The of pharmacists are altruistic in nature

The
future success and sustainability of the practice of pharmacy relies on the
ability of pharmacists to advocate for their profession. Pharmacists spend less
time on dispensing functions and are expanding their scope of practice to
include clinical services. In order to further advance the practice model,
education surrounding the positive outcomes for patients and healthcare as a
whole need to be measured and reported. The changing political environment has
many implications for healthcare and pharmacy leaders must be prepared to
advocate for key issues that have the potential to change pharmacy practice.

            Advocacy efforts within pharmacy
should center on the longevity of the 340B program as well as expanding the
pharmacist’s scope of practice. Efforts should be made at the local, regional, and
national level to advocate for each of these key areas of pharmacy practice.
Registration with advocacy groups including the Ohio PAC and 340B Health are
vital to promoting the success of this program. Educating lawmakers and
engaging representatives from national pharmacy organizations are also ways to
ensure the 340B program continues to grow and expand. The scope of practice for
pharmacists should be analyzed internally with the goal of reporting
pharmacist-based outcomes to senior leadership. Involvement with the Ohio Board
of Pharmacy BOP Rules Committee allows pharmacy representatives to shape the
rules to push the envelope on the current pharmacy practice model. Lawmakers
and congressional representatives should also be educated and invited to witness
the positive effects of a pharmacist seeing patient’s independently in clinic.
To the public, the primary role of the pharmacist is to dispense medications;
however this perception must be changed through advocacy and education efforts.

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            Advocacy must start within the
pharmacy department and extend beyond our institution to the local, regional,
and national levels. A renewed focus on pharmacy advocacy and encouragement
from the pharmacy leadership team will provide for a culture of advocacy within
the department. All pharmacists will assess their current level of advocacy and
efforts to support continued pharmacy advocacy will be provided by the
department.

Introduction 

                  As the model of pharmacy practice expands
from a more traditional role of dispensing medications to providing independent
clinical services, pharmacists must focus their efforts on advocating for the
profession of pharmacy as a whole. The majority of pharmacists are altruistic
in nature and patient care is always a top priority. As pharmacists, we
advocate for our patients on a daily basis but we do not focus on the needs of
the profession as a whole. Pharmacists are considered the drug experts, however
many do not realize that our expertise extends beyond the pharmacy counter.
Prior studies have shown that clinical services provided by pharmacists improve
patient outcomes. Pharmacists must inform others of their clinical expertise
and associated positive outcomes in order to continue to expand the pharmacy
practice model.1

            The changing political landscape has
increased the need for political advocacy in the pharmacy space. Educating
policymakers on the role of the pharmacist in healthcare is crucial to ensure
the future of pharmacy practice and the sustainability of health-system
pharmacy department efforts. The opportunity to set a precedent for pharmacy
advocacy at the political level is one that should be capitalized on in order
to effectively promote and expand pharmacy services.2

Advocacy
in the simplest form is combining education and action to support, defend, or
argue for a particular issue or cause.1,3 Historically, the pharmacy
profession has not placed a strong emphasis on advocacy efforts.2 As
directors of pharmacy, we must be able to advocate for our profession at the
local, regional, and national level in order to continue to cultivate
innovative pharmacy practice. The goal of this assessment is to outline the
current pharmacy department plan to promote advocacy around issues impacting
pharmacy and to provide a timeline for execution of these efforts.

 

 

Identify key political
initiatives that influence pharmacy practice and prioritize their advocacy
efforts.

The first step to identify the focus of
future advocacy efforts will be to discuss key issues impacting pharmacy
practice with leaders at our own institution as well as leaders at other health
systems and institutions in the area. This allows for collaboration among
institutions and a more accurate gauge on the issues impacting pharmacy
practice as a whole. Visiting the website of local pharmacy organization
chapters, which include the Ohio Pharmacists Association (OPA) and the Ohio
Society of Health-System Pharmacists (OSHP), to review the legislative issues
they are focused on will also be helpful in determining advocacy efforts. To
determine the top priorities at the state level, it is imperative to contact an
Ohio Board of Pharmacy (BOP) board member. Learning more about the concerns of
the BOP and supporting their efforts serves to increase advocacy at the local
level.

            Issues should also be identified at
the national level by reaching out to delegates of national organizations.
Members of the American Society of Health-System Pharmacists (ASHP) and the
American Pharmacists Association (APhA) need to be engaged in the advocacy
discussion. Researching information on the website of national organizations
and participating in the conversations of national forums provides insight into
topics that are being discussed amongst others in the profession. Proposed or
current state and federal legislation should also be reviewed for any laws that
may have an impact on the pharmacy profession. This review also serves to
highlight what lawmakers are focused on for the upcoming term. After review of
these resources, top initiatives should be identified and prioritized before a
plan is put into place.

Analyze previously
identified political initiatives that influence pharmacy practice in order to
prioritize their advocacy efforts.

            After
completing research to identify the key focus areas evidence to support the
importance of each issue to the practice of pharmacy should be reviewed.
Members of the pharmacy leadership team need to come together as a unified
group to prioritize the issues and align their efforts to advocate for
pharmacy. After review of all resources outlined above, two critical issues rose to
the forefront of necessary pharmacy advocacy efforts. These topics include the
340B Program and continued efforts to advance the scope of practice for
pharmacists.

340B Program

      The 340B Drug Pricing Program (340B program)
was established by Congress and mandates that, to remain eligible for
participation in the Medicaid program, drug manufacturers must provide
outpatient drugs to eligible healthcare providers, also known as covered
entities, at reduced prices. Covered entities include certain nonprofit
organizations such as qualifying hospitals and federal grantees identified in
the Public Health Services Act. The program helps reduce the prices of covered
drugs for certain participating entities that, in turn, provide care for
patients. To date, the 340B program has received strong bipartisan support in
Congress and it is estimated that discounted medication purchases under the
340B program totaled more than $16 billion in 2016.4

            Beginning
in calendar year 2018, the Centers for Medicare and Medicaid Services (CMS)
will no longer reimburse separately payable, non-pass through drugs and
biologicals, other than vaccines, at the average sales price (ASP) plus six
percent. The new reimbursement structure for these medications will be the ASP
minus 22.5 percent.5 This change in reimbursement structure will
dramatically reduce the savings and revenue that covered entities receive
through the 340B program and use to extend care to patients and provide for the
well-being of the community. A renewed focus in the department of pharmacy on
340B legislation and advocacy for the program is necessary to ensure that the
additional services that are made possible because of the program and the
expansion of new services remain viable.

Expand Pharmacist Scope of Practice

The rising cost
of healthcare, along with increasing demands of healthcare providers, allows
pharmacists to play a significant role in patient care by offering their
clinical expertise at a traditionally lower cost.6 Despite the view
that pharmacists are best suited to dispense medications and counsel patients,
healthcare experts increasingly agree that the presence of a pharmacist on
interdisciplinary healthcare teams improves patient care and reduces the cost
of treating primary conditions.7

      Clinical pharmacists complete extensive
education and often specialize in a disease state or patient population of
interest. Their clinical expertise as well as knowledge of medications and
disease states allows clinical pharmacy specialists to function as midlevel
providers, similar to a Nurse Practitioner (NP) or Physician Assistant (PA). Under
the State of Ohio Revised Code and Ohio Administrative Code, pharmacists in the
state of Ohio are eligible to practice under a Consult Agreement with a
physician to expand their scope of practice. Many of these agreements are
institution-specific and the appropriate credentialing or privileging
procedures are necessary before the pharmacist may practice under collaborative
practice with a physician.6 One major limitation of expanding
pharmacy practice at the national level is the lack of provider status for
pharmacists and the resulting inability to bill for services. Continuing to
advocate for these efforts as well as local and regional expansion of
collaborative practice is an important advocacy effort. The comprehensive care
package at our institution requires significant focus to expand the clinical
privileges of pharmacists and to continue to grow the practice model.

Develop key strategies to
advocate for each political concern at the local, regional, and national level.

340B Program

 A
member of the pharmacy leadership team should be identified to join the Ohio
Pharmacy Political Action Committee (PAC) to advocate for the importance of the
340B program and to stay up to date on current legislation that may compromise
its current structure. As a department, a registration for an
institutional membership with 340B Health, an organization of approximately
1,300 public and private nonprofit hospitals and health systems who are
enrolled in the 340B program, will be submitted. An institutional membership
with 340B Health provides the opportunity to respond to Congressional inquiries
around the 340B program, educate lawmakers on the benefits of the program,
protect covered entities from increasingly limiting restrictions on the
program, and access to many more advocacy opportunities.8

Educating
lawmakers about the implementation of the 340B program, associated financial
savings and revenue, as well as expansion of services provided through the 340B
program at our institution will be critical to the sustainability of the
program. Many government officials do not understand the benefits of the
program and financial savings that allows the expansion of clinical services to
a greater number of patients. Plans to expand the 340B program as well as
future initiatives to expand pharmacy services with financial savings from the
340B program will be detailed in a report sent to legislative aides in the
Senate and House of Representatives Office with the goal of reaching members of
the Ohio Senate and House of Representatives.

Engaging members
of Congress is crucial to ensuring that their political agenda mirrors the
current initiatives of our department. Along with education efforts,
legislative aides working with Ohio Senators and District Representatives will
be contacted to schedule a time to meet and discuss the impending changes with
the 340B program. An invitation for these congressional officials to
participate in a site visit to the institution will be extended. The focus of
this site visit will be the 340B program from its inception to current state,
new services made possible by the savings from the 340B program, and next steps
to expand the 340B program resulting in increased care for more patients.

Expand Pharmacist Scope of Practice

            To determine the most
effective way to advocate for expanding the scope of practice for pharmacists
our department first must report internal outcomes from current clinics in
which clinical pharmacy specialists now practice. These outcomes will prove
that pharmacists are extremely productive in the clinical practice setting. It
will also quantify the time that pharmacists, as physician extenders, allow
physicians to see new patients or focus on research and education. The results of
this review will be shared with hospital administration and leadership to
demonstrate the value of a clinical pharmacy specialist working under a consult
agreement.

Advocacy at the state level will allow the
pharmacy department to remain aware of the proposed changes to the rules that
may impact the scope of pharmacy practice. A member of the pharmacy leadership
team will be identified to apply to the Ohio BOP Rules Committee. A review of
the current rules and opportunity to suggest changes as a committee member
provides a way to update the Ohio BOP rules to become consistent with the
changing practice of pharmacy instead of adjusting pharmacy practice to
potentially outdated rules.

The Ohio Speaker of the House along with the
local District Representative will be contacted with the goal being to educate
them on the role of pharmacists as providers and to schedule a meeting with state
government officials. This meeting will serve as an opportunity to educate
lawmakers on the role of the pharmacist as a clinical practitioner and to
demonstrate the outcomes achieved by pharmacists. Attendees at this meeting
will include myself, as the Pharmacy Director, a member of the pharmacy
leadership team focused on clinical practice, a clinical pharmacy specialist
who currently practices under a consult agreement, and a patient who sees a
pharmacist in clinic regularly to give testimony to the benefit of this service.

The office of Senator Rob Portman will also be
contacted due to Senator Portman’s lack of support for provider status. After
an initial meeting he will be invited onsite to observe pharmacists in their
practice setting and to provide a glimpse into the advanced pharmacy practice
model. Part of this visit will include interviews with patients who have been
seen by pharmacists. These patients will share their story of how the care of a
pharmacist has impacted their life and the progression of their disease state. The
goals of this visit will be to ensure that Senator Portman recognizes the
importance of pharmacists as prescribers and to encourage him to support
federal provider status efforts and the Pharmacy and Medically Underserved
Areas Enhancement Act (H.R. 592/S. 109). A timeline for implementation of the
above strategies is included in Appendix A.

Identify internal
initiatives within the department of pharmacy to promote advocacy and ensure
all pharmacists play a role in advocating for the profession.

All pharmacy administrators and
pharmacists in the department will complete an assessment of current advocacy
efforts by completing the previously developed Advocacy Assessment Tool.9 Pharmacists
in the department will complete this on an annual basis to gauge the level of
advocacy and involvement. The
Advocacy Assessment Tool was previously developed by Scott M. Mark and
colleagues and is located in Appendix B. Monthly meetings
dedicated to a different pertinent pharmacy topic will be scheduled to outline
strategies to advocate for this topic on local, regional, and national level. Attendance
from all pharmacy leadership team members will be required at this meeting and
individuals will be identified to lead advocacy efforts on topics of their
choice and practice area.

All staff
will be encouraged to join local, regional, or national professional
organizations and provide reimbursement to each pharmacist for the dues for one
professional membership up to $250 annually. Support of annual travel for
members of the pharmacy leadership team who are interested in visiting national
organizations, such as ASHP, or to visit Capitol Hill to meet with government
officials will be provided. As the Director of Pharmacy, quarterly meetings will
be held with Ms. JC to report on the advocacy efforts within the pharmacy
department and update her on the progress of these efforts.

Determine how to measure
and monitor the outcomes of each strategy and cost to the department to support
each strategy.

Advocacy
effort development will be quantified by the amount of contact with lawmakers
through emails, phone, and in person visits. These metrics will be recorded and
tracked over the implementation time period with the goal of monthly contact
with governmental officials. Tracking and reporting the context of the
conversations is important to ensure advocacy efforts are continuous and
lawmakers hear the issues on a regular basis.

The
actions of the Rules Committee within the Ohio BOP will be monitored and
significant changes to the rules will be reported back to the pharmacy
department. The member of the pharmacy leadership team who applies to the BOP
Rules Committee will be responsible for tracking and reporting these metrics.
They will be review at the monthly pharmacy advocacy meetings.

The next
budget season will allocate $50,000 to Pharmacy Advocacy. This fund will
support membership to professional organizations for pharmacists and travel for
pharmacy leadership to promote advocacy. Each membership will be reimbursed
annually for up to $250 for each of the 50 pharmacist positions in the
department. All pharmacy leadership team members will be reimbursed up to
$1,500 annually for attendance at one conference to promote pharmacy advocacy.

Conclusion

                  As a profession, pharmacy has
historically not placed a strong focus on advocacy efforts. The dynamic healthcare
system and unpredictable shifts in the way patient care is provided have forced
pharmacists to assess their advocacy efforts. Taxpayers and lawmakers
contribute the majority of funding to expand healthcare, therefore it is
increasingly important that the pharmacy has a stake in the political and
clinical decisions that result from this funding.2  

It is the responsibility of pharmacy
leadership and ultimately the pharmacy director to educate and encourage
involvement in advocacy efforts within the entire department.9
Advocacy efforts should stem from the grassroots level and aim to reach
national lawmakers and governing bodies. All advocacy efforts should reach
other pharmacists, all healthcare providers, patients, and the community. The
success of pharmacy advocacy efforts is vital to sustain the innovative nature
of the profession and to ensure that pharmacy practice continues to expand
beyond the counter.

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