Not Always to the Swift

July 29, 2009

As Appeared on The Hill's Congress Blog 

By National Community Pharmacists Association Executive Vice President and CEO Bruce T. Roberts 

If reforming health care system is like a marathon, and it sure looks that way, then the finish line is still miles away—much of it up hill. And like a marathon, the early leaders don't always win. But from the start, theNational Community Pharmacists Association (NCPA) has been in the race, not on the sidelines. That's our obligation to the 23,000 community pharmacies we represent. They make up an $84 billion marketplace, dispense over 1.4 billion prescriptions a year, and employ more than 300,000 people. 

Our race began last December with the White House as the focus. NCPA and other pharmacy groups met with President-elect Obama's health care transition team to explain that pharmacists are highly trained, widely accessible, underutilized, and can help improve patient outcomes and reduce costs. Our three main principles were to improve quality and safety of medication use, assure patient access to pharmacy services, and incorporate pharmacy into health information technology. In January, we spoke to the HHS Transition Team to reiterate these points, but also pushed for community pharmacists to have a seat at the table during the health care reform process. We have also met with White House aides on health care, including twice with White House health czar Nancy-Ann DeParle. 

Our Congressional efforts have been even more robust. We have participated in briefings for the Congressional Community Pharmacy Coalition—a bipartisan group of House members we helped establish two years ago? the House Blue Dog Coalition health care task force and Democratic members of the House Small Business Committee. In May, 400 + community pharmacists at our legislative conference heard from four Senators and 17 Representatives, including House Majority Leader Rep. Steny Hoyer (D-Md.) and Chairmen Henry Waxman (D-Calif.) of the House Energy and Commerce Committee, and Frank Pallone (D-N.J.) of its Health Subcommittee. We have also testified, submitted comments, and written letters to various committees in the House and Senate, with the most notable event being a July testimony before Pallone's subcommittee. 

So where do we stand now? The emerging House reform bill, America's Affordable Health Choices Act, H.R. 3200, contains some favorable pharmacy provisions. It exempts community pharmacists who sell durable medical equipment, such as diabetes testing strips, from the pending, redundant, and expensive accreditation and surety bond requirements. It also includes a better formula for Medicaid generic drug reimbursement , which as currently configured will force pharmacists to dispense drugs well below acquisition costs. However, the adjustments need to rise to ensure community pharmacies can continue serving Medicaid patients. There are also "sunshine" provisions requiring drug manufacturer disclosure payments of "value" to health care providers like pharmacy benefit managers (PBMs). We believe this is a foot in the door to greater PBM transparency, since these administrators of prescription drugs plans work under a cloak of darkness that allows them to maximize their profits at everyone else's expense. 

There has been much talk about a public plan option. We have expressed our concerns with the lack of specificity about the public option's drug benefit component, including the need for it to be run by a pharmacy benefit administrators (PBA), not PBMs. The Senate Finance Committee has been operating in secret, but is considering something called a co-op instead of a public plan to compete with private insurance. Since the co-op would negotiate rates as well as provider participation, the PBM/PBA issue would be less prominent. 

We are encouraged by some developments, others not so much. We must keep our eyes on the finish line. We must ensure whatever emerges addresses our issues, positions pharmacist to play a primary caregiver role, and puts protections in place for community pharmacies if a public plan option plan is included. We want to offer a constructive dialog, in which we are neither carping antagonists nor willing patsies to those who don't have our best interest at heart. If we are successful the true beneficiaries will be the millions of patients we serve on a daily basis. 

To see the blog post, click here.

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