Dr. Urmie is an associate professor in the Health Services Research Division at the University of Iowa College of Pharmacy. She received a B.S. 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 an M.S. in pharmacy administration and a Ph.D. in social and administrative sciences in pharmacy. Her teaching interests include insurance and reimbursement in pharmacy, health insurance, the US 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.
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 health care delivery and financing will be changed by the Affordable Care Act of 2010 (commonly referred to as “health care reform”).
Discuss federal and state legislation that is of interest to pharmacists.
Discuss challenges and opportunities for pharmacists in Medicare, Medicaid, and under health care reform.
Joshua Anderson is a newly licensed pharmacist who just started working at Badger Pharmacy in North Central Wisconsin. Bob Smart, the pharmacy owner, recently returned from a pharmacy association meeting and is eager to talk to Joshua about what he has learned. Bob says “Joshua, I need to sit down this week and write a letter to our state legislator about H.R. 3546. You should write one too. It is critical to Badger Pharmacy's survival that this legislation passes! Have you seen the latest set of Medicare Prescription Drug Plan (PDP) contracts? Not to mention all this talk about health care reform. I just don't know how it will affect Badger Pharmacy. Oh, and legislation has been intro-duced again to reduce Medicaid reimbursement in Wisconsin. I sure hope the pharmacy association can lobby successfully to defeat that bill.” Joshua thinks to himself “What on earth is he talking about. I hate politics—I'm here to help patients with their medication therapy and learn how to manage a pharmacy, not be a politician. Why should I get involved? Oh, and who's “bill” and why do we need to defeat him?” However, as a new employee Joshua is eager to make a good impression so he wants to learn more. Joshua wonders what is the best way to learn more about the health policy process. He vaguely remembers learning about Medicare and Medicaid in pharmacy school, and he knows he needs to understand the basics in case patients ask him questions, but he does not understand how pharmacists can influence government ...