniversary celebration space called 75th Street, and the chance to hear a very special guest at our opening session. And, we’ve reserved the entire Universal Studios Florida Theme Park for our closing party. We can’t wait to see you there!

We want to thank each and every one of our nearly 45,000 members for making ASHP the best organization in pharmacy, and for the contributions you have made to our collective efforts to advance pharmacy practice and improve patient care. You are all a very special part of something wonderful that our founders would be truly amazed by and proud of. Thank you so much for being a member of ASHP and for everything you do for your patients.

Sincerely,

Paul

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