Letters to the editor: July 24, 2006

July 24, 2006

As a healthcare advocate working with mentally ill dual-eligible patients, I'm concerned that many of my clients cannot afford all their medications since their Part D coverage began. Medicare Part D stripped these patients of key protections Medicaid uses to insure that poverty won't prevent them from filling their prescriptions. Medicare drug plans charge $1-$5 co-pays on all medications, even to very poor consumers. Medicaid charges smaller co-pays of $1-$3 per medication. Further, annual co-pays under Medicaid were capped at $200. Medicare's cap is much higher: Only after consumers have spent $3,600 on Rx drugs will Medicare cover the co-pays.

That said, Medicare Part D reimbursement rates on some drugs are so low that pharmacists would actually lose money on some prescriptions if they waived even the smallest co-pays. This situation pits the healthcare needs of patients against the financial needs of pharmacies and seems to be a no-win situation.

You don't have to sell to the chains

I write in response to your June 19 article on pharmacists in Florida who were insulted by offers from Walgreens to buy their operations. The best strategies in response to these inadequate reimbursement rates are: (1) Don't take insurance. I know you think you can't do it, but think twice. Develop a different business plan and you will be happier for it. I did, and I am. (2) NEVER sign a contract with a PBM with which you cannot negotiate. Send it back with YOUR terms. Ask your colleagues to do the same. (3) Train pharmacists (and pharmacy interns) to be business partners and entrepreneurs. If Walgreens thinks there is a shortage of pharmacists now, wait until we start opening independent pharmacies with solid "outside-the-box" business plans. When it's time to retire, you won't have to sell to the chains, you will have groomed your buyer/replacement. (4) Lastly, don't think you have to be everybody's pharmacist. Pick a demographic that you would like to work with and go after that niche. Why do we think we have to get every possible body through the door? Let Walgreens do that. You need to be special. Treat your customers as special. They will come back. They will be loyal and they won't compare your prices with Walgreens because Walgreens won't have ANYTHING like what YOU have.

Mark Burger, Pharm.D.
Health First! Pharmacy
Windsor, Calif.
mark@healthfirstpharmacy.net

Your story noted that Walgreens' Michael Polzin said he "doesn't know how many letters were sent or how many pharmacies have been purchased since Part D began on Jan. 1." (This is information he could easily have retrieved.) However, he does know that 99% of the owners who responded to Walgreens' solicitation letter have provided "very positive feedback." How did he come up with the 99% figure when the data needed to determine it are supposedly not known or available?

Walgreens participates in the Medicare prescription program in a manner that is harmful to independent pharmacies, its letter adds insult to injury, and its response is disingenuous.

Daniel A. Hussar, Ph.D.
Remington Professor of Pharmacy
Philadelphia College of Pharmacy
University of the Sciences
DHussar353@aol.com