NCPA Lobbies for Community Pharmacy

The National Community Pharmacists Association(NCPA) is revving up its campaign in support of theCommunity Pharmacy Fairness Act of 2005, or HR1671. Sponsored by Reps Anthony Weiner (D, NY) andJerry Moran (R, Kan), the bill would give pharmacists a narrowantitrust exemption to collectively negotiate withpharmacy benefit managers (PBMs). Represented by thePharmaceutical Care Management Association (PCMA),PBMs'clients include health plans, unions, and largeemployers.

The bill, introduced in the House of Representatives onApril 14, 2005, was the focus of the NCPA's lobbying effortsduring the 37th Annual Conference on National Legislationand Government Affairs held May 1 to 3 in Washington,DC. NCPA members are seeking cosponsors and bipartisansupport for HR 1671. A variety of issues, including the following,could be addressed if PBMs are mandated to negotiatewith pharmacists:

• Limiting formularies that restrict a patient's treatmentoptions
• Diminishing reimbursement that threatens to shutdown independent pharmacies
• Unfair and untimely payment for pharmacist servicesthat could keep patients out of emergency rooms andnursing homes
• Denial of the right to dispense a 90-day prescriptionwith fair payment
• Mandatory mail order, which forces patients to use thePBM's own mail-order pharmacy
• Confusion in the pharmacies created by the lack of uniformityand completeness of information on prescriptiondrug cards
• Switching patients to more costly, inappropriate medicationsbased not on the patients'health care status,but on the PBM's financial interest
• Harassment of compounding pharmacists

John Rector, NCPA senior vice president of governmentaffairs and general counsel, said that, if the bill passes, independentpharmacies will bargain for the following:

• Payment of medication therapy management services
• Patient choice of pharmacy provider
• Restored rights under the Uniform Commercial Code (astandard set of guidelines protected by the law thatdetermine how business transactions are conducted)
• Right to dispense 90-day refill prescriptions

During the annual meeting, antitrust attorney David A.Balto—of Robins, Kaplan, Miller, & Ciresi LLP—said that HR1671 is important because "pharmacists have direct patientcontact, making them best-equipped to negotiate withPBMs for pharmacist/patient terms."

The legislation is a modified version of Weiner/Moranbill HR 5278 from the last Congress. The bill provides anantitrust exemption permitting "independent pharmacies"to bargain collectively with health plans regarding termsand conditions of contracts with the pharmacies withoutviolating antitrust laws.

Another piece of legislation causing friction between theNCPA and PBMs is the Pharmacy Benefit Manager TransparencyAct of 2005 (HR 1669). That bill also is sponsoredby Weiner and Moran and was introduced in the House onApril 14, 2005. The bill will prohibit any pharmaceuticaldrug manufacturer from having a controlling interest in anyentity that is a PBM. Furthermore, the bill specifies thatPBMs would not be able to make any drug interchange proposalfor a patient served by a PBM if the net cost of the proposeddrug exceeds the cost of the original drug. The PBMsalso would be prohibited from changing a patient's medicationwithout informing the patient of the savings to theindividual associated with the change.

The PBMs argue that HR 1669 would give drug companiesmore bargaining power in negotiations. Mark Merritt, presidentand chief executive of PCMA, said that the bill would"undercut our ability to negotiate discounts. They wantpublic transparency of PBMs'confidential information,which would undermine our ability to get deeper discountsfrom drug companies, and undermine our ability to get drugcompanies to compete against each other"(as reported inRoll Call, April 27, 2005).

Rector, however, rebutted that PBMs do not favor thetransparency bill because it would show that the companiesovercharge their customers for prescription medicines. "Ifthey had to disclose to their client that they're doing that,they're going to have a very unhappy client."Rector explained,"Our objective is to establish in everybody's mindthat you don't need a PBM. In fact, they're negative in theequation, and we're under way to demonstrate that."

In a statement, Rep Weiner said, "We're going to give[community pharmacies] a helping hand."