Druggists prepare bad medicine for lawmakers

Lawmakers can expect to find odd items in their mail over the next few weeks: pill bottles containing only a penny and affixed with a cranky note from their local druggists.

But it’s not a prank. It’s a coordinated protest organized by a grassroots group of 15,000 disgruntled pharmacists.

Members of Congress will soon be reading messages like these, which were printed on bottles intended for President Bush last month:

“Thanks to you, Mr. President, this [penny] is about all my independent pharmacy is worth now.”

“Mr. President, I hope you buy your drugs from Canada. Because you don’t deserve service from any pharmacist in the United States. You stabbed us right through the back, and straight through the heart. I can’t believe that you would knowingly put me out of business. I am ashamed of having voted for you.”

“Your legacy will be the downfall of my profession, and your country’s health.”

These latest salvos are the work of a little-known organization called the Association of Community Pharmacists Congressional Network (ACPCN).

The group is an offshoot of the Association of Community Pharmacists (ACP), a trade association of North Carolina pharmacies that lobbies the state’s lawmakers and has ventured into nationwide grassroots organizing. The group has a small but growing federal affairs budget; it plans to spend more than $60,000 on lobbying during the first half of this year.

The pill-bottle campaign is part of the organization’s effort “to help each member of Congress hear from his constituents,” said Mike James, ACP’s vice president of governmental affairs.

The ACPCN is the smallest of the pharmacy associations in Washington. The National Association of Chain Drugstores (NACDS), the National Community Pharmacists Association (NCPA) and the American Pharmacists Association are the leading groups. Most of the pharmacists in the ACPCN are also NCPA members, including James.

“With all due respect,” James said, “I think we can get the message out better.” About the larger groups, James said, “Sometimes their attention isn’t turned to what I call the big picture.”

Pharmacists say the Medicare drug benefit shortchanges them and has forced them to bear the brunt of the problems it endured during its rocky first months. They are also steeling themselves for reductions in their payments from Medicaid, which will kick in next January.

And they are hopping mad.

The ACPCN says that its members lose money on the prescriptions they fill for Medicare drug-benefit enrollees. Pharmacists are offended that they are treated simply as retailers and are not explicitly compensated for their services as healthcare providers.

Pharmacists also feel unfairly targeted for federal spending reductions. “The cost of the product is what’s going up,” James said, referring to the drugs. The cost of dispensing the medicines is not the problem, he said.

Rural pharmacies, they say, are the most vulnerable and are sometimes the only places within reach of local patients.

Already displeased about the Medicare benefit, the pharmacy lobby undertook a full assault last year against the Medicaid provisions in the budget-reconciliation bill.

But the pharmacists failed to persuade Congress to go easy on them. Moreover, congressional aides grumbled that their bosses felt they were being unfairly tarred by ads that aimed to illustrate how cuts to pharmacists’ payments would hurt patients.

Pharmacies also bristled at recent comments by President Bush in defense of the Medicaid provisions in the budget-reconciliation bill.

“People talked about how the decision to reform Medicaid was immoral. Well, it’s not immoral to make sure that prescription-drug pharmacists don’t overcharge the system,” Bush said Feb. 8, the day he signed the bill.

That remark sparked the penny-in-a-pill-bottle campaign.

The failure of last year’s fight against the budget bill, which will cost the industry an estimated $6.3 billion in Medicaid payments over the next five years, also bred discontent among pharmacies with their representation in Washington, healthcare lobbyists say.

Two weeks ago, the NACDS board expressed its displeasure with the leadership of President and CEO Craig Fuller, who offered to step down.

The ACPCN is directing its ire at the small drugstores’ traditional nemeses: pharmaceutical benefit managers (PBMs), the middlemen that negotiate bulk-price discounts on prescription medicines on behalf of insurance companies, including Medicare drug plans, and drug makers.

The small-pharmacies group did not mince words in a recent statement, which described PBMs as “nothing more than profit-mongering companies robbing seniors of real savings and putting community pharmacies on the brink of extinction.”

The small druggists say that PBMs do not offer them fair prices and that PBMs are not paying them in full or on time under Medicare.

PBMs have become a vital part of the healthcare system since the advent of health-maintenance organizations in the health-insurance industry. They have taken on a central role in the Medicare drug benefit and are responsible for bringing down the cost of prescription drugs.

Pharmaceutical Care Management Association spokesman Phil Blando said that their PBMs are paying most pharmacies within 15 to 30 days. He also acknowledged the early problems with the Medicare drug benefit, some of which affected reimbursement, but noted: “We’re only 90 days into this program.”

Blando also said that pharmacies could hurt themselves by being too aggressive in criticizing PBMs or the new Medicare and Medicaid policies.

“This actually could backfire on them,” he said, arguing that it could aggravate lawmakers. “Their business model is built around the federal trough,” he said.