ISPOR Student Corner – Contributing to Evidence-Based Policy
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 . But even more exciting, two congressmen (Walter Jones
(R-NC) and Marion Barry (D-Ark)) wrote a letter  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 . 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 .
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 . 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.
 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.
 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).
 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
wav (Last accessed November 3, 2008).
 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).
 Fein AJ. Hype vs. research. http://www.drugchannels.net/2007/09/hype-vs-research.html (Last accessed November 3, 2008).