If ever there was a "Troubled Asset" in need of relief and/or a stimulus package, it is the Retail Pharmacist. We need a "bailout" as bad as Wall Street, GM, Chrysler, Fannie Mae or Freddie Mac ever did. There are about 275,000 practicing pharmacists in the US and roughly 200,000 of them practice in the retail setting. The latest figures I could find on the number of retail pharmacies were from 2009 and listed approximately 56,000 unique retail pharmacies with 17,000 of those being independents. You can argue the change in numbers from then to now, but I'm betting there are fewer that 17,000 independent pharmacies left and more than 56,000 chain, grocery, mass market pharmacies.
In lieu of the complete loss of control and lack of professional common sense so prevalent in pharmacy today, how about a Retail Pharmacist Rescue and Recovery Act. This act could be introduced in Congress immediately, passed unanimously and rushed to the Presidents desk for his immediate signature. The Bill would be quite simple. It would probably be two pages or less. The lobbyists of Big Pharma, PBMs, large chains, mail-order and Internet pharmacies would not be allowed to comment (read exert influence) on the content of the Bill before passage. You wouldn't have to pass this bill to see what's in it. It wouldn't require the taxpayer to become an unwilling owner of any pharmacy(s) or corporation(s). It would level the playing field, restoring fairness and competition to the marketplace. It would improve patient care, eliminate counterfeiting and diversion of drugs in the supply system and lower the costs of prescription drugs while increasing patient access to the same level of comprehensive pharmacy care regardless of where or how they chose to receive their prescriptions. It would stimulate the economy across the country at a local level. Companies would grow, jobs would be created and communities would prosper both economically and from a health standpoint. Best of all it would cost the taxpayers - nothing!
The RPRR Act would encompass the following key points:
1) All drugs would be priced uniformly across all classes of trade. In other words, retail pharmacy would buy the same drug for the same price as mail order, hospital , HMO, LTC, specialty or any other type of pharmacy. While prices would rise for some classes of pharmacy, the overall price of medications would decrease. The pricing gimmicks, rebates and kickbacks employed by drug companies would be eliminated. Retail pharmacy would cease to bear the brunt of discriminatory drug pricing because drug companies would not have to artificially raise prices to retail pharmacy to offset discounts given to other classes of trade. The incentive for diversion by wholesalers, secondary suppliers and pharmacies to increase profit would be gone. The ability for counterfeit drugs to reach the marketplace, while not eliminated, would be largely decreased and controlled due to a flattened supply chain. The need for pharmacies to carry two separate inventories when serving more than one class of patient such as a pharmacy that serves retail and LTC patients would be eliminated.
2) All laws and regulations that affect how pharmacists deliver information to patients would be uniform. It is simply UN-American that your next door neighbor or the person down the street or anyone else in the country should have better (or worse) access to information, counselling and other services implicit with the purchase of a prescription because their employer or the government dictates where they must purchase their prescription drugs. Yet Boards of Pharmacy across the nation have relegated many of the people they are sworn to protect, i.e. patients,to second class citizens based on where and who they purchase their prescriptions from. Retail pharmacists are held to the highest standards of care, in some states we are required to counsel patients on new and refilled prescriptions and many life saving interventions result. In most states, if not all, mail order and Internet pharmacists are not required to provide direct counselling to patients and in addition these pharmacies more often than not mandate a minimum 90 supply of any drug that even resembles a maintenance medication. Why are those patients short-changed on the information? Ever call a 800 pharmacist line to Medco, PPS or any other mail order "pharmacy"? Good luck getting a live person, much less a pharmacist. That is why as a retail pharmacist, patients bring their medications from those guys to us for advice or identification of a different looking drug in their bottle. This act would forbid discrimination (and it is discrimination) based on the origin or type of pharmacy a patient receives their prescription from. So if you live in Arizona, for example, you would be entitled to the same level of professional services from Medco as you are from your local pharmacy. If your local pharmacy is required by state statute to provide "live" pharmacist counselling at the time of service, so is Medco. If your local pharmacy is required to document OTC drugs you take along with your prescriptions, so is Medco. No patient should be discriminated against because they are required to purchase from a pharmacy not of their choosing. Let's see mail order try to perform at our level!
3) Any retail pharmacy must be at least 51% pharmacist owned and operated. I could write a long explanation of my vision for this, but will instead just borrow from the Pharmaceutical Profession Act of Alberta (Canada):
"Licenses to operate a pharmacy can only be issued to pharmacists. The
applicant must manage and supervise the pharmacy, ensure that a
pharmacist is present at all times, ensure that an adequate supply of
drugs is available and that suitable compounding and dispensing
equipment and a pharmaceutical reference library is available......
...The holder of a pharmacy licence shall not
(a) hold more than one pharmacy licence, or
(b) permit a proprietor of the licensed pharmacy or a person
who is not a pharmacist to direct, influence, control or
participate in the management or operation of the licensed
pharmacy in a way that contravenes this Act or the
Oh what a wonderful world it would be......
4) PBMs would be subject to anti-trust laws or conversely, retail pharmacy would be allowed to negotiate as an equal partner. Pharmacy Benefit Managers and their mail order surrogates have enjoyed the classification as "insurance companies" instead of the profit generating beasts they are since their inception. To the best of my knowledge, they have always been able to share the information on contract negotiations with each other. As a result retail pharmacy has been forced to swallow the swill offered by the PBMs without so much as a whimper. Courts across the country have continually struck down any effort by community and chain pharmacy to attempt to negotiate reimbursement pricing as a group. The result has been very one sided, all in the PBMs favor, and is the single biggest reason for the demise of retail pharmacy and the denigration of the profession, not to mention the health and well being of patients across the country. The elimination of this misguided anti-trust protection of PBMs would allow the marketplace to dictate fair reimbursement rates and allow pharmacists to provide the services required by patients and state and federal statute without sacrificing patient safety. It would ultimately lower health care costs by allowing the marketplace to provide the balancing point between services and cost.
So there you have it. My four pillars for restoring the profession of pharmacy. It would increase the level of patient care and services to all patients and would ultimately lower prescription drug costs. The Retail Pharmacist Rescue and Recovery Act. Good for the profession, good for patients and good for the economy. Maybe it's a pipe dream. But what if it wasn't?
What a wonderful world it would be.........