Jesse Hogue, Pharm.D., Bronson Methodist Hospital, Kalamazoo, 2019-2020 Michigan ASHP Delegate
The American Society of Health-System Pharmacists (ASHP) will convene its 72nd Annual Session of the House of Delegates virtually (it’s a whole new world!) this June to address an agenda that includes considering 25 policy recommendations and a statement, receiving board and committee reports and considering a variety of other society business items. Your elected delegates this year are Ryan Bickel, Peggy Malovrh, Mike Ruffing and me, with Jim Lile and Dianne Malburg as alternates. The Michigan delegates have already been quite active in 2020. In March, we caucused to consider 15 policy recommendations for the Virtual House of Delegates, and supported all but one policy which we thought needed to be worded more clearly. After voting, 13 of the policies met the >85 percent threshold and were approved and two were deferred for consideration in June. We all also participated in virtual Regional Delegate Conferences in late April and caucused again in early May to discuss which of the 25 policies might be of most interest to MSHP members and/or for which we would like member input. While a full discussion of each of the policy recommendations is beyond the scope of this article, the few we chose to highlight are outlined below.
New Categories of Licensed Pharmacy Personnel. The Council on Public Policy was tasked with considering this issue after several states introduced laws allowing the creation of a “pharmacist assistant.” The Council questioned the need for any new midlevel role. Consistent with the stance MSHP/MPA has traditionally taken, the Council felt the focus should be on reinforcing the importance of and professionalization of the pharmacy technician. The policy recommendation is therefore to oppose the creation of new categories of licensed pharmacy personnel. In support of this policy, many delegates noted that creation of midlevel pharmacist assistants would likely lead to employers cutting back on pharmacists, negatively impacting patient care and making a bad job market even worse.
Funding, Expertise and Oversight of State Boards of Pharmacy. This was an existing policy that the Council on Public Policy reviewed as part of sunset review. The existing policy did a nice job supporting the role and necessary funding of the state boards of pharmacy. After review, the Council has proposed updates to the policy which more clearly identify the need for health-system representation on the state boards of pharmacy, as well as pharmacy technicians. The existing policy also identifies pharmacists competent in the applicable area of practice as the people who should perform board inspections. Some delegates have proposed broadening it to recommend pharmacy technicians as inspectors (see below for proposed language) – your Michigan delegates would like to know if you agree or disagree with this, please let us know your thoughts!
- To advocate that inspections be performed only by pharmacists and pharmacy technicians competent about the applicable area of practice.
Safety and Efficacy of Compounded Topical Formulations. The Council on Therapeutics crafted this proposed policy to speak to the clinical effectiveness of and issues pertaining to compounded topical formulations. The Council identified a lack of reliable data demonstrating safety and efficacy, lack of standardized composition and concentration and significant increases in insurance fraud with these products. It does not seek to oppose compounded topical formulation, recognizing there is clinical evidence to support their use in some disease states. Rather, it encourages appropriate reimbursement for medically necessary compounded products as well as for hospitals and health systems, with pharmacist leadership, to develop policies and procedures to support informed decision making on these products. The policy includes wording that implies a call for more regulation but that will likely be amended to shift the focus to advocate for internal process that ensure the quality and safety of the products rather than outside regulation. The Michigan delegates support this, understanding that regulation may mean PCAB or similar certification, which would be untenable. We may, however, propose an amendment to ask ASHP to develop a repository of evidence-based formulations that could serve as a resource for topical products compounding for members. If you have strong feelings on these ideas, please let us know!
Residency Training for Pharmacists Who Provide Direct Patient Care. With MSHP’s history of strongly supporting residency training, we thought this policy would be of high interest to our membership. For this policy recommendation, the Council on Education and Workforce Development reviewed two older policies related to residency training and decided they should be updated and combined. The resulting statement continues to support requiring residency training for new pharmacy graduates intending to serve in direct patient care roles, while still recognizing that comparable skills may be attained through years of practice experience for pharmacists previously unable to complete a residency. The old policy included a target of 2020 for this requirement. After considerable discussion, the Council agreed that the need for this is now, and so opted not to include a future target date in the proposed policy statement to underscore the current urgent need for residency training and the expansion of training sites.
Preserving Patient Access to Pharmacy Services in Medically Underserved Areas. Since patient access to care in rural and underserved areas has been a big issue in our state, we thought this proposed new policy from the Council on Pharmacy Management would be of interest to MSHP members. The Council recognized the national trend of low reimbursement rates and decreasing populations in rural and underserved areas resulting in closures of hospitals and clinics and, thus, challenges in recruitment and retention of healthcare professionals. These trends disproportionately affect elderly and low-income populations. The new policy calls for funding and innovative payment models to preserve patient access to acute and ambulatory care pharmacy services in these areas, support for telepharmacy to extend patient care services and enhance continuity of care, advocacy for availability of advanced communication technology to support this care model in rural and underserved areas, and loan forgiveness or incentive programs to aid in recruitment and retention in these areas.
Continuity of Care in Pharmacy Payer Networks. Similar to the previous policy, payer policies and practices that adversely affect continuity of care has been a hot topic in our state. This new policy statement, also from the Council on Pharmacy Management, is very similar to a policy our MSHP caucus in the MPA House of Delegates helped work on earlier this year. This proposed policy would highlight our opposition to provider access criteria that impose requirements or qualifications on participation in pharmacy payer networks that interfere with patient continuity of care or patient site-of-care options.
This discussion merely scratches the surface of the policy recommendations. Many of the other policy recommendations will also be of significant interest to MSHP members, and they all will affect us as health-system pharmacists, so I would encourage you to review the proposed policies and contact one of the delegates with any questions or comments you may have (Jesse: firstname.lastname@example.org; Mike: MRuffing@dmc.org; Ryan: Ryan.Bickel@ascension.org; Peggy: Margaret.Malovrh@Sparrow.org). I have listed the titles of all the policy recommendations below for your review. Members can view the official language of the policy recommendations at the ASHP House of Delegates website as well as follow online discussions via the House of Delegates community within ASHP Connect. There has already been quite a bit of good discussion on ASHP Connect, feel free to join the conversation!
Policy Recommendations to be considered by the 2020 ASHP House of Delegates:
COUNCIL ON PUBLIC POLICY
- Credentialing and Privileging by Regulators, Payers, and Providers of Collaborative Practice
- Access to Affordable Healthcare
- Care-Commensurate Reimbursement
- Importation of Drug Products
- Public Quality Standards for Biologic Products
- New Categories of Licensed Pharmacy Personnel
- Funding, Expertise, and Oversight of State Boards of Pharmacy
- Dispensing by Nonpharmacists and Nonprescribers
COUNCIL ON THERAPEUTICS
- Naloxone Availability
- Safety and Efficacy of Compounded Topical Formulations
- Postmarketing Studies
- Gabapentin as a Controlled Substance
COUNCIL ON EDUCATION AND WORKFORCE DEVELOPMENT
- Residency Training for Pharmacists Who Provide Direct Patient Care
COUNCIL ON PHARMACY MANAGEMENT
- Pharmacist’s Role in Health Insurance Benefit Design
- Preserving Patient Access to Pharmacy Services in Medically Underserved Areas
- Multistate Pharmacist Licensure
- Continuity of Care in Pharmacy Payer Networks
- Network Connectivity and Interoperability for Continuity of Care
- Medication Formulary System Management
- Health-System Use of Medications Supplied to Patients
- Health-System Use of Administration Devices Supplied Directly to Patients
- Staffing for Safe and Effective Patient Care
COUNCIL ON PHARMACY PRACTICE
- Role of the Pharmacy Workforce in Violence Prevention
- Role of the Pharmacy Workforce in Preventing Accidental and Intentional Firearm Injury and Death
- Safe Use of Transdermal System Patches
SECTION OF PHARMACY INFORMATICS AND TECHNOLOGY
- ASHP Statement on the Use of Artificial Intelligence in Pharmacy