NCPA seeks legislative relief to the business challenges faced by community pharmacy

WASHINGTON — Community pharmacy operators are the "canary in the coal mine" when it comes to federal or state prescription programs, said Douglas Hoey, CEO for the National Community Pharmacists Association, during a press conference held Tuesday afternoon.

"[Independent pharmacies] serve a disproportionate share of Medicare and Medicaid patients," he said. And with 93% of community pharmacy revenue being derived from prescriptions versus the front-end, those pharmacists also share a greater sensitivity to any changes in prescription drug reimbursement. "[Consequently], any changes in federal or state programs disproportionately affect these small-business owners," Hoey added. The remarks were made in support of NCPA's ongoing 2012 Legislative and Government Affairs Conference, which began on Monday and will continue through Wednesday.

Also on the call was Rep. Cathy McMorris-Rodgers, R-Wash., who talked briefly regarding two of her pieces of legislation currently before committees: H.R. 1971, the Pharmacy Competition and Consumer Choice Act; and H.R. 4125, the Medicare Pharmacy Transparency and Fair Audit Act.

And NCPA provided an update on its joint suit opposing the Express Scripts-Medco merger. 

An annual cost of more than $290 billion is associated with the mismanagement of prescription remedies, Hoey said, and independent pharmacy owners play a significant role in helping to mitigate that cost — the more than 23,000 independent pharmacies dispense approximately 40% of all retail prescriptions, he said.

"[As many as] 80% of the reasons people go back to the hospital is they no longer manage their medicines properly," McMorris-Rodgers noted in support of community pharmacy's role in helping to reduce overall healthcare costs. For the current congressional session, McMorris-Rodgers has sponsored two bills in the House that would help community pharmacies remain in place to do that common good by redefining the relationship between pharmacy benefit managers and the independent pharmacist. "There's a lot of interest in the [H.R. 1971] legislation," she said. "Members are just waiting for the final score" before throwing their support behind the bill, she added.

Presently the bill is before the House of Representatives' Subcommittee on Health, Employment, Labor and Pensions where it is undergoing a cost analysis to determine its potential impact on government health programs.

McMorris-Rodgers also introduced a similar piece of legislation that is more cost-neutral, H.R. 4125, that would help codify PBM audit practices and help provide transparency around generic pricing. 

Community pharmacies face significant challenges from PBMs, Hoey said, such as contending with PBM-mandated restrictions on where certain prescriptions can be filled, contending with PBM-funneled prescriptions being redirected into in-house mandatory mail centers in exclusion of retail pharmacy, contending with PBM-negotiated take-it-or-leave-it prescription-reimbursement contracts and contending with PBM-fueled abusive auditing practices that go well beyond identifying potential fraud and waste practices.
 
The suit challenging the Express Scripts-Medco merger that NCPA filed in conjunction with the National Association of Chain Drug Stores and nine Pennsylvania-based pharmacy operations is currently in a holding pattern, noted Jennifer Mallon, NCPA VP and general counsel. A district court judge presided over a hearing on April 10 and ruled against NCPA et al.'s motion that Express Scripts and Medco continue to operate as separate entities until the case had been ruled upon. The next step will be a ruling on a motion filed by Express Scripts to dismiss the case, which has yet to happen, Mallon said.

That Express Scripts-Medco merger generated the most opposition letters from Congress members — around 80 — ever, said John Coster, NCPA SVP government affairs.

Coster noted that another piece of legislation supported by NCPA members is the Preserving Our Hometown Independent Pharmacies Act (H.R. 1946), which allows community pharmacies to join together to negotiate contracts with PBMs.