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Executive Summary

NARD CALLS FOR "EQUAL ACCESS" IN ITS "PROCOMPETITIVE AGENDA" position paper, forwarded to President-elect Bill Clinton's transition team and publicly released on Dec. 1. Entitled "Independent Retail Pharmacy and Health Care Reform: a Procompetitive Agenda for the Pharmaceutical Marketplace," the paper espouses three types of equal access: health plan beneficiaries should have their choice of pharmacy provider, all pharmacies should be permitted to meet the terms of and participate in health plans, and pharmacies should have access to drug manufacturers' lowest prices. Equal access in these areas "fosters competition," the paper states. "If health care reform is truly based on managed competition, then equal access must be a centerpiece of that reform in the pharmaceutical marketplace." Historically, "managed care" efforts have failed to capitalize on the "highly competitive nature of retail pharmacy," NARD said. "Anticompetitive barriers include multi-tier pricing" by the drug industry, "refusal by pharmaceutical manufacturers" to recognize the economies of scale offered by pharmacy buying groups and sell at discount prices, restrictions on consumer access to pharmacies of their choice and restrictions on pharmacies' participation in provider networks. NARD said "consumer access to the provider of one's choice is a key provision of the Democratic platform that will be guiding the Clinton-Gore Administration's activities in the health arena, as well as an essential component of the 1991 health reform initiative developed by the influential Democratic Leadership Council when Gov. Clinton was the DLC's chairman." By framing its equal access position in "procompetitive" terms, the retail pharmacy association has geared its appeal to the concept of "managed competition," which is gaining currency in Washington as the likely approach the new Congress and administration will take to health care reform. NARD noted that consumer choice of providers was included in the Democratic presidential platform and that it "promotes cost containment." NARD also recommended that national health care reform legislation include outpatient drug coverage and "fair" pharmacy payments. Pharmacy payments at a "minimum" should be based on "either marketplace pricing or another fair methodology that ensures the pharmacist full payment for the cost of the product, a markup to cover business operating expenses and provide a return on investment, plus a reasonable fee for the pharmacist's professional services," NARD maintained. The independent retailers group also called for "additional fees" to compensate for "a wide variety of other professional interventions by the pharmacist with the prescribed drug therapy." In a press statement accompanying the position paper, NARD said it "is currently working with members of the Clinton-Gore health care transition team" in an effort to "implement as many components as possible of [the association's] procompetitive pharmaceutical care agenda."

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