[Congressional Record Volume 142, Number 100 (Tuesday, July 9, 1996)]
[Extensions of Remarks]
[Pages E1228-E1229]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            THE SAFE MEDICATIONS FOR THE ELDERLY ACT [SMEA]

                                 ______
                                 

                        HON. FRANK PALLONE, JR.

                             of new jersey

                    in the house of representatives

                         Tuesday, July 9, 1996

  Mr. PALLONE. Mr. Speaker, each year tens of thousands of preventable 
health complications arise from inappropriate prescription drug use, 
costing billions annually. Yesterday, I introduced the Safe Medications 
for the Elderly Act or SMEA, a bill that seeks to correct this problem 
of inappropriate prescription drug use.
  Over the course of the last year, I have worked on a solution to this 
problem. In an effort to curb the number of seniors being hospitalized 
or seriously injured--sometimes leading to death--SMEA shifts the 
emphasis of pharmaceutical care from pharmacists who need to dispense 
drugs as rapidly as possible to pharmacists who will sit down with an 
elderly individual and provide adequate consultations with specific 
medications.
  As health care enters the 21st century, it is time to empower 
pharmacists and encourage them to play a greater role in health care 
delivery. Some pharmacists are currently spending the time necessary to 
improve patient compliance, but many are not.
  Senior citizens have special needs that require additional attention 
when it comes to taking prescription drugs. Pharmacists can be an 
important component of the health care puzzle making a significant 
difference in seniors lives.
  SMEA provides senior citizens with Medicare coverage for carefully 
targeted pharmaceutical care services including: vaccine 
administration, consultation with physicians, and consultation with 
patients to improve prescription drug compliance. Pharmacists only 
receive compensation if they achieve results.
  Numerous studies have confirmed the problems and high costs 
associated with inappropriate drug use, especially among senior 
citizens who are particularly vulnerable due to their higher rate of 
prescription drug usage for multiple health problems.
  Last year, the General Accounting Office [GAO] report that 
hospitalizations due to inappropriate prescription drug use cost about 
$20 billion according to FDA estimates. The report added that 
inappropriate use of prescription drugs is a ``potential health problem 
that is particularly acute for the elderly.''
  Another study cited in the Archives of Internal Medicine in October 
1995, stated that:

       Prescription-drug related problems--often caused by 
     patients not taking their drugs properly--cost an estimated 
     $76.6 billion in medical bills and cause 119,000 deaths a 
     year.

  A recent Wall Street Journal article (April 12, 1996, by Frank Bass) 
reported that a program under the H-E-B Grocery Co. and Nueces County's 
Memorial Medical Center in south Texas found that ``pharmacist 
counseling can both benefit chronically ill patients and reduce health-
care costs.'' The Wall Street Journal cited an H-E-B spokesman saying 
that ``among the people in the program, emergency-room trips have 
declined 23 percent, hospital admissions 33 percent, and physicians 
visits 41 percent.''
  These are just a few of the studies and stories that exist to 
illustrate the problems that the elderly encounter with prescription 
drug misuse and positive benefits of proper pharmacist counseling.
  Under the vaccine administration provision, pharmacists would be 
compensated for administering certain vaccines to elderly individuals 
This would only apply to States where pharmacists are authorized to 
provide such services. Typically, States with large rural populations 
certify pharmacists for vaccine administration, because in many 
instances, a pharmacist is the most accessible health care provider in 
a rural community.
  SMEA would provide one more opportunity for seniors to receive 
preventive medicine--a simple vaccine--that can save lives and Medicare 
dollars. Vaccines have a proven record as a cost savings to the health 
care system.
  The second section of SMEA involves physician consultations. A 
pharmacist would only be reimbursed when consulting a physician about a 
senior citizen's prescription drug regimen which resulted in the 
physician taking action on the pharmacist's advice. In other

[[Page E1229]]

words, if a pharmacist advises a physician that a particular drug that 
was prescribed would harm the senior and the physician agreed and wrote 
a new prescription, then the pharmacist would be reimbursed. Many times 
physicians are unaware of other drugs being prescribed to patients for 
other conditions or being human, make mistakes.
  Under this provision, a pharmacist would receive reimbursement only 
in instances that will benefit the health of the patient, but at the 
discretion of a physician. This provision is narrowly focused to 
provide the biggest bang for the buck in preventing elderly Medicare 
beneficiaries from becoming unnecessarily hospitalized or severely 
injured.
  This legislation encourages pharmacists to spend more time reviewing 
the patient's prescription drug regimen, instead of racing to dispense 
prescription drugs quicker. Under current pharmacy care, even 
pharmacists can overlook possible drug prescribing mistakes. SMEA 
provides more opportunity for adequate review.
  The final section of SMEA concerns consultations with a patient. A 
pharmacist would only be reimbursed when consulting a senior citizen 
which results in improved compliance with regard to specific drugs for 
six specific high-risk diseases or when a senior is on a drug regimen 
that requires four or more drugs.
  Here, senior citizens will receive counseling from pharmacists for 
treatments that necessitate extra concern with compliance. Again, this 
legislation is carefully constructed to maximize Medicare savings, 
minimize hospital visits, and improve health care delivery for the 
elderly.
  Pharmacists would be required to do more than just tell a patient to 
take two tablets a day with meals. SMEA would require pharmacists to do 
much more to improve patient compliance. Patient consultation sessions 
would involve increased pharmacist interaction with seniors about drug 
side effects, proper intake, and better drug regimen management with 
multiple prescriptions. These are just a few of the additional 
responsibilities that SMEA would require.
  The end result is America's seniors living longer and remaining 
healthier without undue hospitalization and excessive costs. The 
elderly win. Medicare wins. And smart health care prevails.

                          ____________________