Top priorities in community pharmacy

During the next year, I will have the honor of serving as president of the National Community Pharmacists Association (NCPA), while continuing in my roles as executive vice president and CEO of the Arkansas Pharmacists Association and owner of East End Pharmacy in Little Rock, Ark. These three positions offer me a unique vantage point. As an independent community pharmacy owner, I understand the prescription-drug business model, and as a pharmacy association official, I work to ensure that policies at the state and federal level are fair to pharmacies and maintain patient access.

In my acceptance speech at the 115th Annual NCPA Convention and Trade Exposition, I focused on two specific areas of concern. First, we need fairness in the way pharmacy benefit managers (PBMs) use the maximum allowable cost (MAC) reimbursement scheme for multi-source generic prescription drugs. Second, we need governmental recognition of pharmacists as providers for the multitude of tasks we undertake that extend beyond the dispensing of prescription drugs.

I once worked for a PBM, but that was before their predatory practices and increased negotiating leverage saw them grow from simple claims adjudicators into corporate middleman behemoths. That insider’s knowledge has helped me bring credible solutions to health plan sponsors and to elected officials. While I have always spoken out on behalf of America’s more than 23,000 independent community pharmacies when trying to foster PBM reform, to have the NCPA president’s platform certainly increases my ability to press for change.  

MAC pricing

Increasingly, more and more pharmacists have expressed their anger to me about the lack of transparency connected with MAC pricing. PBMs typically refuse to divulge the formulae they use to determine generic prescription-drug price reimbursements in the take-it-or-leave-it contracts pharmacists must sign to obtain access to patients. In addition, PBMs often fail to update MAC prices in a timely fashion, especially when there is a price spike. When you consider that generic prescription drugs make up approximately 80% of all dispensed drugs, you can understand why this has become such a vexing issue for pharmacists.

Transparency is the best solution, and we are pushing heavily for states to enact legislation to address this issue. This year we have already enjoyed success in places like my home state of Arkansas, as well as in Kentucky, North Dakota, Oregon, and Texas. While effecting change in gridlocked Washington, D.C. is a considerable task, we are pursuing relief on this issue through bills such as The Medicare Prescription Drug Program Integrity and Transparency Act (S. 867).

Provider status

When it comes to getting pharmacists recognized as providers, I have taken up the baton from NCPA’s immediate past president, Donnie Calhoun, who championed this cause last year. The role of pharmacists in healthcare continues to grow, and the opportunities to broaden our scope of services are plentiful with programs such as Medicare Part D and the Affordable Care Act. From immunizations to participation in accountable care organizations, pharmacists bring considerable value to the delivery of effective healthcare in America. But because we are not recognized as providers under the Social Security Act, we face barriers to our complete participation and compensation.

While the federal government is our focus, we are also prepared to work at the state level to achieve comparable results. For example, in California a bill that expands the role of pharmacists in healthcare, SB 493, was signed into law. We hope to replicate that success in other states. Regardless of whether we are talking about federal or state legislation, independent community pharmacists intend to use those gains as a template to convince commercial plans and payers of the need to fully incorporate pharmacists into attempts to create better health outcomes that ultimately can reduce health spending.

Neither of these goals will be easy to achieve, but they are essential to ensuring that independent community pharmacies not only survive, but thrive, going forward. I look forward to working with everyone and making real progress over the next year.

Mark Riley is president of the National Community Pharmacists Association and executive vice president and CEO of the Arkansas Pharmacists Association.