Supermarket NONFOODS Business: Hanging together

"We must all hang together, or, most assuredly, we shall all hang separately."

Benjamin Franklin's admonition to the signers of the Declaration of Independence is being echoed throughout America's pharmacy community. Once fractured by turf wars between chain pharmacists and independents, between traditional drug stores and supermarkets, the combatants have formed a united front against a common enemy: Congress.

The consistent failure of federal lawmakers to pass a prescription drug plan for senior citizens and the finger-pointing at pharmacists over prescription drug costs has galvanized the pharmacy community.

"Everyone is all in this together," says Crystal Wright, v.p. of media relations for the National Association of Chain Drug Stores, which has led the initiative to create interim national drug care relief for the elderly while a legislative solution languishes. The Together Rx program created by NACDS and the Pharmacy Care Alliance built by many of the leading drug manufacturers have come together to create a stronger alliance.

Craig Fuller, president and c.e.o. of NACDS, told attendees at the Pharmacy and Technology Conference in San Diego last month, "Together Rx and the Pharmacy Care Alliance joined forces, working together to educate low-income seniors about meaningful prescription drug assistance programs offered by pharmaceutical companies.

"By offering one-card access to savings, this program makes it easier for eight million to 11 million Medicare enrollees who have no prescription drug coverage to get medicines used to treat some common afflictions of older Americans, such as diabetes, hypertension, high cholesterol, cancer, arthritis, and others."

Industry officials are keeping a close eye on legislative and policy issues, at both the federal and state levels, to ward off challenges to the key role pharmacists play in the medical process.

Mark Griffin, president and c.e.o. of Lewis Drugs, Sioux Falls, S.D., and chairman of the board of NACDS, sounded the battle cry at the San Diego conference. "State after state is reducing Medicaid reimbursement rates. The federal government, in one of the most misguided policies in recent years, actually went to the [pharmacy benefit managers] before community pharmacy in crafting a Medicare prescription drug plan. Even the media have taken aim at retailers in recent news reports criticizing retail drug pricing.

"Now is the time to fight back."

One fight is taking place in Massachusetts, where the state is proposing a reduction in Medicaid reimbursement. NACDS is leading the industry to battle against the proposal. "Whether you're an independent or a chain, there's a greater realization of the power in numbers," Wright says.

"That campaign has got to go on, after Congress returns [to session this month] and thereafter," said Griffin. "Our collective voice is going to remain just as crucial to this debate as it has been so far, if not more so."

A large part of the work being undertaken now is to provide education for both consumers and pharmacists on the issues and the solutions proposed in the market. "We're trying to find ways to encourage retailers to be part of the educational process," Wright says. Registration programs for the Together Rx prescription drug program were launched in Birmingham, Ala. in August, and the program was expanded through the South. It is expected to continue to play a major role in NACDS' outreach to consumers.

"Some 150 prescription medications are covered through this program. And, to date, nearly 150,000 seniors have enrolled," Fuller told the NACDS conference. "We will continue to encourage other interested manufacturers to join the alliance and to share in our goal of educating seniors about this meaningful prescription drug program."

Online survey

Another education program that helps inform seniors about the safe use of prescription drugs is Pharmacy Cares/RxSmart. Launched in June, the program also promotes the pharmacist's key role in maximizing drug therapy.

A 16-question survey at helps consumers understand the importance of using medications safely. "Since our launch in June, media coverage and a presence on online health sites have brought nearly 15,000 consumers to log on and test their pharmacy IQ," Fuller said. "Our goal is to reach more than a million consumers over the next year."

"We as a society spend more than $177 billion on additional health care expenses, hospitalizations, and other problems resulting from the improper use of prescription drugs," Griffin said. "It's unacceptable that we spend more on the misuse of medications than we spend on the medications themselves."

The message NACDS wants to send is that pharmacists are still in the best position to work with patients to ensure safe drug delivery. "Who is best equipped to improve patient compliance, counsel on safe medication use, and guard against adverse drug reactions and interactions? A pharmacist. In 70 percent of the cases, it is our pharmacists," Griffin said. "So it simply defies logic when, as a matter of public policy, lawmakers target retail pharmacy to cut costs."

Fuller called the $177 billion cost of fixing problems associated with the incorrect use of prescription medications "an astounding statistic."

The issue is so crucial because prescription drug use continues to soar as pharmaceutical companies create new treatments for chronic illness and the baby boomer generation continues to age. As America stays healthier, it lives longer at the same time, increasing prescription drug use.

According to NACDS data, people aged 75 and older receive an average of 12 prescriptions. That demand has fueled higher prices. The average retail cost of a prescription is $40.22, according to the NACDS Chain Pharmacy Industry Profile. For those with co-pay programs, the costs out of pocket are much less. In fact, NACDS figures show just 18 percent of prescriptions are paid for with cash, down from 63 percent a decade ago.

Food or drugs

For seniors without a drug co-pay program, the costs can be staggering. On average, the cost of drugs comes to almost $500 a year for a 75-year-old who is on a fixed income. For those with more serious conditions, the choice sometimes is between food and drugs, and that has sparked the crisis that Congress has been unable to stem as yet.

The hope until now was that lawmakers would address the significant gap between Medicare drug benefits for seniors and the actual costs facing the millions of seniors who do not fill prescriptions because they don't have the money. "When we studied it, we found that one-third of all seniors aren't enrolled in a program because they thought they didn't qualify," Wright says.

NACDS is refocusing the debate over prescription costs and controls into a discussion of who is best qualified to assist customers with decisions about their medications. Grass-roots pharmacists have always been seen as filling that role, but with the increased number of prescriptions and a stagnant work force in pharmacy, the hours they have to put in just filling prescriptions continue to increase.

One solution is to increase the number of pharmacy technicians allowed to fill bottles. But because state regulations vary on the number and training for such technicians, reaching consensus on how to give pharmacists more time to assist customers is difficult.

"That's something our government affairs people have been working on," Wright says. "With the shortage of staff, you can go to many pharmacies and see the pharmacist putting in 12-hour days. In many places, they are the only game in town. If we had more techs to handle some of the administrative work, the pharmacist could be out front more."

But the association is increasingly attempting to get its work done on the legislative front while trying to make its case that the issue is not being created at the retail end. In Massachusetts, NACDS officials will be working to try to convince legislators that cutting Medicaid reimbursement to pharmacists will cut the availability of prescriptions rather than lower costs.

"It's a sad situation for consumers," Wright notes. "The retail pharmacist is not the cause of the problems."

Yet with any revolution—even the one that Franklin and his cohorts helped create—there is a greater sense of common purpose, and Wright views this as a great time for the association.

"This has infused a new energy in the association," she says. "It's a really exciting time for the industry. There is change and growth, and it's exciting to be in the middle of this and help it grow in the right direction."
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