Independents’ lobby urges changes to health-reform bill passed in House

NEW YORK Like their chain pharmacy counterparts, the people who own and operate their own single-store or small-chain drug stores — as well as the advocacy groups that lobby on their behalf — are keeping close tabs on the progress of the various health-reform bills moving through the U.S. Senate and House. They should. Independent pharmacists have been hammered hardest by the steady evaporation of profit margins at the hands of managed care payment plans over the past two decades, and their numbers and market penetration across the United States have diminished as a result.

Despite the well-documented problems independents have had to surmount, however, the owner-operated drug store industry continues to assert itself, both on Main Street U.S.A. and in both houses of Congress. Thanks to the grassroots activism of thousands of pharmacy owners, a well-funded political action committee and capable leadership at the National Community Pharmacists Association and other groups, many lawmakers have gotten a clear message about the value community pharmacists bring to the health care system at the neighborhood level.

The “Affordable Health Care for America Act” now advancing in the House of Representatives “doesn’t go far enough” in assuring a fair profit for independent pharmacists, NCPA EVP and CEO Bruce Roberts asserted several days ago. But it does contain “many provisions that we can support,” he told House Speaker Nancy Pelosi in a letter Nov. 5.Among the bill’s pharmacy—friendly features:

• A more generous formula for establishing a payment standard for Medicaid generic prescriptions, based on the “weighted average” of a drug’s market price, rather than the lowest price obtained for the drug by a manufacturer;


• A process to establish new transparency and reporting requirements for pharmacy benefit managers that participate in the “health exchange” envisioned by the White House and Congress to boost patient choice of insurance plans;


• A plan to exempt qualified retail pharmacies from new accreditation and insurance requirements imposed on firms that sell durable medical equipment and supplies to Medicare Part B enrollees;


• Establishment of a grant program to test new and innovative methods of delivering medication therapy management by pharmacists, especially in treating chronic conditions;


• Help for seniors who hit the Medicare Part D drug coverage gap known as the “donut hole.”

The inclusion of those elements in the “Affordable Health Care” bill reflect the hard lobbying work done in recent years by grassroots pharmacy owners, NCPA, the American Pharmacists Association and other groups. Drug store owner-operators have aggressively courted their own congressional representatives, both as local business people contributing to the financial health of their districts, and as community-based resources for patient health and disease management. And the national organizations — including the National Association of Chain Drug Stores — have been effective at reaching legislators with a consistent message about pharmacy’s value and patient access.

There’s still plenty of work to be done as the community pharmacy lobby works to shape health reform legislation. None of the bills under consideration in the House and Senate fully embrace the value pharmacy could bring to a redesigned health care system that’s more cost-effective, patient-centered and outcomes-driven. To reach that goal, pharmacy leaders say, Congress and the White House will have to assure a fair reimbursement and a broader, more defined role for the pharmacy profession.

“Patients’ well-being,” said Roberts, “can either be compromised or enhanced depending on Congress’ actions.”