Dr. Urmie is an associate professor in the Health Services Research Division at the University of Iowa College of Pharmacy. She received her BS in pharmacy from the University of Wisconsin and worked as a community pharmacist prior to returning to the University of Wisconsin for graduate school, where she received MS in pharmacy administration and PhD in social and administrative sciences in pharmacy. Her teaching interests include insurance and reimbursement in pharmacy, health insurance, the U.S. health care system, health policy, and pharmacy management. Her main areas of research are prescription drug insurance and consumer preferences related to health care use.
Dr. Urick is a PhD student studying Pharmaceutical Socioeconomics in the Health Services Research Division at the University of Iowa College of Pharmacy. He received his PharmD from Drake University and works part time as a community pharmacist. Dr. Urick’s teaching interests include leadership, pharmacy management, health policy, the U.S. health care system and pharmacy history. His research interests include reimbursement policy for pharmaceuticals and pharmacy’s impact on health care cost and quality.
After completing this chapter, readers should be able to
Understand the health policy process in the United States and how pharmacists can get involved.
Describe resources to understand and stay current on health policy issues relevant to pharmacists.
Describe the Medicare program, including Parts A and B, Medicare Advantage, and Medigap plans.
Describe Medicare Part D and discuss its effects on pharmacies.
Describe the Medicaid program and understand the dual role of states and the federal government.
Explain how the Affordable Care Act (ACA) of 2010 has changed health care delivery and financing.
Discuss federal and state legislation that is of interest to pharmacists, including recent efforts to achieve provider status.
Discuss how the health care policy and government health care programs present challenges and opportunities for pharmacists.
Katie Olert, a Pharmacy Manager at a small chain pharmacy, recently took a class on smoking cessation. She enjoys using her new skills to help people quit smoking, but wishes she could bill for her time and provide varenicline (Chantix™) to her patients. Checking her email one morning, she sees a message from the state pharmacy association informing her about a bill, H.R. 321, being considered in the state legislature that would designate pharmacists as health care providers and allow them to, among other things, furnish prescription smoking cessation aids to patients without the need of a prescription.
Katie knows that this would make a big difference in her ability to provide care for patients and really wants to have these new privileges. She doesn’t know, though, how to advocate for this bill and the idea of “getting involved in politics” makes her uncomfortable. She also doesn’t understand why the state has the power to make this change but ...