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Advocates for drug collaboration bill say
passage is a race against time
By Kyle Cheney May 29, 2008 ...With the last major policy objections apparently overcome, a bill aimed at improving patient health by forming collaborative agreements between doctors and pharmacists faces one more formidable obstacle: a time limit. With two months of formal meetings left in this two-year session, backers of a bill (S 2706) enabling pharmacists, with the permission of a physician, to alter a patient's drug regimen, say six years of stark disagreement among competing interests have ended with a breakthrough consensus bill that is awaiting action in the House. The bill, sponsored by Sen. Richard Moore (D-Uxbridge), co-chair of the Committee on Health Care Financing, passed in the Senate May 15. Formal sessions of the Legislature typically end on July 31 in election years. With lawmakers gearing up for reelection campaigns and weighing thousands of bills, and with all proposals subject to the whim of legislative leaders, the fact that opposition has evaporated does not guarantee the bill's passage. Supporters say failure to pass legislation to date is costing the state money, endangering patients and discouraging local pharmacy students from practicing their craft in Massachusetts. The practice known as collaborative drug therapy management (CDTM) is the norm in 43 states - New Hampshire became the most recent state to approve it in 2006. CDTM allows physicians to form agreements with pharmacists that authorize the pharmacists to manage patient prescriptions. The agreements would be contingent on patient consent. In addition, any changes made to a patient's regimen must be reported to that patient's physician within 24 hours. According to the bill, collaborative agreements could also enable pharmacists to order laboratory tests, provide counseling and education to patients and to administer drugs. "[CDTM] has shown to be improving the quality of care and to be reducing the errors that occur when you have multiple prescribers," Moore said in a phone interview. Supporters say the agreements will help get patients the drugs they need more rapidly, without having to set up time-consuming appointments with their physicians first. Consequently, they say, patients will suffer fewer drug-related medical emergencies and require fewer hospital trips and doctor visits, saving costs in the long run. "Getting the right med to the right person at the right time can save huge dollars," said Mary Ann Mulligan, a lobbyist for the Massachusetts Society of Health-System Pharmacists. "If my meds are properly managed, I don't get hospitalized. HIV and AIDS [patients], people who are managing very complex regimens, are going to truly benefit from this." Pharmacists spent years at odds over the issue with the Massachusetts Medical Society, which opposed earlier proposals the group said were too vague and left room for pharmacists to unilaterally alter prescriptions without explicit physician approval. After lawmakers challenged the opposing sides to negotiate, proponents narrowed the language to ensure patients consenting to a collaborative agreement received an explicit referral from a doctor to a specific pharmacist. "We weren't going to get in the way of good clinical practice just because it's done by pharmacists," said Bill Ryder, a government and community relations official for the Massachusetts Medical Society. "I think this was a good example of people working together." One of the most immediate impacts of the bill will be its effect on the state's ability to retain pharmacists trained at local colleges and expert faculty, said Kathy Keough, executive director of government affairs at the Massachusetts College of Pharmacy and Health Sciences. "Many faculty members are taken aback that in many of the states they're coming from, they've been doing CDTM for years," Keough said. "It's sort of a slap in the face of your profession in some cases. For our students, we're teaching all of these clinical skills once they graduate and move on and start practicing … it puts us at a competitive disadvantage." Most recently, supporters of the bill, confident of a consensus, were given a scare when the Massachusetts Chain Pharmacy Council objected to provisions that would have prevented them from hiring a physician to oversee their pharmacists. Backers of the bill, concerned that pharmacies would hire doctors simply to give out or alter prescriptions, tailored the provision to allow pharmacies to hire doctors as overseers of the pharmacists but preventing them from practicing CDTM and changing prescriptions. The bill's stakeholders, which also include the Massachusetts Pharmacists Association, the Massachusetts Independent Pharmacists Association, the Massachusetts College of Pharmacy and Health Sciences and the Northeastern University School of Pharmacy, hailed the compromises and tweaks as an example of lawmaking at its finest; however, supporters interviewed by the News Service said they were worried the House may simply run out of time before members act on the bill. "It's like David and Goliath at this point," Keough said. "This is the right thing. Now that we've come up with all the solutions without any objections, it's just a matter of doing the final push. I think we're going to try to do a little grassroots organizing to have [pharmacists] call their local reps." Mulligan agreed, saying, "The only obstacle I know of at this point is time." Rep. Peter Koutoujian, who has taken the lead on shepherding the bill through the House, was not available for comment. The bill will require the Board of Registration in Medicine and the Board of Registration in Pharmacy to issue regulations in consultation with the Department of Public Health the Massachusetts Pharmacists Association, the Massachusetts Medical Society, the Massachusetts Hospital Association, the Massachusetts Psychiatric Association and 10 other stakeholders. DPH would also have to issue its own regulations governing implementation of CDTM. A spokeswoman for DPH said the department had no position on the bill. Story courtesy of the State House News Service. |
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