NCPA Lobbies for Community Pharmacy

JUNE 01, 2005
Eileen Koutnik-Fotopoulos, Staff Writer, Pharmacy Times

The National Community Pharmacists Association (NCPA) is revving up its campaign in support of the Community Pharmacy Fairness Act of 2005, or HR 1671. Sponsored by Reps Anthony Weiner (D, NY) and Jerry Moran (R, Kan), the bill would give pharmacists a narrow antitrust exemption to collectively negotiate with pharmacy benefit managers (PBMs). Represented by the Pharmaceutical Care Management Association (PCMA), PBMs'clients include health plans, unions, and large employers.

The bill, introduced in the House of Representatives on April 14, 2005, was the focus of the NCPA's lobbying efforts during the 37th Annual Conference on National Legislation and Government Affairs held May 1 to 3 in Washington, DC. NCPA members are seeking cosponsors and bipartisan support for HR 1671. A variety of issues, including the following, could be addressed if PBMs are mandated to negotiate with pharmacists:

  • Limiting formularies that restrict a patient's treatment options
  • Diminishing reimbursement that threatens to shut down independent pharmacies
  • Unfair and untimely payment for pharmacist services that could keep patients out of emergency rooms and nursing homes
  • Denial of the right to dispense a 90-day prescription with fair payment
  • Mandatory mail order, which forces patients to use the PBM's own mail-order pharmacy
  • Confusion in the pharmacies created by the lack of uniformity and completeness of information on prescription drug cards
  • Switching patients to more costly, inappropriate medications based not on the patients'health care status, but on the PBM's financial interest
  • Harassment of compounding pharmacists

John Rector, NCPA senior vice president of government affairs and general counsel, said that, if the bill passes, independent pharmacies will bargain for the following:

  • Payment of medication therapy management services
  • Patient choice of pharmacy provider
  • Restored rights under the Uniform Commercial Code (a standard set of guidelines protected by the law that determine how business transactions are conducted)
  • Right to dispense 90-day refill prescriptions

During the annual meeting, antitrust attorney David A. Balto—of Robins, Kaplan, Miller, & Ciresi LLP—said that HR 1671 is important because "pharmacists have direct patient contact, making them best-equipped to negotiate with PBMs for pharmacist/patient terms."

The legislation is a modified version of Weiner/Moran bill HR 5278 from the last Congress. The bill provides an antitrust exemption permitting "independent pharmacies" to bargain collectively with health plans regarding terms and conditions of contracts with the pharmacies without violating antitrust laws.

Another piece of legislation causing friction between the NCPA and PBMs is the Pharmacy Benefit Manager Transparency Act of 2005 (HR 1669). That bill also is sponsored by Weiner and Moran and was introduced in the House on April 14, 2005. The bill will prohibit any pharmaceutical drug manufacturer from having a controlling interest in any entity that is a PBM. Furthermore, the bill specifies that PBMs would not be able to make any drug interchange proposal for a patient served by a PBM if the net cost of the proposed drug exceeds the cost of the original drug. The PBMs also would be prohibited from changing a patient's medication without informing the patient of the savings to the individual associated with the change.

The PBMs argue that HR 1669 would give drug companies more bargaining power in negotiations. Mark Merritt, president and chief executive of PCMA, said that the bill would "undercut our ability to negotiate discounts. They want public transparency of PBMs'confidential information, which would undermine our ability to get deeper discounts from drug companies, and undermine our ability to get drug companies to compete against each other"(as reported in Roll Call, April 27, 2005).

Rector, however, rebutted that PBMs do not favor the transparency bill because it would show that the companies overcharge their customers for prescription medicines. "If they had to disclose to their client that they're doing that, they're going to have a very unhappy client."Rector explained, "Our objective is to establish in everybody's mind that you don't need a PBM. In fact, they're negative in the equation, and we're under way to demonstrate that."

In a statement, Rep Weiner said, "We're going to give [community pharmacies] a helping hand."

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