The Torch, Spring/Summer 2010

Spring–Summer 2010 | TORCH 25 system, given the potential for pharmacists to profoundly reduce costs and enhance patient health. To understand the legislation’s impact on the pharmacy profession, we must begin with defining the role of the pharmacist. Traditionally, pharmacists have been viewed as professionals responsible for ensuring the accuracy of dispensed medication, dosage, and dosage form. In other words, pharmacists ensure that a patient receives the medication intended by the prescriber. Achieving this function could be reasonably, even appropriately, replaced with technology. Existing robotics and computerized management systems certainly represent more cost-effective means than hiring highly trained professionals. Furthermore, by using these technologies in mail-order prescription processing models, patients can receive accurately dispensed medications at their homes in a convenient manner, which certainly eliminates hassle and apparent cost. Unfortunately, some in the health care debate hold this narrow view of the pharmacy profession and fail to fully understand the implications of embracing this approach. Minimizing the role of pharmacists would lead to serious consequences. The Scope of Knowledge What exactly do pharmacists bring to the health care system? Based on increased educational requirements and cost-cutting innovation, health care workers and many others recognize the profound benefits of the pharmacy profession to our nation. The required professional curriculum for colleges and schools of pharmacy now includes between two and four years of prepharmacy coursework followed by a minimum of four years of professional coursework leading to a Doctor of Pharmacy degree. Almost one-third of the professional curriculum involves off- campus clinical training focused on evaluating and managing complex medication therapy regimens. In addition to learning in-depth information and application of medication therapy, students study patient assessment, pathophysiology, disease management, preventative medicine, health economics, methods to improve overall health, and the complexities of non-prescription medications. Many pursue postgraduate training in residencies and fellowships to improve their clinical skills or to specialize in areas like cardiology, oncology, pediatrics, or geriatrics. Clearly, the scope of pharmacy training has expanded well beyond the accuracy of prescriptions to the appropriateness of prescriptions. The changes to pharmacy curricula over the past 100 years were not made without due cause. The profession has evolved to include both science and art of practice, which cannot be replaced by automation. A Model for Savings Research indicates that the expanding roles of pharmacists can reduce the cost of health care. When speaking at the American Medical Association’s annual conference in June 2009, President Obama discussed the need to pursue excellent health care practice models and highlighted pharmacists as major resources to reduce costs. As an example, he cited the Asheville Project in North Carolina, where pharmacists were empowered to provide Medication Therapy Management (MTM) services to patients. MTM involves the pharmacist working with both the patient and physician to monitor the effects of medication therapy and to recommend changes when they are needed. Between 1997 and 2001, direct medical costs in Asheville were reduced by $1,200–$1,800 per patient per year when compared to baseline costs. This model has been repeated in cities around the nation with similar results and is now considered a proven model. Proper medication use is the key to reducing hospitalizations, improving care, and reducing costs for treatment of chronic disease, which costs approximately $1.3 trillion annually in the U.S. Inappropriate medication use costs an estimated $177 billion annually. There are more than 10,000 prescription medications and more