Estimating the Cost of the Medicare Pharmacist Services Coverage Act of 2001

• Published in: Pharmacotherapy 2003-08, Vol.23 (8), p.955-965
• Main Authors: Poole, Virginia H., Moran, Donald W., Webb, C. Edwin
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Costs and Cost Analysis - statistics & numerical data; Health Care Costs - statistics & numerical data; Health participants; Humans; Medical sciences; Medicare - legislation & jurisprudence; Patient Care - economics; Pharmaceutical Services - economics; Pharmaceutical Services - legislation & jurisprudence; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.23.8.955.32880

Background. In recent years considerable attention has focused on pharmacists' professional evolution toward patient care‐oriented practice. The Pharmacist Provider Coalition (PPC), established in 2000, seeks recognition and payment for pharmacists' patient care services. Concerted effort by the PPC on this issue resulted in the introduction of the Medicare Pharmacist Services Coverage Act of 2001, which would have amended Title XVIII of the Social Security Act to create new types of covered services under Medicare and recognize pharmacist practitioners as providers. However, the legislation was not passed by the 107th Congress. Study Objectives. The PPC engaged The Moran Company to measure the potential net cost to the United States government of the Medicare Pharmacist Services Coverage Act of 2001, and to perform this measurement in a manner that is consistent with the cost‐projection methods used by the Congressional Budget Office (CBO). Design. The model is anchored to the 10‐year projection of revenues and spending within the federal government developed annually by the CBO. It examines the anticipated magnitude and cost of patient care services with respect to chronic disease and pharmaceutical therapy management, in both facility and nonfacility settings. Results. The methodology yields a final cost estimate of $427 million in 2004, the first year of implementation, and a 10‐year estimate of $13 billion. Conclusions. Recognition of pharmacists as providers of selected drug therapy management services under Medicare will have a considerable financial impact. It is instructive, however, to view the 10‐year cost estimate of $13 billion for pharmaceutical therapy management in light of the CBO's projected $1.5 trillion estimate, over the same time frame, for drug spending among the Medicare population.