Pharmacist Calls on Colleagues to Speak Out on Healthcare Reform


Elan Rubinstein, PharmD, MPH, voiced his frustration with the lack of presence the pharmacy profession has had in the negotiations of repealing and replacing the Affordable Care Act.

In a letter to the editor of the Journal of Managed Care & Specialty Pharmacy, Elan Rubinstein, PharmD, MPH, voiced his frustration with the lack of presence the pharmacy profession has had in the negotiations of repealing and replacing the Affordable Care Act (ACA).

“Why do I not hear the voice of the pharmacy profession reacting to congressional efforts to repeal and replace the ACA, given the significant effect that repeal and replace proposals will have in community and institutional pharmacy settings on the access to prescription pharmaceuticals and on the health status of at-risk populations?” asked Rubinstein.

Since January 2017, Congress has made 4 proposals to repeal and replace the ACA: The House’s American Health Care Act (AHCA), the Senate’s Better Care Reconciliation Act (BCRA), the Senate’s Obamacare Repeal Reconciliation Act (ORRA), and, most recently, the Senate’s Graham-Cassidy-Heller-Johnson Amendment to HR 1628 (GCHJ). According to Rubinstein, these proposals failed to pass in part because of public outcry and opposition from health care professionals, hospital and insurer associations, and patient advocacy groups.

“This is about millions more uninsured, hospitals with unpaid bills for those uninsured, an uptick in medical bankruptcy for those who access care but cannot pay for it, and people who have very bad medical outcomes because they cannot afford treatment and therefore do not seek it. Prescription drugs are critical for the treatment of many illnesses. People and dependents who cannot afford these medicines and therefore do not take them, or who take half of the prescribed amount to save money (for example), are likely to have poor medical outcomes, which is likely to impact their quality of life and productivity,” said Rubinstein in an email to The Center for Biosimilars®.

Rubinstein notes in the article that the American Academy of Actuaries wrote a letter to Senators McConnell, R-Kentucky, and Schumer, D-New York, that states, “Unless the funds allocated in the proposal are used to create stable markets by maintaining a level playing field for insurers and achieving a balanced risk pool, GCHJ [would have led] to higher individual market premiums, lower enrollment, eroded protections for those with preexisting conditions, lower insurer participation, and more unstable markets than under current law.”

Rubinstein closes his letter to the editor by urging pharmacists to raise their voices regarding the effect of health care reform proposals on access to prescription pharmaceuticals.

When The Center for Biosimilars® asked why Rubinstein believes members of the pharmacy profession have stayed out of the “repeal and replace” conversation thus far, he said, “I have long been frustrated by this question. Conversations that I have had with pharmacists and pharmacy association leaders suggest that pharmacists do not consider elimination of access to health insurance through the ACA to be their problem—that they do not desire a voice in the ‘repeal and replace’ conversation. This despite the fact that this [is] about their patients, who can only access their services and products if those patients, their insurers, a patient assistance program or a public program will pay the cost. How can these pharmacists not see and appreciate the importance of the fact that issue A, loss of access to health insurance, leads directly to issue B, loss of access to pharmaceuticals and pharmacy services?”

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