Aw, what's the matter Mr. Republican Pharmacist? The
new Republican Medicare prescription drug bill putting
you out of business? Aw...poor things! Pfffft! :-p
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March 13, 2006
Pharmacists Say Drug Plan Threatens Their Livelihood
By ROBERT PEAR
WASHINGTON, March 12 — Pharmacists say they have been
losing money under Medicare's new prescription drug
benefit, and they have taken their concerns to the
White House, forcing the administration to confront
political problems caused by the rocky start of the
program.
In a meeting last week with Karl Rove, the president's
senior adviser, the druggists said many independent
pharmacies might have to shut their doors because they
were not being paid adequately or promptly under
Medicare. In the last two months, they said,
pharmacists have given away millions of dollars' worth
of medications for which Medicare drug plans should
have paid.
The pharmacists who visited the White House were all
from Texas. Several have close ties to Mr. Rove and
President Bush. But their concerns are shared by
retail pharmacists across the country, who said that
Medicare drug plans were paying them less than it cost
to fill prescriptions for the beneficiaries.
Bill C. Pittman, a former president of the Texas State
Board of Pharmacy who is chairman of Pharmacists for
Bush, a political fund-raising group, arranged the
meeting, held on Monday at the White House.
Richard E. Beck, one of the Texas pharmacists who met
with Mr. Rove, said, "Pharmacies are losing money on
Medicare." Slow payment by Medicare drug plans has
caused cash-flow problems for many pharmacies, he
said.
Mr. Pittman said he told Mr. Rove and other officials:
"If pharmacists don't receive immediate relief, some
will go broke. Others are hurting so bad that they
will choose not to participate in Medicare and
Medicaid."
Mr. Bush has described the drug benefit as "the
greatest advance in health care for seniors since the
founding of Medicare" in 1965. Administration
officials said beneficiaries were saving large amounts
of money because prescription drug plans had
negotiated deep discounts with drug makers and
pharmacies.
The new benefit is delivered by private health plans
subsidized by Medicare. The drug plans have contracts
with pharmacies. Medicare officials said they would
help pharmacists enforce the terms of these contracts.
But pharmacists said this was not enough because
insurers typically offered the contracts on a "take it
or leave it" basis.
The pharmacists underscored the political significance
of their concerns in a report presented to Mr. Rove
and Allan B. Hubbard, assistant to the president for
economic policy.
"Most independent community pharmacists are
small-business Republicans," the report said.
"Pharmacists want to be supportive of this
administration, and they can play an active role in
the midterm elections. But pharmacists need to be able
to point to some corrective actions being taken by the
administration."
Trent D. Duffy, a White House spokesman, said: "From
our perspective, it was a positive, productive
meeting. We want to understand the concerns of
pharmacists. They play a critical role in delivery of
the drug benefit. At the same time, we want to make
sure that seniors are getting the best possible deal."
As of mid-February, 342,000 people had enrolled in
prescription drug plans in Texas, more than in any
other state. An additional 230,000 Texans were in
Medicare plans that covered drugs along with hospital
care and doctors' services.
Even as pharmacists take on new duties under Medicare,
they are discovering that they will be paid less than
they now receive under Medicaid, the program sponsored
by federal and state governments for low-income
people.
In February 2005, Mr. Bush proposed significant cuts
in Medicaid payments to pharmacies. Many of those cuts
were included in a deficit reduction bill that he
signed into law last month. In his 2007 budget, he
proposed further cuts.
Critics called the cuts immoral. Mr. Bush replied,
"It's not immoral to make sure that prescription drug
pharmacists don't overcharge the system." His comment,
in Manchester, N.H., on Feb. 8 this year, infuriated
many pharmacists because it seemed to suggest that
they were cheating the government.
In a letter to the president, James L. Martin,
executive director of the Texas Pharmacy Association,
said, "It has become obvious that you and your
advisers do not understand the profession of
pharmacy."
Druggists said they had no discretion in deciding how
much to charge patients under Medicare and Medicaid.
Those decisions are made by Medicare drug plans and
state Medicaid programs, they said.
Mr. Martin, one of the pharmacists who met with Mr.
Rove, said Mr. Bush's comment was particularly galling
to pharmacists because they had "bailed out the
Medicare prescription drug program" in its first
weeks.
Pharmacists helped hundreds of thousands of people
sort through scores of prescription drug plans. They
filled millions of prescriptions even though they
could not get the information needed to verify
eligibility.
Michael O. Leavitt, the secretary of health and human
services, said pharmacists' efforts had been "nothing
short of heroic." In the first month of the Medicare
drug program, he said, many pharmacists provided
"three-to-five-day supplies of medicines to
beneficiaries without payment."
In an e-mail message to Mr. Rove on Feb. 13, Mr. Beck
wrote, "I have been a loyal Republican for a long
time." But he said pharmacists were "distraught that a
Republican president would attack our profession."
Mr. Beck, who is vice president of American
Pharmacies, a purchasing co-op based in San Antonio,
said the first six weeks of the new Medicare program
had been "a total fiasco" for many pharmacists. "I
have some members on the brink of going out of
business," he said.
In an e-mail response, Mr. Rove said: "The president
was not attacking pharmacists and pharmacies. He was
responding to the Democrat leader of the Senate who
called the Medicaid reforms 'immoral.' "
Pharmacists said that Medicare drug plans were paying
them less than Medicaid and commercial insurers paid
for the same services.
In an interview, Mr. Beck said: "Reimbursement by
Medicare drug plans is very low and slow. Pharmacists
are being asked to bankroll the program. Many have to
dig into personal savings and take out loans to stay
in business."
Medicaid and commercial insurers pay pharmacies 7 to
15 days after a prescription is filled, but Medicare
drug plans often take 30 days or more, Mr. Beck said.
Dr. Mark B. McClellan, administrator of the federal
Centers for Medicare and Medicaid Services, said he
thought the cash-flow problems had been resolved, but
he promised to investigate any complaints.
The pharmacists offered several recommendations to the
White House. They said the government should require
prompt payment, by electronic transfer, every week or
10 days. They said Medicare should give pharmacists a
financial incentive to dispense low-cost generic drugs
rather than brand-name medications.
And they said Medicare drug plans should not be
allowed to advertise a specific drugstore company on
their member identification cards. Such "co-branding
arrangements" confuse beneficiaries by suggesting they
cannot use other drugstores, the pharmacists said.
"You don't have advertising on a Social Security
card," said Marvin D. Shepherd, a professor at the
College of Pharmacy at the University of Texas, who
attended the White House meeting. "Why would you have
advertising on Medicare prescription drug cards?"
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