Notes from HOPA: Not just for oncology pharmacists

Joel Claycomb
I recently had the opportunity to attend the 10th Annual Hematology/Oncology Pharmacy Association (HOPA) conference, which took place at the end of March in New Orleans.

HOPA was officially formed in 2004 with the mission “to reduce the burden of cancer on society and promote optimal, cost-effective care for those affected by cancer.” Ultimately, the organization would like to see a hematology/oncology pharmacist participating in the care of every patient affected by cancer. Over the past 10 years, membership has grown to more than 2,000 members, with more than 800 members attending this year’s conference. In the past four years alone, membership has grown nearly 25%.

Altruism and advocacy

The first session I attended upon arrival at the conference was the keynote session. Founding member and former president John G Kuhn, PharmD, was the speaker. Kuhn has mentored many pharmacists over the years; they, in turn, are now mentoring young pharmacists. Kuhn, a vital advocate for the organization from the beginning, spoke of our responsibility as pharmacists to help educate the next generation. He also extolled the virtues of altruism in practice, closing with the simple, yet often overlooked sentiment that “when you help somebody, you go home happy.”

The second session I attended was the HOPA Advocacy group. Topics addressed during this discussion included prevention of counterfeit medications in the U.S. marketplace; ensuring responsible use of opioid pain medications (in connection with the potential rescheduling of hydrocodone) while maintaining oncology patients’ access to these drugs; and commendation of the efforts of CVS to eliminate tobacco products from retail locations. Most of the discussion delved into potential new legislation concerning pharmacists’ role as providers in healthcare teams.

The crux of this discussion was presented by Jeremy Scott, senior vice president, and Erin Morton, senior advisor for policy and advocacy, who work on Capitol Hill. They began by describing the current fragmented state of Congress. With a House of Representatives controlled by Republicans and a Senate controlled by Democrats, Congress is passing only the most mandatory legislation. In addition, with last year’s government shutdown still fresh in the public mind, elected officials are doing everything they can to avoid being blamed for poor decisions during an election year.

H.R. 4190

The presenters went on to describe two pieces of legislation currently in the works.

The first bill, H.R. 4190, is an amendment to title XVIII of the Social Security Act (SSA). In essence, this bill proposes to provide coverage for pharmacist services under the federal Medicare program. This proposed legislation would allow pharmacists, as providers under Medicare Part B, to bill for services such as counseling.

In addition, it could open the door further to prescriptive authority for pharmacists in collaborative care practices. This could prove beneficial to underserved communities, particularly in remote locations.

While ambitious in nature, this bill is only three pages in length, is rather vague and open to interpretation as it currently reads, and still ultimately leaves the decision to allow provider status to each state’s board of pharmacy. Furthermore, this bill relies on payment through a fee-for-service model instead of an outcomes-based model.

Medicare Coverage Initiative

The second bill to be discussed was the Medicare Coverage Initiative. While similar to H.R. 4190 in amending a section of the SSA, this particular bill is more patient-focused, specifically to ensure that patients “get medications right.” This bill would be likely to compensate pharmacists on an outcomes-based model, rather than fee-for-service.

Under the terms of this bill, the pharmacist would be part of a coordinated care team. The central idea is that a qualified clinical pharmacist with a Doctor of Pharmacy degree would be engaged in a collaborative drug agreement with a doctor or medical practice.

In addition, the pharmacist would probably need to be certified or be eligible for certification in a pharmacy practice specially recognized by the Board of Pharmacy Specialties (BPS).

While both bills have their positive and negative elements, as they are currently constituted the Medicare Coverage Initiative is certainly the more clearly defined bill. With the recent adoption of the Affordable Care Act and a move away from fee-for-service compensation, an outcomes-based piece of legislation is also more likely to be adopted by Congress.

Ultimately, once passed, any piece of properly crafted legislation that increases the role and recognition of pharmacists on healthcare teams would be a huge win, not just for hematology/oncology pharmacists, but for all of us in practice.  

A frequent contributor to Drug Topics, Joel Claycomb specializes in reports from far-flung locations. Contact him at jcclaycomb@gmail.com.