Bush revises drug discount plan and pharmacists still don’t like it
Pharmacists instead throw support behind the House’s MEDS Act
As expected, the Bush administration recently released a revised proposal of its Medicare drug discount plan. Most pharmacists, however, are giving their support to a bill introduced in the U.S. House of Representatives instead.
The administration’s revision was published in the March 6 Federal Register. Pharmacy groups had roundly criticized the first version; they filed suit against the proposal and succeeded when a federal judge in Washington, DC, issued an injunction last September that stopped the program from being implemented. The judge found that the administration lacked the authority to create such a program unless it either obtained congressional approval or wrote a regulation.
This new rule differs from the administration’s initial proposal in several ways, according to the Federal Register notice. For example, card sponsors are required to obtain substantial manufacturer rebates or discounts, which must then be shared with beneficiaries directly or indirectly through pharmacies. In addition, the administrative consortium must consider having an advisory body.
The new proposal isn’t all that new
Critics call the new proposal simply more of the same. The plan relies on the same statutory authority the government had cited previously, says Susan C. Winckler, RPh, JD, group director of policy and advocacy for the American Pharmaceutical Association (APhA) in Washington, DC. This is the same statutory authority that the federal judge previously said the administration did not have.
The specific amount of savings that must be shared also is not in the proposal, she says. "While plan sponsors are required’ to pass on a substantial portion of the rebates or discounts, that term is not defined." Pharmacies certainly could be asked to contribute to the discounts, she adds.
One patient advocate group says the administration’s plan offers little price benefit. "Despite skyrocketing pharmaceutical costs that are making drugs more and more unaffordable for seniors, this proposal offers very meager price relief," says Ron Pollack, executive director of Families USA in Washington, DC. He predicts the savings will be 12.4% at best.
The plan also fails to address the real reasons for high drug costs, Winckler says. "Part of the cost of medications has to do with this reality: The most expensive medication is the one that doesn’t work. If a consumer spends $50 on an antibiotic that doesn’t work, that $50 is wasted — and that analysis doesn’t even consider the other costs for patients. The discount card does nothing to improve medication use, and that’s an essential element of any pharmacy benefit."
MEDS Act is preferred
In contrast, Winckler speaks highly of the Medicare Drug and Service Coverage Act of 2002 (MEDS Act), also known as the Emerson-Ross bill. Reps. Jo Anne Emerson (R-MO) and Mike Ross (D-AR) introduced the bill in the U.S. House of Representatives on January 24. Three other representatives co-sponsored the bill.
"[The bill] provides real coverage for necessary medications and the pharmacist-services to help patients make the best use of that medication," Winckler says. "It also protects consumer choice — allowing them to work with the pharmacist and pharmacy they prefer, and has some provisions to decrease the red tape’ that could permeate a new benefit."
The bill was developed with the help of the Pharmacy Benefits All Coalition, a group that represents pharmacy organizations and other groups. The bill focuses on providing seniors with comprehensive coverage for prescription drugs and includes pharmacy services.
One of the coalition members spoke out in support of the legislation. "We applaud Representatives Emerson and Ross for recognizing that seniors want and need this high level of care," says Craig L. Fuller, president and CEO of the National Association of Chain Drug Stores in Alexandria, VA.
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