By B. Douglas Hoey, RPh, MBA, National Community Pharmacists Association
As submitted to Pharmacy Times
Since Congress returned to Washington from its holiday break, few things have changed. The public continues to express questions about the direction of the country and there is still much work to be done on issues important to patients and the independent community pharmacists who serve them. Nationally, independent community pharmacies generate over $93 billion annually in revenue and employ over 240,000 people and policymakers ought to promote policies that encourage further growth in this small business sector.
First and foremost, policymakers should ensure patients maintain access to pharmacies of their choice to improve patient outcomes that result from face to face consultations, and to lower costs to patients and plan sponsors through the proper use of generic medications.
In the New Year, NCPA continues to support H.R. 1971/S. 1058, the bipartisan Pharmacy Competition and Consumer Choice Act. This bipartisan legislation would require transparency on the part of pharmacy benefit managers (PBMs) who are supposed to negotiate lower cost drug benefits for health plans but often do just the opposite—driving up costs for the plans and ultimately patients. The bill would require the PBM to disclose to the plan sponsor what it charges for a pharmacy claim and what the PBM is reimbursing the pharmacy (usually a much lower amount) for the same prescription. The bill would force the PBM to disclose rebates and other revenue received from manufacturers to ensure the appropriate amounts are being passed on to plan sponsors and not being retained by the PBM.
These reforms are particularly important for government sponsored prescription programs such as Medicare Part D, TRICARE, and the Federal Employee Health Benefit (FEHB) where taxpayers are on the hook for any overcharges by the PBM. Additionally, this proposal would allow for reasonable oversight audits of community pharmacies while safeguarding against abusive PBM audit practices. Furthermore, identifiable patient data would be better protected from use without the patient's consent.
These are common sense reforms for a largely unregulated industry. They would help ensure patient choice of pharmacy and also help reduce costs by both exposing costly PBM markups as well as boosting the appropriate utilization of lower-cost generics. (Independent community pharmacies dispense generic medications with greater frequency than the PBM-owned mail order houses, which profit from brand manufacturer payments.)
Congress should also pass bipartisan legislation to ensure patients with diabetes can continue to obtain their testing supplies from their independent community pharmacy. H.R. 1936, The Medicare Access to Diabetes Supplies Act. For people with diabetes, it is important that they not only test their blood sugar often, but that they also do it correctly and accurately read the results. An inaccurate reading can lead the patient to seek costly unneeded treatment or, worse, incorrectly avoid seeking appropriate treatment. To ensure patients properly understand how to use and read their test strips and meters, it is vital that they maintain access to their local pharmacy where they can obtain face to face consultation.
Furthermore, Congress should consider H.R 1946, the Preserving Our Hometown Independent Pharmacies Act. This would allow up to 10 independent pharmacies to group together and negotiate contracts with the PBMs with leverage similar to that of chain drug stores. Fairer contract negotiations would benefit patients by providing additional competition in the market and more choices for consumers.
As our population ages, consumer choice also includes preserving patient access to long term care pharmacies. To accomplish this goal, we support a legislative solution to the nurse-as-agent issue and increased transparency in maximum allowable costs (MACs). We also need Congress to address potential abuses of the 340b system in the long term care setting. By promoting these issues, we believe Congress can ensure that patients deserve the quality of care they deserve.
In addition to Congressional action, we also believe there are issues at the regulatory departments that should be addressed. We remain steadfast in our belief that the Federal Trade Commission (FTC) should reject the proposed mega merger between PBM giants Express Scripts (ESI) and Medco. If approved, this merger could cause independent community pharmacies to close or reduce services and restrict patient choice and access. We are committed to working with the FTC to demonstrate the severe negative consequences approval of this merger would have on pharmacies.
These are common-sense actions that Congress and regulatory agencies can take to promote patient choice in pharmacy and to reduce overall costs to both patients and plan sponsors. These practical solutions put patients and small businesses first and could be small steps to reestablishing the American people's faith in government.
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