Decision Time: Pharmacy's Stake in Health Care Reform

Decision time is fast approaching on overhauling the nation's health care system, as the legislation finally moves to the floor of the House and Senate for a vote. Each chamber has its own version, and pharmacy advocates are actively weighing in on provisions that they believe would help-or hurt-the profession.

The National Association of Chain Drug Stores (NACDS) recently activated its grassroots RxIMPACT program and sent more than 1000 letters to Capitol Hill in opposition to a possible amendment in the Senate that would permit personal and commercial importation of prescription drugs. In addition to concerns about the safety and effectiveness of imported drugs-as well as patients' loss of access to the professional services and advice of local, licensed pharmacists-NACDS opposes new mandates likely to accompany importation: track and trace requirements it sees as costly and unproven, and that would have the effect of treating legitimate brick and mortar pharmacies the same as illegitimate Internet drug sellers.

The amendment is embodied in a bill (S 1232) introduced earlier this year by Senator Byron Dorgan (D, ND) with the support of 31 cosponsors. In a letter to Senate Majority Leader Harry Reid (D, NV) and Minority Leader Mitch McConnell (R, KY), NACDS President and Chief Executive Officer Steven C. Anderson, IOM, CAE, noted that "NACDS shares the goal of reducing the cost of prescription drugs," but argued for other, "safe, proven, cost-saving alternatives, such as wider integration of medication therapy management [MTM] and increasing generic utilization in health care programs."

The House version, which may come to the floor as early as this week, contains a limited exemption for pharmacies from Medicare's durable medical equipment regulations, which is good news for pharmacy, as is inclusion of the MTM pilot program, according to the National Community Pharmacists Association (NCPA). NCPA is worried, however, that the bill's Medicaid average manufacturer price (AMP) provisions for covering generic drug acquisition costs may not go far enough.

NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, said that his organization applauds many of the changes made to the formula but that members are "concerned about the proposal to cap payments at 130% of AMP. It would still force many independent community pharmacies to reduce staff and operating hours, leave the Medicaid program, or close their doors altogether." NCPA plans to continue to work with House leaders to develop a more equitable formula.

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