Pharmacy Response to Affordable Care Act Decision


Pharmacists can play a role in improving patient understanding of health insurance.

Pharmacists can play a role in improving patient understanding of health insurance.

For many pharmacy organizations, the Supreme Court King v. Burwell decision upholding the Affordable Care Act’s (ACA) tax subsidies fended off potential confusion for patients concerning health insurance.

National Community Pharmacists Association CEO B. Douglas Hoey, RPh, MBA, remarked that community pharmacists are often the first providers that Americans—especially those who are in underserved rural and inner-city areas—turn to for help. Community pharmacists can assist those with and without insurance in obtaining the medications they need, Hoey said.

“While the political debate over US health care will continue, (this) ruling provides a degree of clarity for community pharmacists, as they continue to help patients navigate a complicated health care system,” he stated.

Likewise, the National Association of Chain Drug Stores (NACDS) noted that pharmacists can play a role in improving patients’ health insurance comprehension.

“Pharmacy remains committed to helping patients understand their coverage, which has been a priority throughout the roll-out of exchange-based insurance, as well as to maximizing the valuable role of pharmacies in today’s evolving health care delivery models,” the NACDS wrote.

The NACDS also called for pharmacy Medicaid provisions of the ACA to be implemented, allowing for more access to pharmacist-provided patient care.

Academy of Managed Care Pharmacy CEO Edith A. Rosato, RPh, IOM, praised the King v. Burwell decision, referencing a Kaiser Family Foundation estimate that 6.4 million individuals would have lost subsidies worth $1.7 billion per month if the court had ruled in favor of the plaintiffs. In addition, premiums for subsidized enrollees could have seen massive increases.

“Whatever one’s view of the ACA, there’s no denying that this decision has averted significant disruption to the health care marketplace,” Rosato wrote.

While the American Society of Consultant Pharmacists (ASCP) does not foresee any changes to the consultant pharmacy profession and long-term care industry as a result of the ruling, it did recognize that the decision adds more certainty to the future of the nation’s health insurance system.

“[T]he decision allows our members to continue efforts to work with other professions in the health care arena to deliver higher quality, more cost-effective care to the nation’s seniors,” the ASCP said in a statement.

International Academy of Compounding Pharmacist executive vice president and CEO David G. Miller, RPh, said he also does not expect any changes for the compounding community as a result of the King v. Burwell decision.

“Although prescription drugs are a component of both federal and state exchanges, the coverage policy for compounds varies,” he said in a statement. “We do not anticipate today’s Supreme Court ruling to impact that.”

Both Generic Pharmaceutical Association (GPhA) president and CEO Ralph Neas, JD, and International Pharmaceutical Federation (FIP) CEO Luc Besançon expressed positive outlooks from the ruling.

“With today’s decision, GPhA and its members look forward to working with policymakers to ensure that timely access to safe, effective, and more affordable generic drugs and biosimilars continues for millions of people,” Neas told Pharmacy Times.

“The ACA is in line with the concept of universal health coverage, which the FIP—pharmacists and pharmaceutical sciences around the world—strongly supports,” Besançon said. “Any policy or reform that helps to ensure access to quality-assured health products and services for all is to be encouraged.”

Many had feared there would be chaos in the insurance marketplace if the court had sided with the plaintiffs.

For instance, Justice Sonia Sotomayor had previously suggested that if the court shot down tax subsidies, a “death spiral” would result. Without a requirement to sign up, only the sickest would enroll for health insurance, causing premiums to skyrocket and more individuals to drop out of health insurance.

However, the ruling will allow ACA tax credits for those who signed up for insurance using state or federal exchanges.

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