Campaign 2008: No vote of confidence from Rx industry
WASHINGTON —The battle for the White House between Barack Obama and John McCain has energized millions of American voters and unleashed a national dialogue about the fundamental role of government in the troubled economy, in the healthcare system and in global affairs. But for retail pharmacy leaders, the dominant response to the campaign appears to be skepticism.
“Can I say ‘neither one’ for my voting preference?” joked one industry executive.
He wasn’t the only one with a jaundiced view of the election. A survey of industry leaders reveals a general lack of enthusiasm for the Democratic and Republican choices, and a broad sense that the next president will face enormous constraints in implementing real improvements in the healthcare system.
Both candidates favor expanding health coverage to more uninsured Americans, especially children, although they differ on how much of that coverage burden falls on individuals, corporate payers or government. Both men also promote generic drugs and drug importation to lower costs, the acceleration of health information technology and expedited approval of generic versions of biotech drugs. McCain also promotes in-store clinics as a health savings tool.
Nevertheless, “At this point it’s hard to really say who’s best. They’ve talked in such generalities, I’m not even sure if I have a clear picture of what their plans really are,” said a pharmacy operations executive for one of the nation’s largest food-store chains. “And after the $700 billion bailout, what’s left to do anything for health care? So I’m very skeptical.
“All we know is that the more the federal government becomes the payer, the tighter the profitability for retail pharmacy becomes,” she added.
Many other retail pharmacy operatives are equally leery. “I think both healthcare platforms have some pretty big implications [for retail pharmacy],” noted Chris Dimos, president of Supervalu’s pharmacy division. “But let me balance that by saying I don’t think either one of them will be successful in implementing them in the way that they’ve been articulated.”
Many experts with close ties to Washington agreed. “It’s virtually impossible to do major reform in the next year,” noted Dan Mendelson, president of health and policy consulting firm Avalere Health.
Head to head on the issues that matter most to retail pharmacy| Issue | John McCain | Barak Obama |
| Medicare Part D | No specific proposal McCain voted against creation of Part D | Supports direct negotiation of Medicare Rx drug prices |
| Illegal drug importation/ rogue online sellers | Supports drug importation with certain safety protocols | Supports drug importation from developed countries if proven safe and costs less than in the United States |
| Medication therapy management | No specific proposal; Advocates for coordinated care system that requires single bill for all procedures in place of current system; Focuses on management of chronic disease and payment that rewards quality. | No specific proposal; Emphasizes prevention and coordinated care of chronic diseases; Would require health plans in existing and new publicmented healthcare programs to utilize proven disease management programs |
| Recognition of pharmacist services under Medicare Part B | No specific proposal | No specific proposal |
| Behind the counter (BTC) medicines | No specific proposal | No specific proposal |
| Retail clinics | Supports innovative delivery systems, such as retail clinics | No specific proposal |
One source at Walgreens summed up the cautionary view of industry leaders. “In terms of the health care debate, they’re not really looking at one candidate over the other, because they think that the country is moving toward a universal health care system,” he noted. “The real issue is going to be providing access for everyone to the medical system. And that’s where they think there’s an opportunity for pharmacies and in-store clinics to play a role.”
Steve Anderson, president and chief executive officer of the National Association of Chain Drug Stores, observed wryly that “presidential campaigns have a tendency to operate in watercolors,” rather than being pinned down to specifics.
One change that will be of critical importance to pharmacy, said Anderson, is whom the next president taps to head such federal agencies as Health and Human Services, the Centers for Medicare and Medicaid Services and the Food and Drug Administration. Also key, he said, will be the outcome of congressional races this fall.
“The Democrats will…probably strengthen their control of the House and Senate,” Anderson predicted, and Democrats may be in a position to build veto-proof majorities even if McCain wins the White House.
“We’ve been positioning ourselves to be an effective voice, no matter [who] is elected,” Anderson said.
One problem with both candidates, said a pharmacy executive at one Northeast drug chain, is that “both favor [drug] importing. And the biggest question from our side is that if they even think about importing, will the insurance companies…start paying us based on the import price?”
The top pharmacy leader for another major supermarket chain noted that while “Republicans have traditionally been more favorable to retail,” the industry’s experience under the Bush administration has been disappointing. Nevertheless, while he likes many of Obama’s proposals for expanding drug coverage and generic utilization, this executive said he’s concerned with how Obama would pay for that increased coverage. “They expect much of the financing…$50 billion to $65 billion a year…to come from savings within the healthcare system, with additional revenue to come from discontinuing tax cuts for those with incomes over $250,000,” he noted of a recent report from the Kaiser Family Foundation. “So to me, that means savings coming from cuts in reimbursements to healthcare providers—doctors, nurses, pharmacists.”