Pharmacy education and provider status
Validating the 60-year debate
It's been said that the move to the doctoral level of pharmacy education required a 60-year debate that ended just in time. When the provider status bill now moving through Congress is enacted into law, it will underscore the truth of that statement.
The knowledge, skills, and attitudes pharmacists must have in order to meet the needs of Medicare beneficiaries are exactly those that graduates acquire in our colleges and schools of pharmacy today. It might be said that practice will finally catch up with education.
The profession wrestled with questions about the level of education pharmacists needed across much of the last century. Before the establishment of an accreditation system in 1932, colleges awarded many different degrees for programs of varied lengths. The bachelor's degree became the standard in the traditional four-year model, but forward-thinking educators and practitioners argued as early as the 1940s that this level of education would not equip pharmacists to both manage drug distribution systems and provide the education and patient management services that the increasingly complex drug armamentarium required.
A lack of vision
You might ask, "Why were pharmacists not included among the list of professionals when Medicare was enacted 50 years ago?" One simple answer is that at that time, the cost of processing the reimbursement outstripped the actual average prescription cost.
In reality, there was no vision for pharmacists' patient-care services in this era. In fact, the American Pharmacists Association (APhA) code of ethics contained a provision that essentially said a pharmacist should not inform a "patron" regarding the composition of a prescription or its purpose. In many states, pharmacy practice acts forbade pharmacists from putting the name of the medication on the prescription label.
In the decades following the introduction of Medicare, medication use has become increasingly complex. Pharmacists in every practice setting have demonstrated their ability to collaborate with prescribers to identify patients' drug-related needs; monitor response to therapy; adjust drug regimens and dosages; and educate patients and their caregivers to achieve intended therapy outcomes. Numerous studies have provided evidence of the return on investment from such services.
In 2003 Congress enacted legislation to create Medicare Part D. Burdened with high out-of-pocket costs for pharmaceuticals, many elderly citizens had resorted to buying drugs out of the country or had been forced to choose between buying medications or other essentials, including food.The addition of Part D and improved access to medications has actually been shown to lower expenditures in Medicare Parts A and B.
Pharmacy organizations lobbied successfully to include a modest provision for patient-care services in Medicare Part D, and medication therapy management (MTM) services are currently provided on a limited basis to some beneficiaries. The profession has the potential to offer much greater value, especially to those in medically underserved communities.