Pharmacy Consulting – What Does King vs. Burwell Decision Mean to Pharmacies?

What King vs. Burwell Decision Means to Pharmacies:

Last week the U.S. Supreme Court voted in favor of upholding one of the primary tenets of the Affordable Care Act in the King vs. Burwell decision. This is the second ruling by the Supreme Court that was in favor of President’s Obama’s health care law. It basically preserved the rights of an estimated 6.4 million US citizens to retain the tax subsidies that help them afford health insurance. It is also seen as a major defeat for the law’s republican opposition, who have been attempting to undermine the law since it went into effect in 2010. The case centered on whether middle and low-income adults who purchased health insurance were entitled to subsidies based on the language of the law that says tax credits are only to be distributed for marketplaces “established by the state.” Many organizations and individuals had feared that there could be chaos in the health insurance market if the Supreme Court had ruled differently. Had the court shot down the tax subsidies, most feared that only the sickest would actually enroll for health insurance, resulting in premiums “skyrocketing” and causing more individuals to dropping their health insurance.

The question many have been asking is how does the ruling affect the Pharmacy profession? The answer is that most are in favor of the decision as it seems to enhance the role of Pharmacists in providing healthcare to patients and stabilizes the pharmacist’s role as a provider of healthcare information and consultant. Here are the responses to the ruling by many Pharmaceutical organizations and associations:

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.

The 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.

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, but did recognize that the decision adds more certainty to the future of the nation’s health insurance system. “The 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 Pharmacists 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.

Both the Generic Pharmaceutical Association (GPhA) and the International Pharmaceutical Federation (FIP) expressed positive outlooks from the ruling.

As always HCC is here to help you. Healthcare Consulting is a full service Pharmacy Consulting firm that has been in business for over 25 years. HCC has been helping pharmacies plan, prepare and deal with critical business issues since 1989. HCC is owned and operated by pharmacists who are experts in the development and implementation of policies and procedures in all areas of Pharmacy practice. It is also a good opportunity for you to ensure that your pharmacy is in compliance with all state licensing requirements and to have all of your pharmacies’ policies and procedures reviewed by experts! Contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.

Bob Miller
6/30/2015


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