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Price Growth Comparisons

Brands and Generics 1988 to 1992
Wholesaler Acqiusition Price, June of Each Year

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Gen 1 1988 Gen 1 1992 ☐Brand 1988 N Brand 1992 Gen 2 1988 Gen 2 1992

The University of Mississippi

Mr. STARK. Mr. Webster.

STATEMENT OF R. TIMOTHY WEBSTER, EXECUTIVE DIRECTOR, AMERICAN SOCIETY OF CONSULTANT PHARMACISTS, ON BEHALF OF THE COALITION FOR CONSUMER ACCESS TO PHARMACEUTICAL CARE, ACCOMPANIED BY LINDA

GOLODNER, PRESIDENT, NATIONAL CONSUMERS LEAGUE Mr. WEBSTER. Thank you, Mr. Chairman, members of the subcommittee. I am accompanied today by Linda Golodner, president of the National Consumers League. We are testifying today on behalf of the Coalition for Consumer Access to Pharmaceutical Care. This is a national coalition of pharmacists and consumer organizations whose purpose is to increase awareness and utilization of the benefits of pharmaceutical care.

The organizations in the coalition are identified in our written statement. The coalition supports efforts to reform the existing health care system, including improvements to the Medicare program that will insure access to quality health care for all Americans. We believe it is critical that professional pharmacy services, pharmaceutical care, be recognized as part of the solution to the three most significant problems in health care reform: escalating costs, insufficient access, and inconsistent quality.

More than anything else, the coalition believes in the beneficial effect of drug therapies and the need to maximize this benefit on behalf of consumers. Pharmacist services can assure that the most cost-effective medication is being given to the patient and that the patient knows how to take the medication properly.

Our most compelling message is that pharmacists make a substantial difference in the effectiveness of drug therapy. They are available in every community and health care setting and can save the health care system far more money than their services cost. Simply put, no prescription drug benefit can be effective, either from a therapeutic or cost perspective, without incorporating pharmacist services.

Pharmaceutical care is the process by which a pharmacist interacts directly with a patient and other health care professionals to design, implement, and monitor a therapeutic plan that improves the patient's quality of life. Specific pharmaceutical care services provided by pharmacists will include: monitoring drug compliance, reviewing of medication used to assure quality outcomes, counseling the patients to assure adequate understanding of the prescribed medications, identifying and resolving drug interactions, selecting cost-effective generic drug products, and providing case management within or outside a managed health care plan, to coordinate medication use as an individual goes from the community to a hospital or long-term care setting.

As Ms. Golodner's presence indicates, consumers believe pharmacists can make a significant contribution to their health care. For example, in our written testimony, we have provided the results of a recent AARP survey that documents the high degree to which older Americans benefit from the services of pharmacists. Nevertheless, critical problems remain. Of the surveyed population, 42 percent do not always comply with their doctor's orders. And 29 percent stop taking the medication before it runs out.

Because of these and other problems, the combining of medications with pharmaceutical care offers an accessible and effective method for treating disease. Each year a significant amount of money is spent on unnecessary medications and to treat illnesses that result from inappropriately managed therapy.

Consider the following: Medication-related problems, such as noncompliance by patients, is responsible for an estimated 10 percent of all hospital admissions and 23 percent of all nursing home admissions. The failure to fill or refill prescriptions has resulted in an estimated cost of $8.5 billion for increased hospital admissions and physician visits, nearly 1 percent of the country's total health care expenditures.

Drug interactions and adverse drug reactions are said to account for about 70 percent of all hospitalizations. Yet about 70 percent of adverse effects are predictable and preventable through logical application of existing information.

A recent study of medication errors in pharmacist interventions conducted in community pharmacies found that over one-fourth of medication errors identified and corrected by pharmacists could have resulted in harm to the patient. The direct cost of medical care that was avoided as a result of pharmacist interventions was estimated to be at least $123 per problematic prescription.

Mr. Chairman, in conclusion, pharmacists are readily available in every community, hospital, long term care facility, managed care network, and HMO. They are ready to make this contribution to better, more cost-effective health care. When pharmacists, the health care professionals most knowledgeable about the use of pharmaceutical products, undertake these care giving activities, they save the system billions of dollars and improve the health of millions.

This subcommittee has the opportunity to create a sound, costeffective pharmaceutical care situation for our Nation. We urge you and your colleagues to take this opportunity by incorporating pharmaceutical care services into a prescription drug benefit in Medicare. The pharmacy profession is committed to helping you meet the challenge of providing accessible quality and cost-effective health care to beneficiaries of the Medicare program.

This concludes our oral remarks and the summary of our written statement for the record.

Ms. Golodner and I would be pleased to answer the subcommittee's questions and to work with you to make sure that are our Nation's elderly receive the care that they deserve.

Mr. STARK. Thank you.

[The prepared statement follows:]

TESTIMONY OF R. TIMOTHY WEBSTER

COALITION FOR CONSUMER ACCESS TO PHARMACEUTICAL CARE

Mr. Chairman, my name is Tim Webster. I am a pharmacist and the Executive Director of the American Society of Consultant Pharmacists. I am accompanied by Linda Golodner, President of the National Consumers League. We thank you for the opportunity to testify and applaud your leadership in advocating "a reasonable drug benefit for seniors paired with an effective cost containment strategy for pharmaceutical products."

We are testifying today on behalf of the Coalition for Consumer Access to Pharmaceutical Care. This is a national coalition of pharmacist and consumer organizations whose purpose is to increase awareness and utilization of the benefits of pharmaceutical care. In addition to our two organizations, the membership of the Coalition consists of the Academy of Managed Care Pharmacy, the American Association of Colleges of Pharmacy, the American College of Clinical Pharmacy, the American Pharmaceutical Association, the American Society of Hospital Pharmacists, and the National Pharmaceutical Association.

The Coalition supports efforts to reform the existing health care system, including improvements to the Medicare program, that will assure access to quality health care for all Americans. Within this effort, we believe it is critical for professional pharmacy services--pharmaceutical care--to be recognized as part of the solution to the three most significant problems in health care reform: escalating costs, insufficient access, and inconsistent quality.

More than anything else, we believe in the beneficial effect of drug therapies and the need to maximize this benefit on behalf of consumers. One critical key is the utilization of pharmacist services to assure that the most cost-effective medication is being given to the patient and that the patient knows how to properly take the medication.

Our most compelling message is that pharmacists make a substantial difference in the effectiveness of drug therapy. They are available in every community and health care setting, and can save the health care system far more money than their services cost. Simply put, no drug product benefit can be effective, either from therapeutic or cost perspective, without incorporating pharmacist services.

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PRINCIPLES OF PHARMACEUTICAL CARE

Pharmaceutical care is the process in which a pharmacist is involved in direct interaction with a patient and other health care professionals in designing, implementing, and monitoring a therapeutic plan that will produce clinical outcomes that improve

the patient's quality of life. Specifically, the pharmaceutical care services provided by pharmacists include: monitoring drug compliance; systematic review of medication use to assure quality outcomes; patient counseling to assure adequate understanding of the prescribed medications; identifying and resolving drug interactions; selecting cost-effective generic drug products; and case management (within or outside a managed care health plan) which coordinates medication use as an individual goes from the community to a hospital or long-term care setting.

Our Coalition, and nearly 50 other state and national pharmacy organizations, are united in endorsing four principles fundamental to the organization and delivery of pharmaceutical care under a revised Medicare program or under a reformed health care

system. These are:

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Pharmaceutical products and pharmaceutical care (pharmacists' services) should be included as a core benefit in a reformed health care system.

Pharmacists' services and proper management of medications can generate significant savings to a reformed health care system.

Quality assurance programs administered by pharmacists can significantly improve the effectiveness of medications in achieving positive patient outcomes.

Integrated information systems that include pharmacists offer the potential for cost savings and better patient outcomes.

These principles are described further in four one-page position statements that are appended to our testimony.

PROBLEMS ADDRESSED BY PHARMACEUTICAL CARE

Both the need for good pharmaceutical care and the problems it addresses were graphically illustrated by a 1991 AARP survey of individuals 45 and older. It documents the degree to which older Americans benefit from the services of pharmacists-

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33% cite pharmacists as their principal source of information about prescription drugs;

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63% are likely to ask their pharmacist questions when having a prescription filled for the first time;

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83% will ask their pharmacist questions about a new prescription drug if the questions arise after they leave the doctor's office; and

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