Ohio Senate Health and Human Services Committee
Proponent Testimony, Senate Bill 141
Catherine H. Kuhn, Pharm.D., R.Ph.
Pharmacist Care Coordinator; Kroger Pharmacy, Columbus Division
Chairwoman Jones, Vice Chair Lehner, Ranking Member Tavares, and members of the Senate Health and
Human Services Committee, thank you for this opportunity to testify in support of Senate Bill 141, which
enhances collaboration opportunities for pharmacists and physicians as they provide quality care for
patients.
My name is Cathy Kuhn, and I am a community pharmacist for Kroger Pharmacy, Columbus Division,
which includes 113 community pharmacies in Ohio. I am also the Vice President of the Ohio Pharmacists
Association. I have been providing Medication Therapy Management, also known as MTM, to patients
since it first was formally introduced as a result of the 2003 Medicare Modernization Act. This Act,
which is best known for the creation of the Medicare Part D drug benefit, also notably called on
pharmacists to work with patients as a member of the healthcare team to improve medication use and
reduce adverse events. Since its enactment, the role of the pharmacist as a healthcare provider has
quickly evolved.
My current role at Kroger has evolved as well. My position now entails leading our 400+ community
pharmacists as they provide MTM. This year alone, our pharmacists have provided over 5,000
comprehensive medication reviews or CMRs. During a CMR, the pharmacist meets with the patient or
caregiver to review all of the patient’s medications, provide education about the patient’s health and
medications, and address any identified drug-related problems. In addition to CMRs, our pharmacists
have provided over 12,000 targeted medication reviews, where they provided specific education,
adjustments, and updates to medication therapies. The large majority of these patients are those
covered by a single Ohio managed Medicaid plan. In 2012, the plan reported $1.35:$1.00 return on
investment in drug cost savings alone. Total savings, including avoided hospitalizations, emergency
department visits, and other unnecessary health care consumption for their patient, yielded a ROI of
$4.40:$1. While you can see that pharmacists have positively impacted patient lives and healthcare
dollars, there is still work to be done. Currently, only half of our eligible patients receive a successful
MTM service due to barriers including communication and collaboration delays between pharmacists
and physicians. We need improvements to our law so that more patients can benefit from the
pharmacist’s expertise and care.
Pharmacists work collaboratively with other health care providers to make decisions to improve health
outcomes for patients. Here are just a couple example results of pharmacist-provided MTM services:
 Pharmacist identifies that a patient with asthma is regularly visiting the emergency department
due to uncontrolled asthma. The pharmacist determines that the patient is not taking an inhaler
that would prevent asthma attacks. The pharmacist collaborates with the patient’s primary care
provider to initiate a new, preventative inhaler.
 A patient with high blood pressure presents to the pharmacy for a pregnancy test. The
pharmacist discusses how to use the test and importance of prenatal care. The pharmacist
follows up with the patient and prescriber to ensure any needed prenatal care has been
initiated and to change her current blood pressure medication to one that is safe in pregnancy.
In these two examples – like many instances – the accessible, skilled, and knowledgeable community
pharmacist served as the initial triage for these patients’ health concerns. Furthermore, the
collaboration and communication between the pharmacist and physician that typically occur through
telephone calls and faxes will take in some cases, a few weeks or worst case scenario, will not occur at
all. The reality is that calls and faxes create administrative burden to practices, disruption in patient
care, and delays or misses in updates to medications that patients need. However, if the pharmacist,
physician, and patient enter into a consult agreement, the pharmacist will have the opportunity to make
the necessary update to patient’s medication right away through a pre-determined protocol.
Our current law allows an individual pharmacist to enter into a consult agreement with an individual
physician and an individual patient to manage a specific disease state. The proposed changes outlined
in SB 141 to sections 4729.01, 4729.281, and 4729.39 of the Revised Code would expand the
opportunity for consult agreements to allow one or more pharmacists to collaborate with one or more
physicians to manage medications for multiple patients as determined and contractually approved by all
parties. While in reality, consult agreements for all of Ohio pharmacies are probably not feasible, key
opportunities do exist for collaboration in medically underserved areas, where patients lack access to
care and where pharmacists have strong relationships with local physicians. Strengthening the current
consult agreement process will undoubtedly lead to improved outcomes and decreased healthcare costs
in an era where quality cost-efficient patient care is imperative. With this in mind, I urge you to support
Senate Bill 141. Thank you, and I would be happy to answer any questions you may have.
Cathy Kuhn, RPh, PharmD
Phone: (614) 748-1092
Email: cathy.kuhn@stores.kroger.com