Pharmacists’ value: Time to be heard
In January, the Iowa Pharmacy Association (IPA) held its annual Legislative Day, during which Iowa pharmacists met with their legislators to discuss the legislative priorities established by IPA’s Legislative Committee and Board of Trustees. This was a particularly interesting session because in the previous year, both the Iowa House and Senate unanimously passed House File 2297 (HF 2297), which provided greater transparency of PBMs’ practices to the Iowa Insurance Division (IID) and implemented changes related to maximum allowable cost pricing.
Six months later, the Pharmaceutical Care Management Association—a national association that represents PBMs—filed a lawsuit against Iowa’s Attorney General and Insurance Commissioner, stating HF 2297 was unconstitutional. Furthermore, IID has attempted to implement and enforce HF 2297 by conducting audits of the four largest PBMs, to which none complied, citing specious legal reasons.
Currently, IPA is working to pass House Study Bill 68 (HSB 68), a very short piece of legislation that clearly provides IID with oversight and enforcement authority for PBMs to comply with existing legislation related to transparency, pricing, and exercise of good faith.
This legislation becomes particularly important when looking at the impact of PBMs’ pricing practices on community pharmacies around the state. In the past 2 years, 71 Iowa pharmacies have closed, limiting the access of Iowans, especially those in rural areas, to an important member of the health care team—the community pharmacist.
Sadly, this is not just an Iowa “thing”; it is happening across the country. As I was preparing for the IPA Legislative Days, I came across a publication that discussed the closures of independently owned rural pharmacies from 2003 to 2013.1 Following are some key points:
- From March 2003 to December 2013, the number of independently owned pharmacies in rural areas declined by 12.1% (924 pharmacies).
- The sharpest decline occurred between 2007 and 2009 (7.2%), a period coinciding with implementation of the Medicare Part D program and Medicare prescription discount cards. As a result of this decline, 409 communities that had at least one community pharmacy in March 2003 had none in December 2013.
- Furthermore, 121 of those communities lost access to a community pharmacy between May 2009 and December 2013, indicating continued declines in more recent years.
These communities didn’t just lose access to a local pharmacy. As I mentioned, they also lost access to a trusted health professional, the community pharmacist, who is often the only health professional in the community.
As a profession, we should not take that loss lightly. We are not just fighting for fair and transparent reimbursement for drug products but for fair reimbursement for the care and services we provide to our patients daily. This is about our value as pharmacists in the health care system and about having payers recognize and pay for that value.
A medication is just that, a drug: a substance that can provide benefit to patients or potentially harm them if not managed and monitored appropriately. For a medication to provide benefit, it has to be taken as directed, managed appropriately to maximize effectiveness and minimize risks, and monitored to ensure that it continues to be safe and effective for the patient. This requires coordination, collaboration, and communication among prescribers, patients, and pharmacists. If any of these factors are missing—including the pharmacist—then the patient is at greater risk of a drug misadventure.
We are in some of the most exciting times in our profession as the value of pharmacists is being recognized. Legislation has been introduced in both the U.S. House of Representatives and U.S. Senate to recognize pharmacists as providers in medically underserved communities. At the state level, similar to Iowa, many states have introduced or already passed maximum allowable cost legislation to increase the transparency of PBMs’ pricing methodologies.
But all of us need to step up our advocacy efforts. We need to be in tune with what is happening nationally and in our own states. We need to reach out to our state and federal legislators and communicate to them the value of pharmacists and the need for legislation that fairly reimburses pharmacists. We need to support our state and national organizations that continue to promote our profession to legislators and other key stakeholders. And we need to continue to push our practices to ensure that our patients receive safe and effective drug therapy that optimizes their therapeutic outcomes.
My business partner and I are giving it our best effort to make sure that our pharmacy does not become another pharmacy closure statistic. We owe it to our profession and our employees, but most important, we owe it to our patients!
- Update: Independently Owned Pharmacy Closures in Rural America, 2003–2013. Rural Policy Brief No. 2014-7. June 2014