By Anthony P. Morreale, PharmD, MBA, BCPS; Heather Ourth, PharmD, BCPS, CGP; and Julie A. Groppi, PharmD, CDE  VA Pharmacy Benefits Management Services for Clinical Pharmacy Services and Healthcare

Anthony P. Morreale, PharmD, MBA, BCPS

Clinical Pharmacy Specialists have an irreplaceable role within VA’s team-based care model due to their extensive experience in managing complex medication regimens used in the treatment of the most common disease states. In 2013, we will continue our effort to fully incorporate these highly skilled professionals into our team-based approach to healthcare.

Reducing the Burden on Physicians

Today, multiple medications are used to treat a chronic disease and a variety of patient factors to evaluate when selecting a medication. The extensive knowledge demonstrated by the Clinical Pharmacy Specialist (CPS) in pharmacology, pharmacokinetics, pharmacodynamics, pharmacogenomics and therapeutics is leading VA healthcare to a new paradigm that fully utilizes the advanced practice skills of our CPS workforce in improving care and reducing the burden on both primary- and specialty-care providers.

The CPS is authorized, under an advanced scope of practice, to prescribe medications in all healthcare settings in VA.

VA’s highly skilled clinical pharmacy specialists have the qualifications and training to address multiple medication management needs, across multiple disease states, for VA patients during a single patient visit. They play an important role within VA’s team-based care model. Photo courtesy of the Department of Veterans Affairs

VA recognizes that clinical pharmacy specialists have a wealth of knowledge, training and experience to assume this responsibility. Since 2004, all graduating pharmacists in the United States possess a doctor of pharmacy degree. Many pharmacists undertake further professional development in the form of post-graduate pharmacy residency or fellowship training, professional experience and obtaining advanced board certifications as pharmacotherapy specialists (Board of Pharmaceutical Specialties).

VA has approximately 6,100 pharmacist full-time equivalent employees, and approximately 2,640 (43%) have an advanced scope of practice with prescriptive privileges.

This highly skilled workforce has the qualifications and training to address multiple medication management needs across multiple disease states for VA patients during a single patient visit.

Background on Clinical Pharmacy Programs in VA

Beginning in 2010, we launched an effort to begin measuring and describing the activities of our CPS professionals. We also wanted to organize, standardize, energize and expand our clinical pharmacy base by developing a national program office with oversight for clinical pharmacy services.

Consequently, we instituted our Clinical Pharmacy Program Office in April 2010 and rapidly set about developing a robust infrastructure to assess and measure clinical pharmacy activities in VA.

At the very time the program office was created, VA was realigning ambulatory care practices to follow the team-based approach, otherwise known as Patient Aligned Care Teams (PACT). We viewed this as a perfect opportunity to further define the progressive role of CPS within PACT. Specifically, we focused on how the highly evolved skills of the CPS in disease and complex medication management could be standardized throughout VA in the nonphysician provider role serving to bridge patient care needs between primary care and specialty care.

To this end, we pursued an aggressive agenda to transform our practices to fully utilize the skills of these highly trained individuals. A large component of this effort involved educating providers and VA leaders on how to properly integrate the CPS into team based settings in a transformed healthcare delivery system.