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On scope of practice, cybersecurity, and prior authorizations – a congressman’s perspectives

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Rep. Buddy Carter discusses issues affecting the American health care system.

U.S. capitol congress © Sagittarius Pro - stock.adobe.com

© Sagittarius Pro - stock.adobe.com

Pharmacists want to assist primary care physicians who are the captains of the teams of health care professionals who aid patients, said Rep. Earl L. “Buddy” Carter (R-Georgia).

A career pharmacist, he was owner of Carter’s Pharmacy Inc., an independent business that dispensed medicines to patients of south Georgia. In Congress, the Republican is a member of the House Energy & Commerce Committee, where he chairs the Subcommittee on Environment, Manufacturing, and Critical Materials, and the House Budget Committee.

Carter spoke with Medical Economics about scopes of practice in health care, cybersecurity and the recent computer attack on Change Healthcare, and the effects of prior authorizations.

This transcript has been edited for length and clarity.

Medical Economics: Primary care physicians sometimes view expanded scope of practice for pharmacists, as a form of competition that might hurt their business. How would you address that concern?

Rep. Earl L. “Buddy” Carter (R-Georgia)

Rep. Earl L. “Buddy” Carter (R-Georgia)

Rep. Buddy Carter: I certainly understand that concern. I think it's somewhat unwarranted. Look, physicians are the quarterback, they are the captains of our team. We all understand that whether you're a pharmacist, whether you're a PA or whatever. We all understand that the physician is the captain and they're the ones in charge of the health care team. We want to assist and we certainly don't want to replace. Now I will tell you that I am a strong proponent of expanding to the full extent and allowing pharmacists to practice to the full extent of their license. Now we're not diagnosticians. I'm not trained to diagnose a skin disease or an illness like that. That's not what we're trained to do. But we are trained in the way of therapy and what drugs are going to work and I just want us to be able to utilize our training to the full extent that we can, and I think that's the only way we're ever going to be able to save health care costs, to cut health care costs. And as we suffer through the shortage of physicians, I think that's going to play a bigger role as well.

Medical Economics: By now, we've all heard about the effects of the cyberattack on Change Healthcare. What did you hear from your constituents about that?

Rep. Buddy Carter: Well, this was a disruption, there's no question about it. In fact, we had the CEO of Change Healthcare, of United Healthcare, I should say, before our Energy and Commerce Committee and the Oversight and Investigation Subcommittee of Energy and Commerce, and we had an opportunity to ask him questions during that hearing about what they did in the way of trying to accommodate people and for pharmacies. I thought it was interesting that one of the points that he made was that they were able to get the pharmacies back up quickly. And I asked him to define quickly and quickly was defined as in within two weeks. You go without your medication for two weeks and that's a problem. So, I think we have different definitions of quickly, but at the same time, we all understand cyberattacks. I'm sure that United and Change would have preferred not to have to go through this. But at the same time, we have to understand that this is what happens, especially when you've got so many different providers who are depending on you, when they hit a system as big as Change Healthcare, as big as United, it's going to have a tremendous impact.

Medical Economics: For years, physicians and patients have complained about the prior authorization process, and the Improving Seniors’ Timely Access to Care Act would streamline some prior authorizations. It has widespread medical support and bipartisan political support. Why has that not passed in Congress yet?

Rep. Buddy Carter: Well, that's a good question. And let's face it now, the insurance companies have strong lobbyists. They spend a lot of money up here and they have a strong influence up here, particularly on those people who don't necessarily have a medical background. They don't understand it like I understand it. You talk about prior approvals, when I still had my pharmacy, I had an employee who was totally dedicated, and that was her job, taking care of prior approvals. And I mean, full time. That's a pretty busy drugstore, we had three stores and they were all pretty busy, so you would expect to have quite a few prior approvals. But at the same time, one employee dedicated to nothing but that? That's a big problem. That's why this legislation is very important and that's why it needs to pass. I will tell you that not only here but all throughout our committee, the Energy & Commerce Committee and everything that we deal with, whether it be permitting and the permitting process for communications, for broadband, or in health care, or whatever, we're setting shot clocks and telling the agencies look, you’ve got to have an answer by this point. We're trying to do the same thing with the prior approvals, to tell the insurance companies you’ve got to respond in a timely manner and we're going to put a shot clock on you.

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