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The Official News & Technical Journal Of The International Society For Pharmacoeconomics And Outcomes Research
ISPOR CORNER

ISPOR Student Corner – Contributing to Evidence-Based Policy

Angela Lowe Winegar MS., Doctoral Candidate at The University of Texas at Austin, Austin, TX, USA


We are in graduate school because we feel the research is interesting, that it is important, and that at the end of the day, we want to contribute to the field of pharmacoeconomics or other related arenas. But the end goal of our research should not necessarily be to publish a manuscript, or to have a poster/presentation accepted at an international conference. To truly unlock the power of research, the findings should to be translated into policy (either legislative or corporate) that provides better healthcare for the patient or better value for the payer. Despite being students in the initial phases of our careers, we are still researchers, and as such, we should strive to provide lawmakers and other decision makers with “evidence-based policy.”

Some projects lend themselves to the objective of influencing policy more than others. If your goal is to see the research findings implemented in everyday practice, then you should evaluate the project's inherent practical applications as part of the research selection process. Fortunately for just about every researcher who cares about health policy, Medicare Part D was implemented a mere three years ago. This program has dramatically changed the landscape for pharmacy benefits managers, patients, and pharmacies, among others. Furthermore, this benefit has provided an environment ripe for research. Immediately following the implementation of Part D, patients, pharmacists, and others clamored for Part D optimization or even overhaul. Without research to support their anecdotal claims, however, constituents were hard-pressed to communicate the extent of their frustration.

As a fourth-year graduate student, I do not have a tremendous range of experience to draw upon when providing guidance for pursuing policy research. However, I can relay one example of how a graduate research project produced results that lawmakers in Washington, D.C. found convincing enough to fuel their legislative pursuits. I can also share some lessons I learned while participating in this project.

Since joining the graduate program in Pharmacy Administration at The University of Texas, I have been drawn to the policy factors that shape the pharmaceutical marketplace. As such, I attempted to follow the development of policy-related topics such as radio-frequency identification (RFID) mandates, drug importation, and of course, Medicare Part D. In the summer of 2007, a unique opportunity came across my desk. Using pharmacy claims data, I was asked to help analyze the average time between claim adjudication and Medicare Part D reimbursement to the pharmacy (a.k.a., payment time). While doing the background literature review, I quickly realized that this was not just an exercise in accounting; slow payment time was one of the major complaints pharmacy owners and pharmacists had with Medicare Part D. With more than two dozen anecdotal reports indicating that Part D payments were “slow and low,” it became clear that a well-executed study could very powerfully communicate the extent of the problem if it did exist.

With such an imperative “call-to-action,” we conducted the research and circulated our initial results and final conclusions through both the American Pharmacists Association and the National Community Pharmacists Association, and they quickly grasped the potential effect of our findings on public policy. Within a matter of weeks, our manuscript was fast-tracked for publication [1]. But even more exciting, two congressmen (Walter Jones (R-NC) and Marion Barry (D-Ark)) wrote a letter [2] to the Chairman of the House Committee on Ways and Means, Health Subcommittee that highlighted how our study supported the need to bring their legislation (H.R. 1474 -the “Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act”) to committee. To reinforce their message, we participated in a press-conference to discuss the findings of our study and the associated need for their legislation [3]. After months of legislative wrangling, prompt pay legislation was incorporated into H.R. 6331, the “Medicare Improvements for Patients and Providers Act,” which was passed into law in July 2008 [4].

Although I thoroughly enjoyed working on such a pressing issue that received attention at the national level, I learned that these types of projects come with their own share of road bumps. Without self-promotion, our findings may never have piqued the interest of pharmacy lobbyists and members of Congress. Many great pieces of research are wasted on library shelves because the researchers did not pursue the translation of their findings into policy and we knew that a published manuscript was unlikely to influence change on its own. Additionally, given the potential impact of our research, our methodology was scrutinized and our biases tested, even more rigorously than by a panel of our peers. Despite our careful evaluation of our choice of words and presentation of results, representatives of Part D payers and other pharmaceutical industry analysts had a field day trying to discredit our study [5]. One of the important lessons learned from these critiques was not to let lobbyists, or even lawmakers, interpret our results for their own purposes, no matter how well-intentioned. A summary that leaves out some of the findings or averages the results to suit a particular position can correctly be perceived as biased. As happened in our case, many readers did not distinguish between the authors of the summary (lobbyists) and the study researchers.

Even knowing that criticisms are likely when proposing changes in the highly charged field of health policy, we should not be dissuaded from trying to find a practical application for our research. The rewards of seeing our research manifest itself into legislation far outweigh the discomfort of short-lived attacks. That said, my advisor taught me one additional lesson that I think is extremely valuable, and especially pertinent to students. When presenting policyrelated research, he recommended staying as neutral as possible and delivering unbiased, nonpartisan results, no matter how strong your political views. In his words, “Let the data do the talking!” Seeing how many different entities have a stake in health policy, that advice could make all the difference for those of us still looking for a post-graduate job.

References

[1] Shepherd MD, Richards KM, Winegar AL. Time from Medicare Part D claim adjudication to community pharmacy payment. J Am Pharm Assoc 2007;47:695-701.

[2] The National Community Pharmacists Association. Letter from Reps. Walter Jones and Marion Berry to Chairman Pete Stark about the University of Texas study. http://www.ncpanet.org/pdf/leg/letter-hr1474jonesberrytostark20070905.pdf (Last accessed November 3, 2008).

[3] The National Community Pharmacists Association. Reps. Marion Berry (D-Ark.) and Walter Jones (R-N.C.) discuss H.R.1474 and the University of Texas study on Medicare Part D payment delays. http://www.ncpanet.org/pdf/audiofiles/media-conferencecallpromptpay20070906. wav (Last accessed November 3, 2008).

[4] The National Community Pharmacists Association. Final summary of H.R.6331. http://ncpanet.savvior.com/pdf/leg/hr6331-finalsummary20080807.pdf (Last accessed November 3, 2008).

[5] Fein AJ. Hype vs. research. http://www.drugchannels.net/2007/09/hype-vs-research.html (Last accessed November 3, 2008).


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