Out of 5000 bills introduced every Congressional session, how many become law? The process of passing a bill is long and arduous and only a small number of introduced bills are eventually signed into law.
In a previous blog, we discussed some of the challenges associated with the passage of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314). One particular challenge is the percentage of bills enacted in the United States every year.
In the legislative arena, it is also rare to get everything you want within one bill in the first year. Many times, a bill is introduced with language that is not controversial, even altruistic (in the best interest of the patient), making it possible to secure a large number of sponsors and supporters and ultimately passage of the bill.
Then a bill might be re-introduced using different approaches. With each unsuccessful iteration, it is possible to learn how to improve the bill and how to neutralize or defeat the opposition.
Prior to the introduction of H.R. 592 and S. 314, four previous attempts were made to obtain pharmacist provider status through amendments to the Social Security Act that added Medicare coverage for pharmacist services – in 2004, 2008, 2010 and 2014.
The first three of these attempts involved using the strategy that services provided by a “pharmacist clinician and clinical pharmacist practitioner” would be reimbursed at 80 to 85% of what physicians are paid for similar services. All three of these bills failed because they were viewed as too restrictive, too narrowly focused and only a small number of pharmacists in the U.S. could meet the pharmacist clinician criteria (per H.R. 5389 -2010) of having completed training in physical assessment, clinical hours of experience, and having prescriptive authority as established by state statute.
A fourth attempt was made last year (2014) with the introduction of H.R. 4190 using the new approach of focusing on the medically underserved community and permitting coverage of all pharmacist services allowed by state law and that would otherwise be covered if furnished by a physician, or incident to a physician’s service. This change in language and strategy predicated the success we have seen to date in 2015.
H.R. 4190 failed to pass because time ran out in the last congressional session, but it laid the groundwork for H.R. 592 and S. 314, with many previous bill sponsors supporting the 2015 bills.
So, out of 5000 bills in every Congress, how many become law? Approximately 5%. When the 112th Congress came to a close the House had passed 561 out of the 6,845 bills introduced. These 561 were then sent to the Senate where many failed to pass. That is why the national pharmacy organizations keep asking you to stay in contact with your congressman about provider status.
“The squeaky wheel gets the oil” but it will need to be a persistent, determined and emphatic “squeak” to become U.S. law.
Keep following and sharing!