Indies harness strengths in push for legislation

ALEXANDRIA, Va. —Faced with threats from slower and lower drug reimbursements and a pending shift in power in Washington, the nation’s 23,000 independent pharmacies have dramatically stepped up efforts to influence policy through lobbying and educational efforts.

Last year the National Community Pharmacists Association spent $380,000 on those efforts, nearly 10 times what it spent three years earlier, according to Senate filings. Its grass roots network generated 40,000 contacts with lawmakers last year.

The NCPA also has increased fund-raising from its political action committee, gathering $692,000 during the last election cycle.

“There was a realization that we had to do more,” said Charles Sewell, NCPA’s senior vice president of government affairs. “Uncle Sam had become our business partner, and he’s not a good business partner. But we have to deal with it.”

Efforts to push pharmacy-friendly legislation are particularly critical this year, Sewell noted. “The legislative calendar is shortened by the presidential nominating conventions this summer and the … election campaigns,” he said. “We need hundreds of pharmacists and pharmacy students personally carrying our message to … Congress.”

In an interview with Drug Store News on the eve of the organization’s 2008 Annual Conference on National Legislation and Government Affairs, which kicked off May 19, Sewell outlined four major policy issues of concern to NCPA and its independent pharmacy members.

“The number one issue is average manufacturer’s price,” he said.

In December 2007, U.S. District Court Judge Royce Lamberth granted an injunction against the plan by the Centers for Medicare & Medicaid Services to impose a new AMP-based reimbursement structure on pharmacies dispensing generic prescriptions under Medicaid, handing community pharmacies a temporary victory. What’s more, the judge agreed that “irreparable harm would be caused if the AMP was ever put into effect,” Sewell said, meaning that “thousands of our pharmacists would go out of business,” particularly independents who depend on Medicaid for much of their business.

The court’s ruling for an injunction, however, is only a stopgap measure; the White House and CMS still appear determined to impose the new payment plan for Medicaid patients. The ruling “put things on hold, but you don’t know ultimately how that’s going to play out,” said Sewell.

For that reason, he said, “We have been working with the Senate Finance Committee and the Energy & Commerce Committee to try to get a…statutory delay, along with a study to show just how bad this is” for community pharmacy. “We want to make sure [the House and Senate] include this in the health care [legislative] package slated for June.

“Along with that in that same package, we’re hoping that will also include “prompt pay” legislation, because we’re still suffering from low and slow reimbursements in [the Medicare] Part D [drug benefit program].”

Prompt-pay legislation, another high priority for NCPA, is needed, said Sewell, because the for-profit drug plans administering Part D for the nation’s Medicare beneficiaries are still dragging their heels on prescription reimbursements, forcing independent pharmacies to borrow money to cover the shortfall in revenues. “We think about three-quarters of the [Part D] claims are being paid over 30 days…and when you’re making a very low margin to begin with, slow pay really puts you in a cash-flow crisis,” Sewell told Drug Store News.

A majority of House members and the Senate Finance Committee endorse prompt pay, said Sewell.

Another top legislative goal is winning the right for NCPA members to circumvent antitrust restrictions and collectively bargain for managed-care pharmacy contracts. “We got our business negotiations bill [overwhelmingly] passed out of the House Judiciary Committee,” Sewell noted. “Now we’ve got to bring it to the floor.”

The bills that address the collective bargaining issues are HR 971 in the U.S. House of Representatives, and S.2161 in the Senate.

Finally, NCPA is also working to head off the ‘‘Safeguarding America’s Pharmaceuticals Act of 2008,” or HR 5839. That legislation, introduced in April by Reps. Steve Buyer [R-Ind.] and Jim Matheson [D-Utah], would enforce rigorous new pedigree requirements uniformly across all 50 states. It would also require pharmacies—along with pharmaceutical wholesalers and manufacturers—to adopt systems and technologies to track and trace each individual prescription from the point of manufacture to the patient receiving the script at the pharmacy counter.

Imposing an electronic pedigree mandate on pharmacies before the industry has developed and adopted uniform technology and communications standards for track-and-trace, Sewell said, would be “unbelievably expensive” for retail pharmacies.