Health Care Reform and Its Impact on Health System Pharmacy

DECEMBER 01, 2008
James C. McAllister III, MS, FASHP

Mr. McAllister is a health-systems consultant based in Chapel Hill, North Carolina.

Regardless of your political leanings or preferences, we now know that President-elect Barack Obama made some substantial campaign promises regarding health care reform. Being from a "swing state," I was really tired of the incessant television ads and telephone calls, but now that we have chosen a new leader, it is time for all of us to get behind the new administration in bipartisan support and do whatever we can to help our country overcome the many challenges that face us all. I think that most of us agree that the economy is our top national priority, but the strategies and actions implemented to improve our financial systems will in turn impact health care reform.

I was encouraged to read about the US Government Accountability Office (GAO) launching a new Web site intended to "serve as a resource to assist with the transition to a new Congress and administration." The Web site ( is certainly worth a visit, but I was disappointed in the listing of urgent policy concerns that the GAO considers "critical and time sensitive and require prioritized federal action." Of the 13 urgent policy concerns, only caring for service members and preparing for public health emergencies were directly related to health care. The Web site does contain many other categories that are extremely relevant to health care, with a plethora of information available for your review. As daunting as my cursory surfing session on the Web site was for me, I cannot imagine how a new president and administration will get their arms around all the information.

Reform will be slow because the economy and our global conflicts will be much higher priorities, but undoubtedly some incremental changes will take place. In addition, changes made in tax code, employment, and even global conflict issues will indirectly impact health care. During his campaign, Obama suggested that his administration will focus on establishing a national health insurance program, requiring more employers to provide health insurance, and expanding Medicaid and children's health insurance programs. Making even a portion of these changes in the near term seems unlikely, whereas the financial implications of such changes would probably worsen the economy, unless substantial cost-saving initiatives are made concomitantly. I suspect instead that the new administration will make small incremental changes in pursuit of its goals. It is widely recognized that health care spending at our current rate is unsustainable, and the statistics bear that out, so dramatic changes are unlikely.

I anticipate that the FDA will be put under a microscope, and changes will be made. Given the numerous quality- and integrity-related issues that have arisen regarding imported drugs, chemicals used to manufacture drugs, and several recalls of drugs with dangerous side effects, the FDA will be under pressure to improve. Hopefully, improvements can be made with additional scientific resources and new public/private partnerships to contribute to achieving the mission of the FDA.

Drug manufacturers will be pressured to reduce drug prices, especially for government-sponsored programs such as Medicare Part D. The generic drug industry may enjoy efforts to promote competition and perhaps even incentives to expand the availability of generic "biotechnology" drugs. Drug importation will likely not be relaxed to stimulate competition in light of quality disasters like contaminated heparin that struck the US market during the past year.

I do not pretend to be a soothsayer, but it is undeniable that a change in administration, especially after promises of dramatic government change that were made and now are expected by the public, will produce some results. It is up to you and the profession of pharmacy to be agents of change rather than continue to react to recommendations from others. What do you think?

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