Indies target power of PBMs at NCPA's annual conference

Drug Store News,  Nov 17, 2003  by James Frederick

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SEATTLE -- If all the speechmaking and panel discussions that went on at the National Community Pharmacists Association's 105th Annual Convention and Trade Exposition could be boiled down to a single message, it would go something like this: Don't take the independent community pharmacist for granted.

NCPA leaders at the event, which concluded Oct. 22 at the Washington State Convention Center, are hoping that message goes straight to the nation's health care plans, physicians and policy makers. And, with threats to community pharmacy's future coming every day in the form of Medicare reform, prescription benefit managers and the overall devaluation of the pharmacist, there is no time to waste in getting the message out, they said.

Incoming NCPA president Sharlea Leatherwood told organization members that "it's a great time to be an independent pharmacist," with "so many opportunities that are on the verge of coming to fruition" in such areas as disease state management, compounding and immunizations. But she cited the steep uphill climb that independents face.

"The biggest challenge that keeps hitting us in the face is that there is not a great appreciation of what pharmacists do by those who are controlling our destiny right now," Leatherwood said.

Bruce Roberts, executive vice president and chief executive officer for the organization of pharmacy owner/operators, put it in stark terms. "This is our Holy Grail," he said. "We must strive for broad recognition of the value of the pharmacist and the pharmaceutical to the overall cost of health care and to the quality of life of our patients."

In a strongly worded speech that went down like a bracing tonic to many of the more than 1,200 pharmacy owners in attendance, Roberts fired one of the sharpest salvos yet in the escalating war of words between drug store retailers and prescription benefit managers. He called the effort to counteract the influence of PBMs "our No. 1 priority" and promised NCPA would continue to lobby in Congress, in the courts and before the public on behalf of the beleaguered independent pharmacists it represents.

"Our No. 1 impediment is pharmacy benefit managers," Roberts charged. "Through their low reimbursement, mail order coercion and the creation of a chaotic atmosphere in community pharmacies, they are doing everything in their power to marginalize us.

"Having spent 25 years owning and operating my own community pharmacies, I know firsthand the chaos PBMs are causing," he added. "I believe it is all part of a plan by the PBMs to drive patients out of our stores and into their mail order operations."

The NCPA chief also accused the Pharmaceutical Care Management Association, the group representing PBMs, of "bald-faced lies" in its depiction of NCPA's lobbying and legal efforts. Those efforts are part of what Roberts called a three-pronged campaign--involving legislation, education and litigation--to ensure "a more appropriate role for PBMs."

Striking a nerve

On the legislative front, NCPA has seen wide adoption of its language in state regulations involving managed prescription plans, said outgoing organization president Joe Smith in a speech at the opening of the conference. "This year, NCPA led the way as independent pharmacists across the nation called for regulation of pharmacy benefit managers at the state level," Smith told attendees. "We revised our model PBM regulation legislation, and it was introduced in 20 states this year. Three states, including the leader of the pack, Georgia, have enacted PBM regulation. Maine and Maryland are the other two.

"We've struck a nerve with the PBMs," Smith added. He noted that NCPA also has beefed up its legislative and regulatory oversight this year by hiring a director of state legislative and regulatory affairs and by creating Pharmacist e-Link, an online legislative action tool for state pharmacy associations and buying groups. "This tool will allow the states to post legislative information on issues of state importance and call for action," Smith explained. "It will allow you to access the contact information for your state officials and legislators so that you can take action on these issues. It will also allow you to access federal legislative issues."

In other federal efforts, Roberts noted, "We have also worked diligently to make sure that any PBM-controlled Medicare pharmacy benefit requires transparency on the part of the PBMs, a level playing field for all pharmacy outlets and freedom of choice of pharmacy and product for Medicare beneficiaries."

NCPA also has lobbied heavily for the right to dispense 90-day prescriptions--an effort heavily resisted by the managed care industry.

On the education front, the group has developed articles for various publications this year on such issues as dispensing costs, third party administration and when to walk away from a dispensing contract. And in the courts, NCPA joined the Pharmacy Freedom Fund and four pharmacy owners from New Jersey and Pennsylvania in August to file separate class-action lawsuits against two PBMs, Medco Health Solutions and AdvancePCS.