[Congressional Record Volume 147, Number 74 (Friday, May 25, 2001)]
[Senate]
[Pages S5706-S5707]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JOHNSON:
  S. 974. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of pharmacist services under part B of the 
Medicare program; to the Committee on Finance.
  Mr. JOHNSON. Mr. President, I am pleased to be able to introduce 
legislation, known as the Medicare Pharmacist Services Coverage Act, 
that will provide for important patient safety and health care quality 
improvements in the Medicare program. This legislation will reform 
Medicare by recognizing qualified pharmacists as health care providers 
within the Medicare program and make available to beneficiaries 
important drug therapy management services that these valuable health 
professionals can and do provide. These services, which are coordinated 
in direct collaboration with physicians and other health care 
professionals as authorized by State law, help patients make the best 
possible use of their medications.
  The members of this body know very well the vital role that today's 
powerful and effective medications play in the maintenance of health 
and well-being of our nation's seniors. The substantial and important 
discussion now underway on how best to craft and implement a 
prescription drug benefit for Medicare beneficiaries is an explicit 
recognition of this vital role. But access to the medications, even at 
the most affordable prices possible, is only one part of the equation 
in achieving the kinds of health care outcomes that patients and their 
health care providers desire. That is where today's pharmacists play a 
pivotal role.
  But members of this body may not be as aware of the tremendous 
changes in pharmacy practice and education that have taken place in the 
past decade that have resulted in an expansion of pharmacists' 
capabilities and responsibilities. Fortunately for my office Dr. Brian 
Kaatz, a clinical pharmacist and faculty member of the College of 
Pharmacy at South Dakota State University was able to spend 6 months 
with us here in Washington last year as we studied and evaluated the 
many policy issues and concerns related to a Medicare prescription drug 
benefit. In the course of that time it became clear to me and to 
members of my staff that pharmacists are critical in assuring safer and 
more effective medication use by our nation's seniors.
  In addition to the important and continuing responsibility for 
assuring accurate, safe medication dispensing, compounding, and 
counseling, pharmacists now provide a much more comprehensive range of 
clinical, consultative, and educational services. Thirty States, the 
Veterans Administration, and the Indian Health Service, among others, 
all recognize the value of collaborative drug therapy management 
services as a way to provide optimal

[[Page S5707]]

patient care using the specialized education and training of 
pharmacists. Unfortunately, Medicare does not.
  Indeed, payment for prescription drugs in almost all types of health 
plans and programs focuses on payment for the product and the 
associated costs of its distribution to patients. The logical financial 
incentive therefore is to dispense more medications, not fewer. Payment 
to the pharmacist for time spent in reducing the number of medications 
the patient is taking or enhancing the patient's ability to understand 
and more properly use the medications they do need is provided only by 
some forward-thinking payers and programs. Unfortunately, Medicare is 
not among them.
  Access to pharmacists' collaborative drug therapy management services 
is particularly important right now, while many Medicare beneficiaries 
are struggling to pay substantial out-of-pocket costs for their 
prescription medications. On average, persons aged 65 and older 
currently take 5 or more medications each day. These medications are 
often prescribed by several different physicians for concurrent chronic 
and acute conditions. Recently published research has indicated that 
drug-related problems cost the U.S. health care system as much as $177 
billion each year, an amount equal to the ten-year cost projections for 
some of the more modest Medicare prescription drug coverage proposals 
now being discussed. A substantial portion of this expense is 
preventable through collaborative patient care services provided by 
pharmacists working with patients and their physicians.
  With careful examination of a patient's total drug regimen, 
pharmacists can eliminate unnecessary or counterproductive treatments. 
For example, pharmacists working closely with the health care team can 
identify or prevent duplicate medications, drugs that cancel each other 
out, or combinations that can damage hearts or kidneys. Pharmacists may 
also find that a newer multi-action drug may be exchanged for two older 
drugs or a slightly more expensive drug may be substituted for a less 
expensive alternative that causes side effects and results in the 
patient either taking additional medication or stopping their 
medication with the result that their medical condition worsens.
  The overuse of medications is particularly common in the elderly, who 
tend to have more chronic conditions that call for drug treatment. In 
addition, physiological changes that occur naturally in the aging 
process diminish the body's ability to process medications, increasing 
the likelihood of medication-related complications.
  The pharmacist's specialized training in drug therapy management has 
been demonstrated repeatedly to improve the quality of care patients 
receive and to control health care costs associated with medication 
complications. As a precursor to a prescription drug benefit, it makes 
sense to take this proven initial step to improve the medication use 
process. This will help Medicare beneficiaries immediately by ensuring 
that each precious dollar spent out-of-pocket is spent wisely on a 
streamlined and effective drug therapy regimen. This is an important 
benefit that we can deliver now while Congress works to address the 
more difficult economic and political issues impacting a prescription 
drug benefit.
  In addition, the quality improvement and cost-control resulting from 
this benefit establishes a critical infrastructure element for whatever 
Medicare prescription drug benefit is ultimately put in place. By 
supporting pharmacists who are working to improve the efficacy and 
cost-effectiveness of medication regimens, as well as reducing 
preventable medication-related complications and adverse drug events 
that result in unnecessary health care expenditures, we can enhance the 
prospects of achieving an affordable Medicare drug benefit that will 
bring real value to beneficiaries and taxpayers alike.
  Recognition of qualified pharmacists as providers within the Medicare 
program is the logical and very affordable first step in establishing 
the essential infrastructure of a Medicare prescription drug benefit. 
As the Institute of Medicine report ``To Err is Human: Building a Safer 
Health System'' stated: ``Because of the immense variety and complexity 
of medications now available, it is impossible for nurses and doctors 
to keep up with all of the information required for safe medication 
use. The pharmacist has become an essential resource . . . and thus 
access to his or her expertise must be possible at all times.'' This 
legislation will empower Medicare to catch up on this important health 
care quality issue. Pharmacists' collaborative drug therapy management 
services can and will make a real difference in the lives of Medicare 
beneficiaries. I encourage my colleagues on both sides of the aisle to 
give this proposal their serious consideration.
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