SPECIAL REPORT

Standard Rx card:
Half empty or half full?

Three years into a drive to standardize prescription drug benefit cards, only 18 states have passed legislation that many hope will be a remedy for one of community pharmacy's biggest headaches. But the pace of adoption has picked up this year, so it's hard to tell whether pharmacy's glass is half full or half empty.

It's true that a dozen states have passed bills so far this year to require insurers to issue Rx benefit cards that include the same information in the same place to save time for pharmacy staffers fed up with calls to third-party help lines. During all of 1999 and 2000, only seven states had won passage of such legislation. The bad news is that legislation introduced this year bit the dust in at least nine states—Alaska, Connecticut, Louisiana, Mississippi, Missouri, New Mexico, New York, West Virginia, and Wyoming—according to the National Association of Chain Drug Stores.

North Carolina became the first state to mandate a uniform Rx card, which went into effect July 1, 2000. At first, many insurance companies tested the waters to see if they could avoid complying with the mandate, said Mike James, R.Ph., owner of Person Street Pharmacy in Raleigh and a lobbyist for the North Carolina Mutual pharmacy cooperative.

"I think it's working fairly well now," said James. "We've gone on record that we didn't pass this just to have something to do. We're slowly seeing the majority [of insurers] come around. It's our intention to come back to the legislature to fine-tune the card so we can keep what's working and correct any problems."

The South Carolina Pharmacy Association took a novel approach last winter when it forged an agreement for voluntary adoption of a standardized Rx card with a group representing insurers, said Jim Bracewell, executive v.p. He's giving the insurers until the end of the year for some signs of movement.

"We're the only ones in the country that have done an agreement instead of legislation," Bracewell told Drug Topics. "We're either going to be the smartest people for doing it or the dumbest. I think they're stalling us, and we'll probably have to fight."

Individual states are using a blueprint that was developed by the NACDS and the National Community Pharmacists Association. Also endorsed by the American Pharmaceutical Association, the national model regulation gives states some latitude for tweaking to meet local conditions. In general terms, it mandates the new format the first time a card is issued, when it's reissued, or when the information changes. The initiative grew out of a white paper the three groups issued a few years ago that identified prescription benefit cards as a major source of roadblocks for both pharmacists and their patients.

The National Council for Prescription Drug Programs (NCPDP) then developed a standard card format with mandatory and conditional fields that give third parties some flexibility to meet their own unique needs. An implementation guide was developed to ensure state-to-state uniformity.

But such uniformity can be a little unnerving to others in health care who are worried about possible antitrust violations, said John Rector, NCPA's general counsel. "Anytime you propose uniformity among competitors, people start scratching their heads," he said. "So you have to work through those kinds of concerns and lay out the narrow nature of the proposal and how consumers can benefit."

The Pharmaceutical Care Management Association, which represents pharmacy benefit managers and mail-order pharmacy, did not respond to requests for comment.

The cost of changing insurance cards to fit the new format is behind opposition from the Health Insurance Association of America and its members, according to spokesman Joe Luchok. "The estimated cost is $1.50 just to produce each [standardized] card," he said. "We've lobbied on the state level because it's a tremendous expense that's not needed. The problem may be in pharmacies to properly handle things."

Resistance to pharmacy's efforts to standardize Rx cards has been stronger than many in the profession anticipated, said Rector. One major opponent has been PBMs. "Pharmacy has done a good job of promoting a standardized card," he said. "A lot of pharmacy groups thought it was a no-brainer, but other people have other needs. And there is deep-pocket opposition from PBMs, which seem to have a lot of influence. It's not clear whether it's a money issue for PBMs, but they've got pharmacists in difficult circumstances with their contracts. They're used to controlling everything in a unilateral way. This is a fly in the ointment, and they don't like it."

Carol Ukens

Standard Rx card legislation

Carol Ukens. Standard Rx card: Half empty or half full?.

Drug Topics

2001;19:30.