Community Pharmacists Fighting Back

Posted April 4, 2008 at 6:06pm

Community pharmacists, facing what they call unprecedented threats from slower and more meager drug reimbursements, have executed a dramatic overhaul of their lobbying operation to fight back.

The small, mostly family-owned operations, represented in Washington by the National Community Pharmacists Association, got their wake-up call two years ago with the implementation of the Medicare Part D prescription drug bill.

The measure switched millions of independent pharmacists’ customers from state-run Medicaid to programs administered by private drug plans. That has meant slashed drug reimbursements that often arrive weeks after their payments to drug wholesalers are due.

In 2006 alone, as many as 1,100 community pharmacists — or 5 percent of their total ranks — were forced out of business by the change, the group said.

“I know people who will give you a drugstore if you’ll take it,” said Rep. Marion Berry (D-Ark.), the only pharmacist in Congress. “It’s not worth the pain and struggle you go through dealing with the insurance companies and the other government programs you have to deal with.”

Now, the association is going on the offense on Capitol Hill.

It has overhauled its once-sleepy lobbying operation, last year spending $380,000 on its efforts, nearly 10 times what it shelled out just three years prior, according to Senate filings.

Among the new recruits to the government affairs team: Charles Sewell, a veteran political consultant and now the group’s top lobbyist; Lisa Camooso Miller, former communications director of the Republican National Committee; Jim Hippe, deputy chief of staff to then-Senate Majority Leader Bill Frist (R-Tenn.); and direct-mail fundraising operative Chris Nave.

Its newly built grass-roots network generated 40,000 contacts to lawmakers last year, the group said. And it has goosed fundraising for its political action committee, gathering $692,000 during the last election cycle, more than three times its haul over the previous two years.

This cycle, group officials said, they are on track to vault into the Million Dollar Club, having set a target of $1.3 million in receipts for the account.

The NCPA last year spearheaded the creation of the Congressional Community Pharmacy Caucus, which now claims 53 members.

“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. That’s just the reality.”

There are early indications the investment is paying off. The group succeeded in blocking the transfer of 55 million prescriptions from community pharmacies to mail-order facilities in a military health care program. It killed a proposal for surety bonds on pharmacists’ durable medical equipment that would have cost $20 million. And it stopped an effort to allow the FDA more control over compounding, the process pharmacists use to mix drugs.

Now, Sewell said, it needs to prove it can not only stop damaging proposals, but get those it backs passed into law.

The group is marshalling its newfound force behind three measures it calls make-or-break.

One, a bill to force pharmacy benefit managers — or PBMs, the middlemen under the new drug plan — to reimburse pharmacists faster, has attracted support from 239 House members. The Senate companion, sponsored by Senate Finance Chairman Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) has attracted support from a majority of the panel.

On that measure, the NCPA is collaborating with the National Association of Chain Drug Stores, a sometimes-rival whose membership includes small chains and bigger players like Walgreens and CVS.

But it faces stiff opposition from the trade group for the PBMs, the Pharmaceutical Care Management Association, which argues the measure will increase administrative costs and hamper the ability of PBMs to detect fraud and abuse.

“A lot of folks would love to find a way to help their independent drugstore owner,” PCMA President Mark Merritt said. “But it’s hard to do so when their agenda calls for higher costs, less accountability and less access.”

Rep. Walter Jones Jr. (R-N.C.), who with Berry is co-sponsoring the so-called prompt pay measure, said the survival of pharmacists is critical for the delivery of health care in rural districts. “They’re an important link for people who can’t get to a doctor every week or every month, either because they can’t afford to” or because they’re too far away.

The NCPA has also partnered with the chain drugstores to reverse a government move to cut by as much as a third reimbursements on Medicaid prescriptions. And it is pushing for an antitrust exemption so independent pharmacists can join together to bargain collectively with the PBMs.