Make no mistake about it. Community pharmacies are in peril, thanks largely to low and slow reimbursement from Medicare Part D and aggressive efforts by pharmacy benefit managers to pressure beneficiaries to switch to mail order. What are pharmacy associations doing to rescue pharmacies from the plight they are in?
Last month, the National Community Pharmacists Association and National Association of Chain Drug Stores joined forces to create the Coalition for Community Pharmacy Action (CCPA). "The coalition will be mounting a comprehensive campaign to promote the various interests of community pharmacy-from direct lobbying to research and strategic communications," said NCPA executive VP/CEO Bruce Roberts, R.Ph.
NCPA has also posted a series of political ads that relate to proposed Medicaid cuts. These ads can be downloaded and posted in pharmacies. Carol Cooke, NCPA spokeswoman, told Drug Topics, "We are fighting very hard to make sure community pharmacists can continue in the Medicaid program. Medicare Part D has severely impacted community pharmacies, and dozens and dozens have closed their doors since Jan. 1. We are supporting legislation that addresses prompt payment, cobranding, and increasing the dispensing fee for generics. We are also working with Health & Human Services to get a good definition of average manufacturer price [AMP]."
Meanwhile the Association of Community Pharmacists Congressional Network (ACP*CN), a four-year-old organization of 15,000 independent pharmacists, has hired Julie Philp as director of government relations. As a former legislative director for Rep. John Campbell (R, Calif.), she will concentrate on encouraging members of Congress to pass legislation that would ensure that pharmacies receive timely payment for Medicare claims.
Legislation that has been introduced to require that drug plans pay pharmacies promptly includes the following: S. 2563, the Pharmacist Access & Recognition in Medicare Act, sponsored by Sens. Thad Cochran (R, Miss.), Michael Enzi (R, Wyo.), and Jim Talent (R, Mo.), and H.R. 5182, the Fair and Speedy Treatment of Medicare Prescription Drug Claims Act of 2006, sponsored by Reps. Walter Jones (R, N.C.) and Marion Berry (D, Ark.). Both bills would require PBMs to reimburse pharmacies within 14 days for claims submitted electronically. Under H.R. 5182 there is also a provision for payment within 30 days for mailed claims.
Bill S. 2664, sponsored by Sen. Max Baucus (D, Mont.), aims to strengthen access standards and make sure R.Ph.s are paid a fair dispensing fee and receive prompt payment. It would also create greater standardization across the plan and ensure that safety net providers-pharmacies that serve the low-income, uninsured population-have the chance to participate in the Part D network.
"The next battle facing us is that the Centers for Medicare & Medicaid Services is supposed to set a national reimbursement rate for generic drugs in Medicaid programs, which would be very low. We need to beat that back," said Crystal Wright, public strategist for ACP*CN.
Enraged that PBMs are increasingly becoming more aggressive in switching consumers to mail order, Wright said that ACP*CN has created bag stuffers warning consumers about PBMs' efforts. For a sample of the bag stuffer, call (202) 829-0848.
The American Pharmacists Association is also busy on the legislative front, supporting passage of S. 2563, H.R. 5182, and S. 2664. Kristina Lunner, APhA senior director of government affairs, said, "We support all three bills because each of them addresses the remaining concerns that pharmacists have." She said APhA encourages pharmacists to invite policy makers into their pharmacy or contact them about particular issues.