NACDS proposes a one-card program but pharmacists have mixed reactions
Worried that seniors will soon need automatic card shufflers to handle the proliferation of drug discount cards that are now available to them, the National Association of Chain Drug Stores unveiled its own PharmacyCareOneCard last month.
A product of the newly created NACDS entity, Pharmacy Care Alliance, the OneCard is intended to pool existing and future manufacturer pharmacy discount programs under one administrative umbrella. That umbrella is expected to be handled initially by Argus Health Systems in Kansas City. The idea is that instead of carrying a separate card for each manufacturer, the enrolled low-income senior would use a free OneCard to access the programs of all manufacturers.
But what about all those other drug discount cardsthe literally hundreds offered by retailers, associations, insurers, and private companies?
Apparently, they would not be incorporated. According to an NACDS spokeswoman, "It's quite preliminary, but at this point only manufacturers will be working with Argus to determine the discounts on drugs." To date, four manufacturers have established discount cards. These are GlaxoSmithKline (Orange Card), Eli Lilly (LillyAnswers Card), Novartis (Care Card), and Pfizer (Share Card).
And how many manufacturers will sign on to the ideaand as partners? Those contacted gave cautiously positive answers. Nancy Pekarek, v.p. of corporate media relations for Glaxo, noted that GSK was the first company to come out with a savings card. "At the time, we said we were supportive of other companies or organizations offering similar types of savings for seniors." GSK in general supports the idea, Pekarek said, and it will certainly look very carefully at joining the alliance. "But we don't know a lot of the details about it yetand the devil is always in the details." Express Scripts is the middleman that is handling the Glaxo card.
Eli Lilly is another company that is waiting for the fine print. A Lilly spokesman, Ed Sagebiel, said the company is willing to consider participation in the OneCard program.
"We still need to see some of the details of the proposal to be sure it's both acceptable for legal reasons and consistent with our approach," Sagebiel said. Argus handles both Lilly's and Pfizer's respective cards, while McKesson takes care of the Novartis program.
Up to this point, reviews on the OneCard by pharmacies are mixed. Several large drug chains announced their supportamong them Rite Aid, CVS, and Eckerd. A Rite Aid spokeswoman added that while the chain will accept the card, "we don't set the benefits for the card."
Mike Bukach, director of pharmacy for Medic Drug in Cleveland, said that anything the industry can do to help seniors is a very good thing. "I would just hope that it would be enough to give the senior who does have a true problem paying for medications a real benefit. I hope the manufacturers help us enough in getting that done."
Also hopeful but waiting for those details is the American Pharmaceutical Association. Cautioning that she had seen only preliminary information, Susan Winckler, group director of policy and advocacy, said, "Conceptually, the idea makes a lot of sense. I'm not sure I know enough about the program to see that this gets us there, but perhaps it does. The best answer is a full Medicare coverage for medications or an interim plan that provides real relief. So obviously we will be continuing to push for that. But this may be an appropriate interim step; we just do not know enough about it to say so."
The National Community Pharmacists Association, however, doesn't see the OneCard as a viable solution, according to John Rector, general counsel for NCPA. Prefacing his remarks with the caveat that he had seen only newspaper accounts and listened to others' discussions, Rector said, "It sounds as if they're going to give the blessing to some of the cards and not to others. Plus, I think there may be some very stringent antitrust limitations to doing anything along those lines."
In addition, Rector noted, NCPA doesn't like discount cards. "And we're not going to be involved with anything that facilitates their usage."
His major complaints with discount cards have to do with monthly fees, lack of contracts with pharmacies, and their sheer numbers. "I don't think it's going to eliminate the multiple cards. It's going to make it easier, arguably, for the consumers to utilize their cards, but people ought to get the medicine they need as determined by a physician and pharmacist, not determined by which cards they get solicited for, or which PBM got the largest rebate. So we'd rather see a different approach."
Similarly, Margherita Giuliano, executive v.p. of the Connecticut Pharmacists Association, cannot endorse the OneCard because she thinks it would facilitate President Bush's discount card concept, which organized pharmacy has roundly opposed. She said she would rather see "gridlock" at the pharmacy counter from consumers presenting with multiple cards.
Defending the OneCard, Larry Kocot, general counsel for NACDS, explained that the program involves no pharmacy benefit managers or middlemen collecting rebatesonly licensed claims processors processing claims. "We don't want processors to play the role of a PBM," Kokot explained. He believes there will be three or four processors who will step up to the plate. The lawyer added that OneCard should provide a convenience for pharmacists, since half a dozen other manufacturers are waiting in the wings with discount cards of their own.
Dana Cassell. NACDS' PharmacyCareOneCard receives mixed reaction.
Apr. 1, 2002;146:60.