Health Policy Changes: Challenges and Opportunities for Hospital Pharmacists
TL/DR –
Recent changes in healthcare policy, such as the implementation of the Inflation Reduction Act’s Medicare drug price negotiation program, could inadvertently lead to higher upfront drug costs for health systems due to the use of rebates instead of direct discounts. However, there is growing recognition of pharmacists as clinical care providers, with expanding reimbursement opportunities at the state level suggesting broader systemic change. Regulatory guidance is needed to support cost-effective care and strengthen the role of pharmacists in delivering it.
Recent Health Care Regulations Alter Pharmacy Landscape
The recent changes in health care policy and regulations are transforming the pharmacy landscape, especially in hospital settings. The impact of the Inflation Reduction Act’s Medicare drug price negotiation program on health systems is significant, introducing complexities that could lead to higher upfront drug costs. There are also concerns about similar trends impacting the 340B Drug Pricing Program, traditionally effective in reducing drug prices.
Simultaneously, the expanding recognition of pharmacists as clinical care providers could herald broader changes. This offers potential for new reimbursement opportunities at the state level, highlighting the need for regulatory support to drive cost-effective care delivery through pharmacists.
Challenges and Opportunities for Pharmacists in Health-System Settings
Tom Kraus, MHS, explains one challenge is the potential for higher drug costs due to the Medicare drug price negotiation model introduced by the Biden administration. The program’s implementation allows manufacturers to deliver discounts as rebates. This could lead to pharmacists carrying higher priced inventory, with potential issues in securing rebate dollars.
Kraus emphasizes on the need for the Centers for Medicare & Medicaid Services (CMS) to revisit the program’s implementation, ensuring manufacturers provide upfront discounts. He also indicates the potential impact of manufacturers converting 340B upfront discounts to a rebate program, a move opposed by the Health Resources and Services Administration (HRSA).
Furthermore, he asserts that the government should clearly communicate the intention for upfront discounts, which could alleviate concerns about IRA rebates. He also identifies promising opportunities around pharmacist payment, citing favorable shifts in policy makers’ attitudes towards pharmacists as clinical care providers.
Notably, five states have expanded pharmacist reimbursement in the initial months of 2025. This progression could exert pressure on the federal government to standardize coverage for Medicare beneficiaries, potentially paving the way for Medicare reimbursement for clinical services.
—
Read More US Economic News