RETAIL PHARMACY MAY SUGGEST Rx COVERAGE FOR MEDICARE "NEAR-POOR" -- NACDS' ZIEGLER; INCREMENTAL REFORM STRATEGIES LIKELY; VIRGINIA CONSIDERS ANTI-SWITCH BILL

Extending prescription drug coverage to "17 mil. near-poor" is an option that retail pharmacy may suggest to lawmakers as part of Congressional discussions of Medicare and Medicaid managed care, National Association of Chain Drug Stores President Ronald Ziegler indicated Jan. 29 at a D.C. press conference.

The Community Retail Pharmacy Coalition, which includes NACDS and the National Community Pharmacy Association (formerly NARD), would contend that expanding drug coverage could yield an overall cost savings, Ziegler explained. Pointing to the 17.5 mil. Medicare beneficiaries who do not receive outpatient prescription drug benefits, he said that it "seems like it's worth focusing on the savings to the system" if more Medicare patients get a drug benefit. "Proposals to shift more of the nation's 38 mil. seniors under Medicare, coupled with the increasing shift to managed care in state Medicaid programs, only heighten the coalition's concerns," Ziegler said.

Retail pharmacy, however, faces a more immediate challenge: President Clinton's fiscal 1997 budget is expected to include a provision for Medicare reimbursement to pharmacy at the actual or estimated cost of outpatient drugs, rather than the average wholesale price ("The Pink Sheet" Jan. 6, p. 5).

A bill heard by a Virginia house of delegates committee Jan. 30 would outlaw pharmacists from receiving incentives for therapeutic substitutions. However, the bill was tabled pending recommendations from a private-sector study group after opposition from managed care groups.

"It shall be unlawful for any person to solicit or encourage the prescribing practitioner of a patient residing in the Commonwealth...to substitute a prescription drug the prescribing practitioner originally prescribed for the patient with any chemically dissimilar prescription drug, unless the person is the patient, another practitioner or a caregiver," the proposed law states. The law also would have made it illegal for a pharmacist to dispense medication with knowledge that the prescription had been changed through a managed care company's intervention. Fines range from $10 to $1,000 per violation.

The bill (HB 2714, S 1114) was supported by Virginia's retail pharmacy, medicine and nursing associations. The House bill is sponsored by a bipartisan group of delegates; the Senate bill was submitted by Sen. Charles Hawkins (R) and is co-sponsored by a number of other senators.

HB 2714 could be the first of a number of similar bills introduced in statehouses. State pharmacy execs are understood to have discussed anti-substitution bills in recent meetings.

In Congress, NCPA and NACDS will continue to support the Prescription Drug Benefit Equity Act, introduced last year by Rep. Lowey (D-N.Y.), which would require that health plans not differentiate between mail-order and retail pharmacies in their co-payment structures. NCPA Exec VP Calvin Anthony predicted at the press conference that the bill will be reintroduced this session. The coalition is also still supporting bills on reimbursement for diabetes counseling and outpatient pharmacy counseling under Medicare.

The retailers' coalition is continuing its long-standing support for the drug rebate program, Ziegler noted. The pharmacy groups are also following Medicaid waiver activity in individual states.

A working group of NCPA and NACDS members, together with association staff, will address the issue of electronic transmission of prescriptions from the perspective of state regulation, Anthony reported. It is "critical" that the transmission of prescriptions between doctors and pharmacists be "uninterrupted," Anthony said. Pharmacy's concern is that "there are those who would like to interfere" with electronic scripts by checking for formulary compliance and utilization, he commented.

The pharmacy coalition working group will address other state-level topics including patient confidentiality, pharmacy technician issues and the National Association of Boards of Pharmacy proposal to assess the competency of practicing pharmacists, Anthony said. Resolutions of the working group will be incorporated into proposed revisions of state practice acts.