Pharmacy professionals

August 1, 2011

Although Judy Cahill will end her term as CEO of the Academy of Managed Care Pharmacy next year, there's plenty to keep her busy between now and then.

Although Cahill will end her term as Chief Executive Officer of the Academy of Managed Care Pharmacy (AMCP) next year, she says there's plenty to keep her busy between now and then.

Many of AMCP's activities involve collaborative development of industry standards as well as providing input for national policy decisions.

"We know we're going to have to educate the managed care pharmacists who serve on pharmacy and therapeutics committees on how to evaluate whether a specific study can be relied upon because not all CER studies will be created equal," Cahill says.

AMCP members are hospital and retail pharmacists, as well as PBM and health plan pharmacy leaders who make decisions that impact cost, quality and access.

"Documenting quality has always been a high priority in my books for health plans because health plans have that dual challenge of providing the care needed to keep their populations healthy and to save money," Cahill says. "You have to have that external scrutiny of quality to make sure that services rendered need to be rendered. When I came to pharmacy, that was absent."

In the mid-1990s, she reached out to other organizations to gauge their interest in external review of quality for pharmacy practice, not unlike what the National Committee for Quality Assurance does for health plans. AMCP earned some seed money and started trying to build a pharmacy council to measure quality.

"I actually returned the money to the donors because I couldn't get it off the ground," she says.

After the Medicare Modernization Act and the advent of Medicare Part D, the atmosphere had changed. Paying for quality became a cornerstone, and the interest in quality metrics for pharmacy suddenly emerged.

In 2006, AMCP helped to launch the Pharmacy Quality Alliance (PQA) to identify appropriate quality metrics for medication use and medication therapy management services. Today, PQA is made up of more than 60 pharmacy providers, health insurance plans, employers, PBMs, academicians, outcomes researchers, senior advocacy groups, health IT vendors, state and national healthcare associations and pharmaceutical manufacturers.

The Centers for Medicare and Medicaid Services (CMS) is using several PQA measures in their Medicare star-rating system. According to Cahill, some measures are being adopted in the private sector as well.

"For me, this is a real journey that is having a beneficial effect for anybody that's touched by medication therapy," she says. "If you were to ask me what I take the most pride in, that would be it."

A close second, however, might be the Format for Formulary Submissions, a standard methodology for assessing drugs scientifically, based on the value they provide. AMCP created the format in 2000, and it's been adopted by private plans, government agencies and PBMs. Managed care organizations that apply the format represent approximately half of all pharmacy-care beneficiaries.

"We found that most pharmacy students sloughed their way through their pharmacoeconomics class, so we did a whole series of training programs to refresh them on pharmacoeconomics, how to look at the data and what implications it has," Cahill says.