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Executive Summary

APhA Public Affairs Policy cmte. is recommending that the assn. seek legislation to ban differential pricing policies by Rx drug and device mfrs. The cmte. recommended a policy that the assn. "shall actively seek enactment of legislation to eliminate mfr. and distributor differential pricing of Rx drugs and devices." In its report, the cmte. noted that APhA "has adopted numerous policies critical" of pricing policies that disadvantage community pharmacists. The assn. decided to consider a resolution to pursue legislation, the report continues, after the Supreme Court declined to review a circuit court decision permitting Kaiser-Permanente HMOs to receive drug price discounts as "charitable institutions" ("The Pink Sheet" Jan. 14, 1984, p. 3). The policy recommendation was one of 13 that will be considered by APhA's reference cmtes. at the annual meeting, scheduled for March 16-20 in San Francisco. Recommendations must be approved by the APhA House of Delegates to become official association policy. Regarding the differential pricing issue, the cmte. further recommended that APhA seek legislation "to modify the Nonprofit Institutions Act to eliminate the exemption for all health care institutions that dispense, issue, or supply Rx drugs and devices." The Natl. Assn. of Retail Druggists has drafted model legislation that would limit nonprofit antitrust exemptions to those institutions that rely on charitable contributions to treat indigent patients. However, NARD has maintained that such a bill would not be necessary if the current law were enforced as originally intended. The Professional Affairs Policy Cmte. recommended that APhA urge "appropriate restrictions to assure distribution" of home-use in vitro diagnostic and monitoring products solely through pharmacists. In its report, the policy cmte. said it is "concerned with a number of factors that would speak against the unrestricted and widespread distribution of IVDs" (in vitro devices). Such factors include "instructions more complex than is common for most OTC products; the possibility of false-positive and false-negative results; the inability of color-blind persons to properly interpret tests relying on color comparisons; and the need for professional assistance in interpreting results and recommending appropriate action, e.g., referral back to the physician." The Scientific Affairs Policy Cmte. recommended inclusion of children as subjects in clinical trials when "appropriate safeguards" are in place, a pediatric indication is being tested, and the test drug is already approved for adult use. Noting that "fewer than 25%" of drugs marketed in the U.S. have been tested in children, the cmte.'s report declares that "there are still many unknowns involved in drugs used for children." In addition, "mechanisms of drug absorption, distribution between body fluids and tissue, metabolism, and excretion are all greatly dependent on age," the cmte. said. Because age-dependent functions "are not taken into account in drug studies on adult populations, it seems necessary that new drugs which will be used by children receive greater scrutiny and be more routinely tested in a larger number of children." The only other policy proposal for pursuing legislation was also offered by the Public Affairs Policy Cmte. and called for making "designer drugs" illegal. The cmte. also recommended a policy for "rationing" health care services, as it did last year. APhA should "develop criteria with other health care assns. regarding rationing of health care services in order to represent pharmacy's interests," the recommendation states. APhA should support "programs that will actively market the cost-effective benefits of pharmacy services to patients and payors" and support the use "of management tools to assist the pharmacist in maximizing available revenues in an environment of expensive and/or scarce health services and funding," the proposed policy continues. At last year's convention in San Antonio ("The Pink Sheet" Feb. 25, p. 17), APhA's House of Delegates adopted a resolution to "support efforts which seek to control the escalating costs associated with the delivery of quality health care through arrangements which place responsibility for controlling such costs on both health care professionals and the public." The delegates defeated a section of the policy as recommended that would have urged efforts "to equitably apportion expensive and/or scarce health services and resources."

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