Omnibus Budget Reconciliation Act of 1990

Instructor: Dan Washmuth

Dan has taught college Nutrition, Anatomy, Physiology, and Sports Nutrition courses and has a master's degree in Dietetics & Nutrition.

The Omnibus Budget Reconciliation Act of 1990 was ultimately created to reduce the U.S. budget deficit, but it also largely impacted the health care system. Learn all about this Act and its impact on the medical field.

Drastic Changes in Healthcare

The year is 1985. Kim is a 37-year-old who is on Medicaid. She just visited her doctor and was diagnosed with asthma. Kim's doctor wrote her a prescription for an inhaler and told her to pick it up at a nearby pharmacy. At the pharmacy, the pharmacist gave Kim the inhaler without giving her any tips about how to use it, when to use it, or how often.

Later that day, Kim started to feel as asthma attack coming on. She uses it incorrectly. She had to take several puffs of the inhaler, which is much more than she should have. Her heart began beating very fast and she was having problems breathing, so her husband took her to the ER.

Luckily, on November 5, 1990, Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), which helps to prevent situations like this from occurring. This Act was ultimately created to reduce the U.S. budget deficit. However, the plans laid out by the OBRA '90 would also drastically impact healthcare, specifically the pharmaceutical field.

The Omnibus Budget Reconciliation Act of 1990 made some significant changes to the pharmaceutical field.

OBRA '90 and Pharmacy

The OBRA '90 specifically affects Medicaid, a system that provides medical/health insurance to those who may not be able to afford it due to low income, disabilities, or other factors. The changes involved the following areas include:

  • A Prospective Drug Use Review (ProDUR)
  • Patient counseling standards
  • Maintenance of patient records

Let's look at these requirements and their impacts in more detail.

Prospective Drug Use Review (ProDUR)

The OBRA '90 states that pharmacists are required to perform a Prospective Drug Use Review (ProDUR), requiring that pharmacists:

  • Review the medication profile of all Medicaid patients before filling a prescription
  • Provide patient counseling to Medicaid patients receiving prescription medications
  • Evaluate all aspects of a prescription medication (ex: drug interactions, contraindications, proper dosage, potential abuse)

Patient Counseling Standards

OBRA '90 requires that when a Medicaid patient receives a prescription for a pharmacist, they must also receive counseling from the pharmacist. This counseling should include the following information:

  • The name and description of the medication
  • The medication's effects on the body
  • How to administer the medication
  • Proper dosage
  • Proper storage
  • Possible side effects

If Kim's pharmacist performed this type of counseling, Kim probably would not have taken too many puffs of her inhaler. Therefore, she most likely would not have needed to go to the ER. Since Kim was on Medicaid, this would have saved thousands of dollars of federal healthcare spending.

It should be noted that these basic standards of counseling are required by OBRA '90, but each state can add additional counseling standards as well. Most of the time, this counseling occurs face-to-face when the patient picks up their prescription from the pharmacy, though sometimes it is simply written that counseling is available upon request.

The Omnibus Budget Reconciliation Act of 1990 required pharmacists to provide counseling to Medicaid patients in regards to their medications.

Maintenance of Patient Records

The OBRA '90 also established requirements that ensure pharmacists maintain proper records of Medicaid patients who receive prescription medications, including:

  • Name, address and phone number
  • Demographics (ex: age, gender)
  • Health history (ex: previous diseases, past surgeries, allergies, medications)

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