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Anderson urges renewed grassroots bid to shape health reform, slay DRA ‘dragon’

BY Jim Frederick

BOSTON Determined lobbying and grassroots efforts by the National Association of Chain Drug Stores and chain and independent pharmacy leaders nationwide have enabled retail pharmacy to wrest a hard-won place at the table in the debate over healthcare reform. But progress made thus far “is not enough” to permanently head off such threats to the industry as Medicaid pharmacy reimbursement cuts, NACDS president and CEO Steve Anderson told pharmacy leaders Monday.

Addressing the second business session of the 2009 NACDS Pharmacy and Technology Conference here, Anderson issued another urgent call to chain pharmacy leaders to get more involved in the debate over the future of the U.S. health care system. “Please join us,” he admonished NACDS members. “We have no choice but to embrace our role as true reformers.

“Whatever the outcome of any specific legislation, our objective will remain the same,” Anderson added. “Just as we have over the past two years, we will utilize every legislative, regulatory, legal and media strategy in the pursuit of good policy. For pharmacy and the patients they serve, this battle will continue for a long, long time.”

NACDS, added its president, has remade itself over the past two years to become a more effective advocate on behalf of pharmacy’s interests in the policymaking arena. Those reforms were undertaken in response both to the ongoing health reform debate, and to the Deficit Reduction Act of 2005, which “remains a major catastrophe for pharmacy” in large part because it put into law a disastrous plan to dramatically cut Medicaid pharmacy reimbursements based on a new “average manufacturer price” [AMP] pricing formula.

Indeed, said Anderson, one of the industry’s most critical priorities is to permanently fix the DRA’s Medicaid pharmacy reimbursement cuts under the AMP model, which he said will slash pharmacy payments to below-cost levels for many of the generic drugs they dispense to Medicaid beneficiaries.

“The regulations to implement these cuts have been written. But they remain blocked by two mammoth victories: a legislative delay secured last year… and a Court injunction, which was secured through a lawsuit by NACDS and NCPA. Every day these cuts are not in effect, $5.5 million in pharmacy cuts are prevented.

“Our objective remains the same: to bring about as many of our Principles of Healthcare Reform as possible.”

Anderson cited three key issues of critical interest to pharmacy advocates in the health reform debate. “These include reforming Medicaid pharmacy reimbursement, expanding the availability of medication therapy management — or MTM, and exempting pharmacies that sell durable medical equipment – DME – from the redundant and access—threatening requirements of accreditation and surety bonds,” he said.

It’s a testament to pharmacy’s growing influence in the policy debate, said Anderson, that all three provisions are in the various versions of health reform legislation.

NACDS’ leader also recapped the organization’s advocacy efforts over the past two years, beginning with a letter to The Washington Post in November, 2007, that opened its campaign “to promote pharmacies as the face of neighborhood health care.” Among the highlights: a cross-organizational event with 12 pharmacy organizations at the National Press Club, testimony before several congressional panels, and a Capitol Hill briefing on medication therapy management co-hosted by NACDS, the National Community Pharmacists Association and the Iowa Pharmacy Association.

“There are many other signs that our internal reforms have led to enhanced branding of pharmacy’s role in healthcare delivery,” said Anderson. “For example, NACDS members were invited this year to participate in each of the regional White House forums on healthcare reform.”

NACDS staffers have also been actively engaged in health reform hearings held by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee, he added. One culmination of  those efforts has been the first annual RxImpact Day on Capitol Hill, when pharmacies across the U.S. responded to the organization’s call to flood the halls of Congress with “white coats” and bring pharmacy’s message to lawmakers and their staffs.

“On that day in June, more than 150 pharmacy advocates from 30 states met with more than 180 congressional offices, and with senior staff at the Department of Health and Human Services,” Anderson proudly recalled. “We made a huge splash for pharmacy.

“CNN took notice, interviewing Mary Sammons of Rite Aid, and filming pharmacists in the halls. And we secured some key commitments.” RxImpact Day, Anderson promised, “will be a cornerstone of NACDS’ advocacy forever.”

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Washington, Mo., considers repealing recently passed PSE legislation

BY DSN STAFF

NEW YORK The objective here is closing down clandestine methamphetamine labs. The question is: Who is going to bear the cost? And the answer, ultimately, is the consumer.

It seems that one of the primary reasons behind legislation like this, which is also under consideration by the California state legislature as well as several local municipalities throughout Missouri, is cost shifting.

Indeed, one solution that would prevent the practice of “smurfing,” a practice whereby meth addicts exceed their legal purchase limits in pseudoephedrine products by buying across several nearby pharmacies, is electronic logbooking. By granting access to PSE logbooks to law enforcement in real time, law enforcement officers would not only be made aware of a “smurfer” as they were driving between pharmacies, but would also identify who that smurfer was and where they lived.

Setting up that comprehensive electronic logbooking system requires resources, however. State coffers have traditionally been tapped for that purpose, and at least in the case of California, the Consumer Healthcare Products Association has offered to help defray that cost. In the case of Missouri, more than $500,000 has already been earmarked for the implementation of an electronic logbooking system at the state level.

However,  a not-as-much-talked-about cost is also borne by law enforcement, as pointed out by Franklin County Sgt. Jason Grellner in Missouri. After all, it requires additional resources to actually apprehend and prosecute those criminals, he suggested. And a system that better defines who those criminals may be, by his estimation, could cost the state as much as $350,000 per criminal per year.

Therefore, Grellner argues, it’s a fiscal responsibility to take PSE off the OTC market altogether, and require a prescription for the popular decongestant.

That, in a nutshell, is cost-shifting. Because reverse switching PSE translates into less revenue for retailers (and consequently less taxable revenue, as well) for those consumers who choose to forego PSE-provided relief, and for those who don’t, it’s a greater healthcare cost because now consumers have to schedule an appointment with their primary care practitioner and pay the co-pay for that doctor’s visit on top of the cost of the PSE product.

Regardless of how the consumer ultimately pays for the elimination of meth labs — whether through increased taxes to cover escalating law enforcement budgets or through increased personal healthcare costs — there is another argument to be made here. Switching PSE to prescription-only status may result in fewer meth labs busted, but it’s not going to do anything about those meth addicts still on the street. Necessity is the mother of invention, and for addicts, that simply means sourcing their meth from somewhere else.

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