As predictable as night following day, the debate about adding outpatient prescription drugs to the Medicare benefit package has spurred a new set of healthcare professionals to ask for federal reimbursement: pharmacists.
Arguing that pharmacists do more than drop pills in a bottle, groups representing pharmacists are telling Congress that Medicare should reimburse pharmacists for their professional services if the federal government adds prescription drugs to its list of covered benefits.
The push could result in the addition of new players to the annual lobbying game over Medicare reimbursement, potentially threatening to drain payments away from hospitals, nursing homes, physicians and other providers now receiving them.
Despite that potential threat, hospitals are silent on the question of pharmacist reimbursement. The American Hospital Association supports a prescription drug benefit, but also argues that Congress and President Clinton first need to continue to increase Medicare payment rates and divert some surplus funds to extend the life of the Medicare Hospital Insurance Trust Fund.
Managed-care plans are using disease management and drug therapy to replace expensive hospital and nursing home stays, the pharmacy groups say. As a result, they rely on pharmacists to shorten or prevent hospital stays and also prevent the adverse drug interactions that result in emergency room visits or overnight stays.
"All of that requires professional time, professional judgment and professional services," said Phil Schneider, spokesman for the National Association of Chain Drug Stores, Alexandria, Va. "Those services go much further than the dispensing of the drugs."
"In day-to-day life, doctors rely on pharmacists pretty heavily," said John Rector, general counsel for the National Community Pharmacists Association.
But a study released last week questions that portrayal.
Pharmacists spend more than two-thirds of their time on activities that aren't directly related to patient care, according to the Chain Drug Stores association. Because of state practice regulations and various insurance requirements, pharmacists spend most of their time on administrative and nonclinical tasks, the industry association said.
Its study was funded in part by San Francisco-based McKesson HBOC, which distributes drugs and other healthcare products and provides healthcare information services. The drugstore association argues that freeing pharmacists for more patient-care activities would improve healthcare.
In addition, one analyst questioned the policy implications of the pharmacists' goal of Medicare payments.
"I think what the pharmacists want runs contrary to where the Medicare program is going," said Lawrence Goldberg, director of healthcare services in the Washington office of accounting firm Deloitte and Touche. "Rather than unbundling all sorts of professional components and technical fees, Medicare wants to bundle such fees in a way that does not recognize the individual providing the services but rather pays for services provided to Medicare beneficiaries."
The pharmacists association is working with the American Society of Health-System Pharmacists, which represents hospital-based pharmacists, and seven other groups to promote such a policy under the name Joint Commission of Pharmacy Practitioners.
They said inappropriate use of prescription drugs adds $100 billion a year to healthcare costs and that an expanded role for pharmacists could prevent some of those costs.
With prescription drugs now representing an ever-growing share of healthcare costs, even without the benefit of coverage by Medicare, pharmacists could become one of the most influential interest groups on Medicare policy.
Indeed, prescription drugs are expected to grow as a share of total U.S. healthcare expenditures to 11.2% in 2008 from 7.2% in 1997, surpassing nursing-home care to become the third-largest component of healthcare spending after hospitals and physicians.
During the same time, hospital expenditures are expected to shrink to 30.3% from 34% of total U.S. healthcare expenditures.
The question over whether to add prescription drugs to the list of Medicare-covered benefits is one that's not likely to go away. In signing a budget bill that increases Medicare expenditures by $15.1 billion over five years, President Clinton last week called on Congress to consider a comprehensive Medicare reform package that adds prescription drugs to the benefit package.