US Pharm. 2008;33(4):2.

As the Presidential campaigns heat up, there has been much talk about fixing the U.S. health care system. While the term "universal health care" seems to easily slip off the tongues of all the candidates, aside from who should be eligible and how it will be funded, I haven't heard anything specific about the role health care professionals will play in its execution. Nor have I heard anything about how pharmacy benefit managers and insurance companies will be integrated into such a system, if at all. In fact, there are so many unanswered questions that it is hard to take any of the candidates seriously when they say they are going to fix a system that is in serious need of repair. I personally think the reason why we haven't heard any in-depth discussions of health care is because none of the candidates have a clue as to how our current health care system really works behind the scenes.

Do they really understand how important pharmacists are in keeping our health care system running smoothly? Do they comprehend how pharmacists have been financially beaten up by poorly administered third-party contracts with unfair compensation for their professional services? Do they understand that if the health care system doesn't start paying closer attention to the financial well-being of community pharmacies, they may not be around by the time any kind of health care reform is passed? And most important, do they understand that the pharmacist is playing a key role in keeping health care costs in check by managing patients' medication therapy? I think not.

I am obviously preaching to the choir because as pharmacists we all know the answers to these questions. So how do we communicate our worth to the candidates and the voters? I am encouraged by a flurry of news items lately that could help do it for us. One such item centers around Project Destiny, a joint initiative of the APhA, NACDS, and NCPA. The project is being supported financially by sanofi-aventis, GlaxoSmithKline, Boehringer Ingelheim Pharmaceuticals, Pfizer, and Wyeth. The coordinators of the project claim its objective is "to develop a replicable, scalable, measurable, and economically viable future model for community pharmacy." While I applaud the goals of the project, so far I am not very impressed. Its initial findings came as no surprise to any of us in the industry. The investigators' primary conclusion is that there is a "significant unmet consumer need to manage medication therapy ... as exemplified by increases in chronic conditions and avoidable health care costs." Okay, now tell me something I didn't already know. Identifying the problem is the easy part; the real challenge is how to pay for and utilize pharmacists in executing that unmet need given that they are in short supply and are working in a depressed, distorted financial business environment.

A Wall Street Journal story about a recent Harris Interactive health care poll reinforces the underutilization of pharmacists in this country. One of the findings from the Harris poll showed that "most Americans are concerned about potentially harmful interactions between pain medications and other prescription medications." Yet, according to the poll, only 25% talk to their pharmacist about those possible interactions.

And an article published in Circulation uncovered the fact that there is an 80% increase in mortality in patients who have suffered an acute myocardial infarction and who do not take their medication.

Space here doesn't allow me to list all of the research on the positive effects of medication therapy management, not only on the lives of patients but also on the overall savings to our health care system. And yet I hear nothing from any of the candidates. It's time to stop preaching to the choir and take our message to the voting public. My campaign platform is a simple one: pharmacists need to play an integral role in any universal health care system if it is to be successful, and they need to be properly reimbursed for their involvement.

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