Letters to the editor: April 17, 2006

First, my sympathies to all the retailers who are just now dealing with CMS. Working in a hospital setting, I believe I have some expertise to share with you and your readers. Since I have been intimately involved in CMS' Hospital Outpatient Prospective Payment System since its inception, I would like to say that if the OPPS system is any gauge, the fun with Part D has only started.

What will probably happen in a year to 18 months is that CMS will come up with a base rate of paying for generic prescriptions-I would guess $20 per script. Retailers will be asked to take $20 or so for all generic drugs costing $50 or less-and again I am guessing. You will be expected to make up any loss with the cheaper generics or with your self-pays. Brand drugs will get ASP (average sales price) plus a negotiated fee. Don't kid yourself, CMS knows exactly what you pay for drugs.

You may say No, this can't be. Well, this is what CMS is doing now in the hospital outpatient setting. Hospital outpatient clinics are not reimbursed for any medication that costs less than $50. Outpatient clinics get a flat rate that pays for all the hospital costs-drugs included-and that flat rate depends on what kind of treatment the patient received. Any medication administered that costs over $50, the hospital outpatient clinic gets basically cost plus a fee, which again depends on how the medication is administered. The hospital is expected to make up the losses elsewhere.

Obviously, this will be the end of the smaller retailer, just as the OPPS system has caused the closing of rural oncology centers. I wish I could give the readers of this letter some hope, but all you can do is get to your legislator and get to the voting booth. CMS does listen to complaints-none of mine so far-but that is no reason to stop complaining.

Warren Quillin, Pharm.D.
Lawrence, Kan.
wquillin@sunflower.com

B.S. as good as Pharm.D.

I take offense to Leonard Edloe's comments (Jan. 23) that comparing Pharm.D. and B.S. degrees is like comparing pharmacists with technicians!

As a B.S.-degree practicing pharmacist for the past 21 years in retail and hospital pharmacy, and as a consultant pharmacist, I am respected for my knowledge as a pharmacist in my community by my patients as well as practitioners. I make the same or more money than most Pharm.D.s. I make sure my patients "receive the right drug and the right advice." I know "what questions to ask." I also "have an understanding of the lab data" and "can see the total picture when it comes to drugs." I also, without a Pharm.D. degree, have been able to improve my patients' outcomes, reduce the number of medications they take, and, in many instances, offer them more cost-effective medications.

We all take the same board exam. The Pharm.D., with all its clinical implications, has little use in the retail setting, which employs over 70% of all pharmacists.

Vafa Aflatooni, R.Ph.
Pendleton, Ore.
vafales@uci.net

I have been practicing pharmacy for 17 years, I find it offensive that somehow the Pharm.D. degree is regarded as superior to a B.S. The Pharm.D. is an entry-level degree, we all take the same board exams, and we are all "registered pharmacists."

As one of many B.S. pharmacists, I read regularly, attend continuing education, and stay on top of disease-state management, pharmaceutical care, and medication therapy management opportunities. I as well as my staff of B.S. pharmacists have provided-and successfully billed for-patient care services extensively.