“'The die is cast. It’s done,' a jubilant (Chuck) Schumer said, adding jokingly that 'Harry’s almost going to have a drink.'

"Reid, a devout Mormon, abstains from alcohol."

—From the December 21 Roll Call article by David Drucker on Sunday's Senate debate and the cloture vote taken at 1 AM on Monday

Senate Democrats cleared a major hurdle during the night on Sunday when the Democratic Conference, with its 58 Democrats and 2 independents, closed rank and voted to end debate on the health care reform (HCR) package put forward by Majority Leader Harry Reid (D–NV). Combined with two more procedural votes later this week, the way is seemingly paved for the Senate to approve a HCR bill on Christmas Eve.

That's the big picture. What ultimately remains for pharmacy in the Senate proposal is not totally clear, nor is it certain that major differences between this bill and the House version can be resolved.

Our Government Affairs staff and lobbyists have been in frequent and at times frenetic discussions with Hill staff as relevant provisions are proposed and quickly debated. APhA is in discussions with stakeholders about proposals relevant to several important aspects of pharmacy practice. These would provide funding for closing adherance gaps, a concept akin to but not exactly like MTM; include compounding in the definition of manufacturing, potentially opening the door for FDA regulation of pharmacy compounding (something we oppose); and pay for tobacco cessation counseling in Medicaid. A proposal in an earlier freshmen's amendment (referring to the first-term Senators who introduced it) to improve Medicare Part D MTM has also been included in Reid's final package.

Knowing what to oppose or support has been a challenge when we have not always had access to bills that change rapidly or were released in incomplete form. In general, we have continued to focus on those provisions specifically identified as relevant to pharmacy.

I'd like to offer special recognition to our Government Affairs Committee—a group of involved APhA members (volunteers) who spend many hours working with our Government Affairs staff to review and interpret language in the context of our policies in order to help us frame our positions and approaches.