PHARMACY

NACDS to Senate subcommittee: Help protect patient choice, preserve pharmacy access for Tricare beneficiaries

BY Allison Cerra

ALEXANDRIA, Va. — The Senate Armed Services Subcommittee on Personnel on Wednesday held a hearing to discuss the fiscal year 2013 defense authorization.

In line with the hearing, the National Association of Chain Drug Stores submitted comments to the subcommittee — which has jurisdiction over all matters relating to active and reserve military personnel, including pay rates, military healthcare and education benefits, among others — regarding cuts to the Tricare program. The White House’s recent proposed fiscal year 2013 budget for the Department of Defense includes a host of changes that would prevent Tricare beneficiaries from obtaining many medications at their community pharmacy and increase cost sharing by as much as $34 for a 30-day supply of medications from a retail pharmacy, NACDS said.

"In addition to unfairly penalizing Tricare beneficiaries who prefer to use local pharmacies, NACDS believes this proposal is penny wise and pound foolish," NACDS said in the comments submitted for the hearing record. "Threatening beneficiary access to prescription medications and their preferred healthcare provider will only increase the use of more costly medical interventions, such as physician and emergency room visits and hospitalizations."

In its comments, NACDS also offered the following proposals:

  • The adoption of other policies to reduce costs without negatively affecting either pharmacy access or health outcomes. "The utilization of generic medications by Tricare beneficiaries is low in comparison with other plans. Modest increases in generic utilization by TRICARE beneficiaries would have a dramatic impact on the DoD budget," NACDS said;

  • NACDS also proposed that DoD conduct a demonstration project on the effectiveness of medication therapy management in reducing healthcare costs and improving medication adherence, or the proper use of medicine as prescribed by a physician; and

  • NACDS recommended the development of a "drug stock replacement" program for community pharmacies that could result in savings of up to 30%. This model, currently utilized by the Tricare mail-order pharmacy, would implement depot pricing for prescription drugs provided at retail pharmacies and would enable DoD to obtain more rebates from drug manufacturers. "NACDS believes using depot pricing for covered prescription drugs provided through the retail pharmacy network would assist DoD in negotiating additional discounts from drug manufacturers, beyond the federal ceiling price (FCP) discounts currently required by law."

"We look forward to working with you on policies that control costs and preserve access to local pharmacies," NACDS concluded.


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Sens. Tester, Moran, pharmacy groups gather to discuss role of pharmacists in rural America

BY Allison Cerra

WASHINGTON — During a briefing held for the Senate Community Pharmacy Caucus, two senators and two pharmacy groups emphasized how pharmacists located in rural areas of the United States are playing an increasingly important role in delivering health care to their patients.

Sens. Jon Tester, D-Mont., and Jerry Moran, R-Kan., joined the American Pharmacists Association and the National Community Pharmacists Association to discuss how 1,800 independent community pharmacies operate as the only retail pharmacy within their rural community and serve 86% of rural Americans who reside within a 10-mile radius. During the briefing, Eric Beyer, owner Frenchtown Drug, an independent pharmacy in Frenchtown, Mont., spoke to the Caucus on what it means to be a rural community pharmacist.

"Community pharmacies keep rural Montana strong and healthy by providing life-saving medicine, consultations and medical supplies," Tester said. "Today’s event let us know what’s working and what needs to improve so we can take smart, responsible measures to ensure better access to affordable health care."

Meanwhile, Brian Caswell, a community pharmacist with Wolkar Drug in Baxter Springs, Kan., also addressed the gathering by delivering three main points that aimed to illustrate how community pharmacists improve health care in often-underserved rural areas.

"Community pharmacists are a vital part of our nation’s healthcare delivery system, and in many Kansas communities the local pharmacist is a patient’s most direct link to health care," Moran said. "Access to medications, healthcare supplies and the counsel pharmacists provide is very important to the health and well-being of every American. Today’s briefing provided valuable information to Senators as we work to ensure all Americans have better access to affordable health care."


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Community pharmacy coalition calls on state attorneys general to block PBM merger

BY Michael Johnsen

WASHINGTON — The Preserve Community Pharmacy Access NOW! coalition — formed in opposition of the proposed Express Scripts-Medco merger — Wednesday afternoon hosted a press conference making a direct appeal to attorneys general to block the ESI-Medco merger in the courts should the Federal Trade Commission approve the merger.

"There are few mergers I’ve ever seen that are as anticompetitive as this meger," said David Balto, antitrust attorney and former FTC policy director. "When the states think there’s a problem, and they’ve already recognized there’s a problem involving PBMs, they are as every bit as capable … litigators as the FTC," he said. "Ultimately, if [the states] bring a case, it isn’t a bureaucrat in Washington who’s going to make a decision whether or not this merger is anticompetitive, it is a federal court judge."

Balto pointed out that as many as 78 Congress members have written the FTC advocating that this merger be disallowed.

Balto outlined four reasons why an ESI-Medco merger would be detrimental to consumers of health care:

  • One, many consumers will lose access to their community pharmacies because they’ll be forced into mail order;

  • Two, because more patients are pressured into mail-order participation, drug prices actually will rise because of a lower rate of generic substitution;

  • Three, $4-generics available through many retail pharmacies will disappear as the merged PBM will be able to significantly reduce reimbursements for these low-cost pharmaceuticals; and

  • Four, prices will increase across specialty pharmacy offerings as a larger PBM is able to dominate this marketplace through a greater buying power.

History has shown, Balto said, that when Express Scripts "gets exclusivity, they significantly ratchet up prices."

Balto and others project an Express Scripts-Medco merger will eliminate many community pharmacies. "How convenient — the pharmacies disappear and the PBMs take consumers from an open, competitive channel and funnel them into a closed, mail order [system]," said Steve Pociask, president of the American Consumer Institute.

Express Scripts earlier Wednesday filed a Form 8-K with the Securities Exchange Commission that they expect the proposed merger to close as early as next week, suggesting that an FTC decision may be imminent.

According to published reports, attorneys general in New York, Pennsylvania, Ohio, Texas and California already are considering filing suit to block the merger if it is passed without serious conditions.


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