As appeared in TheHill.com
By Joseph H. Harmison, PD
Presidentand Arlington, Texas pharmacy owner
National Community Pharmacists Association
Each year J.D. Power and Associates asks consumers about their experiences with various retail and mail order pharmacy providers and the recently released 2010 survey offers some interesting findings for patients and policymakers alike.
Patients Vote "Independent"
Consumers gave nearly all of their highest marks to independent community pharmacies, placing them far ahead of national, publicly traded pharmacy chains and the most common, volume-driven mail order pharmacies.
Good Neighbor Pharmacy, Health Mart, and the Medicine Shoppe Pharmacy—which are networks of independently owned, locally operated pharmacies—rated at 869, 856, and 851 respectively on a 1,000 point scale. Independent pharmacists pride themselves on superlative customer service and this survey bears that out. They offer face-to-face consultations that can make a world of difference in health outcomes by promoting patient adherence to their medication. These pharmacists are also increasingly an accessible source of other health care services like immunizations, diabetes management and preventative screenings.
Bigger isn't always better
In describing its methodology to Drug Topics magazine, J.D. Power and Associates is quoted as saying that a difference as small as 8-14 points in the survey's 1,000 point scale is statistically significant. With that in mind, the J.D. Power and Associates 2010 U.S. National Pharmacy Study finds that patients were not as satisfied with publicly traded, national retail pharmacy chains like CVS Caremark (789), Walgreens (807) and Wal-Mart (769).
CVS Caremark, in particular, stands out. An enormous, joint retail pharmacy chain and pharmacy benefit manager (PBM), CVS Caremark received below-segment averages in customer satisfaction for both its retail and mail order pharmacies. Meanwhile, the company continues to aggressively promote its ironically-named Maintenance Choice program to employers and other health plan sponsors. Under this scheme, many customers of independent community pharmacies are being forced to CVS Caremark's retail and mail order pharmacies against their will. Judging by the J.D. Power and Associates survey, that "will" is significant.
Dozens of Members of Congress from both parties and NCPA brought allegations of anti-competitive and anti-consumer activities by CVS Caremark to the Federal Trade Commission (FTC). The FTC and 24 state Attorneys General are actively investigating the company.
Bigger not necessarily cheaper?
Many Americans assume that big, national companies use their buying power to get lower prices and pass all those savings on to customers. But is it always true?
Americans are as cost-conscious as ever. In announcing their survey, J.D. Power and Associates stated that, "the importance of cost-competitiveness in driving overall satisfaction has more than doubled from 2009 among both brick and mortar and mail order pharmacy customers. Cost competitiveness accounts for 24 percent of overall satisfaction among brick and mortar customers (vs. 10 percent in 2009)."
Even in that context, according to J.D. Power and Associates, in a number of instances patients gave independent pharmacies higher marks on price than they did the likes of CVS Caremark. This echoes previous findings by Consumer Reports.
With prescription drug coverage accounting for nearly 90 percent of all prescriptions, many patients pay the same co-pay regardless of pharmacy. Those patients without prescription insurance also find good value in the competitive prices, personalized services, and same day delivery independents provide.
Mail order woes
The biggest mail order pharmacies, run by pharmacy benefit managers (PBMs), garnered scores from patients about as mediocre as the major retail chains.
Independent pharmacists support giving the patient a choice in pharmacy, including mail order. But most mail order customers wind up there not through choice but through mandates or co-payments set up to favor mail order. And mail order "savings" seldom materialize as advertised.
In reporting on the 2009 survey by J.D. Power and Associates, Drug Topics magazine wrote this: "Customers who don't have a choice about using mail order are unhappy. Fully 61% of mail-order customers surveyed by J.D. Power and Associates are locked into the program by mandates or differential copays. They are ready to escape at the first opportunity. 'They aren't loyal customers,' [director of healthcare practice Jim] Dougherty said. 'They're hostages, and they don't like it.'"
Lessons for policymakers
This survey should encourage all patients, policymakers and health plan sponsors to give independent community pharmacies another look. It's also a reminder that denying patients access to independent pharmacies, such as by mandating the use mail order pharmacies, both eliminates patient choice and the vital face-to-face interaction with clinically-trained pharmacists.
There are many reasons why government programs, health plan sponsors, taxpayers and patients are presently paying inflated prices for prescription drugs. NCPA and consumer advocates say that prime targets for savings are the myriad markups imposed by billion-dollar middlemen, pharmacy benefit managers. (Read more at www.ncpanet.org).
Bipartisan legislation (H.R. 5234) introduced by Reps. Anthony Weiner (D-N.Y.) and Jerry Moran (R-Kan.) would bolster the patient's ability to choose their pharmacy while also tackling many of the most egregious, profit-padding PBM tactics. We encourage all Members of Congress to consider co-sponsoring this bill.
The full article can be found in The Hill.
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