Pharmacist seeking Hill help

Andrew Edwards

Rep. Chris Cox said Friday he would attempt to alter a pending

Medicare provision that worries some small pharmacists, but a federal

official suggested that any change would require a new law.

Small pharmacists, including Mike Martin of Balboa Pharmacy, are

concerned the prescription drug benefit outlined in the 2003 Medicare

Modernization Act could siphon patients away from their businesses.

For about three weeks at his pharmacy, Martin has been collecting

signatures for a petition aimed at amending the law, he said.

He and other pharmacists involved with the petition want to

challenge a portion of the law that would enable pharmacy benefit

managers -- companies that would manage the drug benefit -- to allow

some pharmacies that serve Medicare patients to provide larger

discounts than others.

“We want to get the true ‘any willing provider’ back,” Martin

said, referring to wording in the law that allows any pharmacist

willing to be part of Medicare to join the government-sponsored

healthcare program.

Martin said he is working with other pharmacists across the

country through a group called FixMyHealthcare.com, which is owned by

a North Carolina seniors advocacy group. The organization’s

spokesman, F. Michael James, said about 20,000 pharmacists have been

working on the petition, which is set to be delivered to Congress on

March 15.

While the 2003 law contains language that allows any pharmacist

willing to participate in the Medicare program to do so, it also has

a provision that lets pharmacy benefit managers designate some

pharmacies within their networks as “preferred providers” that could

charge lower prices for drugs.

In January, the Center for Medicare and Medicaid Services, the

federal agency that would oversee the drug program, issued a rule

that reinforced pharmacy benefit managers’ ability to let different

pharmacies in their networks charge different prices.

Martin said he stands to lose a sizable chunk of business if his

pharmacy is not selected as a preferred provider next year. He said

25% of business is derived from Medicare patients.

Pharmacy benefit managers contend that without the ability to

negotiate drug prices by setting up groups of preferred pharmacies,

medical costs would end up being much higher. Under an “any willing

provider” law, pharmacists will “be able to dictate their own prices

and the consumers will pay more,” said Phil Blando, spokesman for the

Pharmaceutical Care Management Assn.

Cox described the rule, which is set to go into effect March 22,

as contrary to the “any willing provider” language in the law, and

said he would seek to have the rule changed after speaking with

Martin on March 4.

“I believe [Martin] needs to be allowed to participate and I

promised that I would work to get that rule changed,” Cox said.

However, an official with the Center for Medicare and Medicaid

Services said the changes sought by Martin and other pharmacists can

only be made by new legislation.

“[Cox would] have to change the law,” agency senior advisor Larry

Kocot said.

Cox could not be reached for comment after Kocot discussed the

difficulty of making the change desired by Martin and other

pharmacists.

The law’s much-publicized prescription drug program is set to go

into effect in 2006. The rule on pharmacists starts earlier to allow

them to prepare for the law.

Martin said he and other pharmacists will continue their efforts

to prod Congress into making changes, and believes many across the

country would be upset if his predictions come to pass and

neighborhood pharmacies fade away.

“These Congressmen are going to see a lot of their constituents

aren’t happy about this,” Martin said