As a local community pharmacist in Kentucky, I feel it is important to call out why big business goes to great efforts to lobby the federal government to maintain health care policies that hurt consumers. Just this February, they successfully lobbied the Center for Medicare and Medicaid Services to continue allowing limited pharmacy networks for Medicare recipients. They are perpetuating an outdated view of community pharmacies. We can't let them continue to mislead policymakers and have patients continue to receive limited access to medicine.
The changes considered by CMS to Medicare's prescription drug benefit plan would have expanded pharmacy participation and ensure access and choice for seniors all across the country. These changes also value the role that community pharmacies play for seniors — ensuring quality care and medication adherence that a mail-order program simply cannot provide.
Yet, opponents to these changes, notably large Pharmacy Benefits Managers express an uneducated view of pharmacies — as simple dispensaries. For years PBMs suggested that patients would be better served by mail-order programs, despite patient dislike for this option, and never based their arguments on quality of care.
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This runs counter to the changes in the health care industry we have seen with the passage of the Patient Protection and Affordable Care Act, which embraces the importance of providers in delivering quality care to patients, no matter their health insurance plan. Under PPACA, pharmacists are serving as a key health care provider, especially in rural communities — where approximately 1,800 rural independent pharmacies are the only provider in their communities.
One striking example is through the increased use of the accountable care organization model under PPACA. In this model, health care providers collaborate together through a patient's full care cycle; meaning the process does not just end at the doctor's office. In ACOs, pharmacists are expected to ensure that patients follow medication usage, advise them and help avoid adverse effects, prevent hospital readmissions, and help patients manage chronic conditions.
I know from day to day experience that these are services that patients often turn to their pharmacist to provide. However, under our current Medicare model, many rural seniors are unable to go to their local community pharmacist for their necessary medications and for the personal service that quality care requires.
Instead, they must drive 20 miles or more to access a pharmacy that is included in Medicare's "preferred pharmacy network" to ensure they get the medication savings they are promised. Or they are forced into mail-order programs that pose the dangers of delayed or incorrect prescription deliveries, and cannot clarify potential confusion about dosage and side effects. These limited networks and mail-order programs cut out critical services for many beneficiaries.
CMS should allow any pharmacy that adheres to their standards to participate in Medicare pharmacy networks. And our health care industry must continue to embrace the critical role of providers, including pharmacists. It makes good medical sense for local pharmacies to continue to provide hands on advice and even better for patients' well being and health.
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