Independent community pharmacists are not just a source of prescription drugs and medication counseling, as important as those are. They also offer patients an access point to healthcare, particularly in underserved rural and low-income, inner city areas.
Pharmacist Beverly Schaefer summed it up well in an email about one recent typical day at her Katterman’s Sand Point Pharmacy in Seattle. Here are some excerpts:
“I made recommendations for dressing a hand wound that was healing poorly; for neck pain; for travel medications; and for the stomach flu. I administered the Hepatitis A vaccine and two shingles vaccines. Then I counseled a mother who has a child with a traumatic brain injury on a new medication regimen, who wasn’t even my customer! ... I called six other pharmacies to find a drug in stock that was needed immediately by my patient ... I fitted an ankle brace for a sprained ankle ... and I accomplished all that while filling 98 prescriptions and supervising a staff of 12 people.”
The combination of expertise and accessibility – no appointment necessary – has made pharmacists one of the most-trusted professionals in America for decades, according to polling by Gallup.
At the same time, pharmacist small-business owners face significant challenges to providing that care. To that end, recently more than 300 independent community pharmacists visited Washington to meet with their senators and representatives. We appreciate the time and attention of busy lawmakers and their staff. There is bipartisan support for action to address these issues, which we hope Congress will take this year.
First, apply common-sense standards to pharmacy audits in the Medicare drug benefit (Part D program) and ensure that any money recouped through audits goes to Medicare, not middlemen. Audits are necessary to detect fraud and abuse in Medicare. But the process is being abused by middlemen singling out expensive drugs and using typographical and other trivial errors to recoup from pharmacies and pocket many thousands of dollars. When a pharmacist gives a patient the right medication at the right time, at the right cost, it should not be a punishable offense.
Earlier this year Medicare officials expressed alarm about this for the first time, saying “We are concerned that the growing practice of post-audit total claim recoupments from pharmacies is distorting Part D payment, as well as compromising Part D data integrity and impairing our ability to oversee the program.” Twenty-four states have enacted legislation addressing abusive auditing tactics, but a uniform, federal law is needed.
S. 867, The Medicare Prescription Drug Program Integrity and Transparency Act, was recently introduced by Sens. Mark Pryor (D-Ark.) and Jerry Moran (R-Kan.) to address these and other issues. Co-sponsors include Sens. John Boozman (R-Ark.), Thad Cochran (R-Miss.), Tim Johnson (D-S.D.) and Roger Wicker (R-Miss.). The bipartisan measure deserves additional support.
Second, pharmacists urge more transparency for Medicare and pharmacies into how drug plans calculate pricing and reimbursement for most generic drugs, which account for nearly 80 percent of drugs dispensed. Increasingly, pharmacies are being paid below their costs to dispense. Moreover, the reimbursement limit, or Maximum Allowable Cost (MAC), is not updated frequently to reflect price spikes. One Georgia pharmacist recently told me of being paid $300 below his cost for a prescription for an anti-blood clotting drug. That’s not sustainable for these care providers.
Third, let more pharmacies participate in “preferred pharmacy” Medicare drug plans. Sixteen senators, more than 30 members of Congress, MedPAC and Medicare have expressed concerns regarding these plans, which have proliferated. Seniors in these plans may have to travel 20+ miles to obtain their prescription drugs in exchange for little, if any, overall savings. Any legitimate pharmacy willing to accept plan terms and conditions, including reimbursement, should be allowed to participate, as Medicare has recommended.
In other areas, expand the pharmacists’ role in patient care through medication therapy management (S.557 / H.R. 1024). Roll back massive cuts in reimbursement for diabetes testing supplies, and remove the senseless ban on same-day delivery of these products by local pharmacies to patients’ homes or long-term care facilities. Pharmacists also continue working constructively with the FDA and Congress on compounding and supply chain integrity, or “track and trace” legislation.
Every day local pharmacists are improving their communities. Reforms such as these will help them help others all the more.
Hoey, RPh, MBA, is CEO of the National Community Pharmacists Association.