Magazine article Drug Topics

Bush's Rx Card: An Assault on Pharmacy

Magazine article Drug Topics

Bush's Rx Card: An Assault on Pharmacy

Article excerpt

VIEWPOINT

The announcement of the President's Medicare drug discount card program has sent shock waves through the profession. The program was planned by the Centers for Medicare & Medicaid Services (CMS, formerly HCFA) in conjunction with some of the largest pharmacy benefit managers. Executives from AdvancePCS, Caremark, Express Scripts, Merck-- Medco, and Wellpoint were at the announcement to indicate their support.

Pharmacists and our associations were not invited to attend the meetings and not made aware that the program was under development. The credibility of the PBMs that participated in these secret meetings has been severely damaged in the pharmacy community. Is it their intent to restrict who can be involved in the program, just as participation in these meetings was constrained?

From the information that's been released about the program, the following flaws are quickly apparent:

* The program appears to focus exclusively on the cost of prescriptions, with no attention given to the pharmaceutical services needed to optimize use of the medications.

* The program requires pharmacies to assume the cost of the discount provided. The question must be asked, "Discount from what?" Nothing in the program addresses the costs pharmacists pay for drugs, which represents about 78% of the average Rx price. Nothing stops a manufacturer from raising drug prices to compensate for the rebates it is providing to PBMs.

* There is a potential for the PBMs to develop restrictive networks of pharmacies and provide financial incentives to encourage patients to use mail-order pharmacies. These situations will result in some patients having to use pharmacies other than their local facilities.

* Many patients will realize little or no savings on their Rx drugs and may receive less in the way of pharmaceutical services.

Winners and losers

If the proposed program is established as planned, the PBMs would be the biggest winners. This is no surprise because they designed the program and intend to profit from it. The pharmaceutical firms would also be winners. Once again they will have escaped any action regarding the prices they charge for their medications.

The biggest losers would be community pharmacies because they're required to assume the burden of the discounts. Many would not survive financially, and, if they decline to participate, their patents may switch to pharmacies that do take part.

Patients will also be losers even though some may realize small savings on their Rx costs. …

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