Collaborative drug therapy management by pharmacists--2003.

Since publication of the initial ACCP position statement on CDTM by pharmacists in 1997, the public, government, and much of the health care community at large have come to better appreciate the growing complexity of providing effective and safe drug therapy in today's health care environment. Increased interest in the issues of cost and quality of drug use is evident in the increasing coverage of the issue in the lay press and professional literature. This represents real progress, as well as real opportunity, for pharmacists. It also heightens the potential for a better understanding of the vital role that pharmacists can play in addressing these concerns. The percentage of patients who take several drugs for chronic diseases will continue to increase. Based on current trends, the number of patients who lack adequate access to care, or who receive either suboptimal, inappropriate, or unnecessarily expensive drug therapy for their acute and chronic diseases, will increase. Even as financial and human resources are increasingly strained within the current health care system, costs will continue to rise unless changes are made. Fortunately, qualified pharmacists are prepared, capable, and willing to help address a significant portion of these challenges. The public, many health care providers, some legislators, and a few insurers now recognize that pharmacists, because of their education and training in drug therapy, are well positioned both to accept additional responsibility for patient care and to provide services that make a real difference in health care quality and outcomes. The health care programs administered by the U.S. Public Health Service, the armed forces, and the Veterans Health Administration, as well as 38 states, now support pharmacist participation in CDTM. Pharmacists, working in an interdisciplinary structure with physicians and other health care providers, have demonstrated that they can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.

Estimating the cost of the Medicare Pharmacist Services Coverage Act of 2001.

BACKGROUND: In recent years considerable attention has focused on pharmacists' professional evolution toward patient care-oriented practice. The Pharmacist Provider Coalition (PPC), established in 2000, seeks recognition and payment for pharmacists' patient care services. Concerted effort by the PPC on this issue resulted in the introduction of the Medicare Pharmacist Services Coverage Act of 2001, which would have amended Title XVIII of the Social Security Act to create new types of covered services under Medicare and recognize pharmacist practitioners as providers. However, the legislation was not passed by the 107th Congress. STUDY OBJECTIVES: The PPC engaged The Moran Company to measure the potential net cost to the United States government of the Medicare Pharmacist Services Coverage Act of 2001, and to perform this measurement in a manner that is consistent with the cost-projection methods used by the Congressional Budget Office (CBO). DESIGN: The model is anchored to the 10-year projection of revenues and spending within the federal government developed annually by the CBO. It examines the anticipated magnitude and cost of patient care services with respect to chronic disease and pharmaceutical therapy management, in both facility and nonfacility settings. RESULTS: The methodology yields a final cost estimate of 427 million dollars in 2004, the first year of implementation, and a 10-year estimate of 13 billion dollars. CONCLUSIONS: Recognition of pharmacists as providers of selected drug therapy management services under Medicare will have a considerable financial impact. It is instructive, however, to view the 10-year cost estimate of 13 billion dollars for pharmaceutical therapy management in light of the CBO's projected 1.5 trillion dollars estimate, over the same time frame, for drug spending among the Medicare population.