As Republicans and Democrats square off on the Medicare debate,
it is important that all parties remember the goal central to the
debate: better health outcomes for seniors. Policy-makers are
seeking to achieve this goal through a new prescription drug
program, which Americans hope will improve access for Medicare
recipients while also controlling costs.
There is an important participant on the front lines of the drug
delivery system who is often overlooked by policy-makers but whose
contribution has significant influence on that chief goal:
community retail pharmacists.
The Importance of Pharmacists
Pharmacies play a vital healthcare role in every community. For
many Americans, the community pharmacist is the most accessible
healthcare professional around -- available within five miles of
virtually every household, without an appointment, sometimes 24
hours a day. Pharmacists may not be the first group that comes to
mind when one thinks about healthcare delivery. But according to
Gallup's annual honesty and ethics poll*, pharmacists are
consistently among the most highly regarded professionals.
According to the most recent poll, 67% of Americans rate the
honesty and ethical standards of pharmacists as "high" or "very
high," ranking them second (behind nurses) on the list of 21
professions included in the poll. (Medical doctors rank fifth,
closely tied with military officers and teachers.)
The patient care that pharmacists provide extends beyond the
accurate dispensing of prescriptions. Pharmacists educate patients
about their medication and the condition for which it is
prescribed, review the patient's medication history, monitor the
patient's drug therapy over time, screen for potential adverse
effects of the medication, and monitor the patient's ability to
take medication correctly. These pharmaceutical care services are
invaluable to all healthcare consumers, but they are a crucial
component of any successful chronic care management program.
A recent analysis using 1999 Medicare claims data showed that
approximately 78% of Medicare beneficiaries have at least one
chronic disease. Almost 32% have four or more, and these patients
drive almost 79% of program spending. Challenges in chronic care
management include making the best use of medications and helping
patients comply with medical regimens. A cost-of-illness model
appearing in the Archives of Internal Medicine stated that
costs could be cut by more than 50% if pharmaceutical care was
provided to all patients.
Pharmacy Benefit Managers
In today's private healthcare system, there is a threat to this
trusted and effective pharmacist/patient relationship: pharmacy
benefit managers, or PBMs. PBMs contract with employers, unions,
HMOs, and other payers of healthcare benefits to manage the
prescription drug portion of the healthcare plan.
Through negotiation with drug companies, they determine which
drugs will be approved for coverage and their cost. In effect, PBMs
steer health plan beneficiaries and their physicians into using
particular drugs, and by doing so exert a powerful role in drug
distribution. The three largest PBMs collectively managed nearly
half of the $132 billion prescription market in 2001, and all have
business ties to large pharmaceutical companies.
Several years ago, the largest PBMs saw an opportunity to expand
their business by competing with community pharmacies. Their
relationships with managed care companies put them in a perfect
position to drive healthcare beneficiaries out of local community
pharmacies into mail-order operations owned by the PBMs.
PBMs are central to the debate over the new Medicare drug
program because they are considered an important factor in the plan
to reduce costs. It is vitally important that the government not
allow them to set the rules for competition with community
pharmacies. It would be a serious detriment to the new prescription
drug benefit if Medicare patients were forced into using mail-order
services and denied the opportunity to use the local pharmacists
they know and trust.
Bottom Line
In its headlong rush to provide a prescription drug benefit for
the elderly and disabled, Congress risks managing the symptom
instead of treating the disease. In tackling the cost issues, it's
easy to forget that the ultimate goal is healthier seniors.
Evidence demonstrates that improved patient health and cost
savings are achieved when pharmacists play an integral role in the
healthcare team. All Medicare beneficiaries should receive the
attention they need to avoid medication-related complications. If
Medicare were designed today, it is unlikely that it would pay for
the practitioner services necessary to diagnose a patient's
disease, but not cover the practitioner's treatment.
A new Medicare prescription drug benefit should support -- not
undermine -- the infrastructure of highly efficient pharmacy
services delivery. Mail-order pharmacy services should be an
option, but those entrusted with administering the pharmacy benefit
cannot use the program to steer business to their own mail-order
pharmacies, or penalize seniors who prefer to use neighborhood
pharmacies. Let the competition for serving Medicare beneficiaries
be equal and fair … and mindful of the invaluable service
that local pharmacists provide.
*Results are based on telephone interviews with 1,017
national adults, aged 18 and older, conducted Nov. 22-24, 2002. For
results based on the total sample of national adults, one can say
with 95% confidence that the maximum margin of sampling error is
±3 percentage points.
