Antidepressants.

Medicines for depression.

By Prescription Online

Consultant pharmacists urged to join in Medicare drug debate

FROM: DRUG TOPICS; Long-Term Care; June 5, 2000

by JUDY CHI

Far from being an issue affecting only the business interests in long-term care, the Medicare outpatient drug benefit is a once-in-a-lifetime opportunity whose outcome will determine the landscape for all of pharmacy. If pharmacists don't get involved in shaping this issue, they might not have an attractive professional and economic future left. So warned Tim Webster, executive director of the American Society of Consultant Pharmacists, at its midyear meeting in Las Vegas last month.

A bit hyperbolic, you say? Not in Webster's opinion. The Medicare drug benefit offers both challenges and opportunities to consultant pharmacists. On the challenge side, any of the proposals presented on the Hill would significantly expand third-party coverage for ASCP members, he cautioned. Pharmacists would also probably have to brace for significantly reduced pricing flexibility, a new collection source, a new formulary, and drug choice limitations.

On the other hand, the Medicare benefit offers the opportunity to recognize consultant pharmacists' unique skills and pay them for what they do with what they know on a broad scale, Webster noted. This opportunity is one that "won't come our way again any time soon." So it's in consultant pharmacists' interests to let their Congressmen know what they can do for seniors and make that a part of the national debate.

So where does ASCP stand on the issue of Medicare drug benefit? ASCP president-elect William Simonson told the opening general session that four principles underlie ASCP's position. Simonson spoke on behalf of ASCP president Dianne Tobias, who couldn't be there because her mother was ill. The principles are as follows:

• The Medicare drug benefit should target only low-income seniors. ASCP does not support universal coverage as President Clinton and Presidential candidate Al Gore do.

• Beneficiaries must have access to all needed FDA-approved drugs, including IVs.

• There should be reimbursement to pharmacists for providing patient medication management services.

• Reimbursement should also cover the specialized packaging services pharmacists provide.

To date, several legislative proposals have been advanced for the Medicare drug benefit. These proposals can be grouped in the following five ways, said ASCP director of government affairs Leigh Davitian:

• Government-contracted competitive bidding, under which the country would be divided into four or more regions. An entity that submits the lowest bid, such as a pharmacy benefit manager (PBM), would administer the contract in each region. Clinton is in favor of this proposal, under which drug prices would be driven by the government.

• The premium support model. The Pharmaceutical Research & Manufacturers of America supports this private-sector approach, which would require the government to help beneficiaries with their premiums. However, the drug benefit would not be implemented until after Medicare is overhauled.

• The House Republican plan. This is another private-sector, insurance-based plan under which the government and insurers would share in beneficiaries' catastrophic costs.

• Discounts to pharmacies. Pharmacies would buy drugs at the same price as that given to federal providers and presumably pass the savings along to consumers. Community pharmacists endorse this plan.

• State pharmaceutical assistance. Some states are contracting with one PBM to provide a drug benefit to seniors and the Medicaid program. Other states want to share their Medicaid pricing with Medicare beneficiaries.

After reviewing these approaches, the ASCP board decided it could not wait for Medicare reform to be completed before a drug benefit is put in place. It wants a stop-gap measure now that could perhaps sunset in five years. So it has formally endorsed SenioRx Gold, a program that calls for federal assistance to states via block grants, so they can provide Rx assistance to seniors whose income falls below 200% of the federally defined poverty threshold who currently lack drug coverage. This is a plan cosponsored by the National Association of Chain Drug Stores, American Pharmaceutical Association, and National Consumers League. It also has the support of the Food Marketing Institute.

Davitian told the audience that ASCP would work with these coalition members and with Congressional representatives to lobby for SenioRx Gold and to draft a legislative proposal addressing the needs of seniors in long-term care settings.

Webster urged all attendees to get involved in advocating their position on the Medicare drug benefit, which he called an emotional, complex, and disconcerting issue. As the old saw goes, he declared, "Get into politics or get out of pharmacy."