COMMUNITY PRACTICE

Community pharmacy gives thumbs down to Bush Rx card

It was déjà vu—all over again—for community pharmacy leaders who quickly rejected the Bush Administration's new plan to have Medicare endorse a private prescription drug discount card program for senior beneficiaries.

Private prescription drug discount cards blessed by Medicare were once again the centerpiece of the Administration's proposal released last month by the Centers for Medicare & Medicaid Services (CMS). The cards are part of a plan to educate seniors about prescription drug programs and generic savings as a prelude to a full-blown Medicare Rx benefit in the future. CMS figures that emphasizing the education component gets around the argument that the agency lacks legal authority for the program.

New provisions of the proposed rule published in the March 6 Federal Register include the requirement that participating drug manufacturers, not just pharmacies, must contribute to discounts. And card sponsors would have to pass savings on to consumers. Medicare beneficiaries would pay a one-time $25 fee for a discount card. Based on projected discounts of 10%-13% and the assumption that seniors would spend $13.3 billion on drugs next year, seniors using approved discount cards would save an estimated $1.65 billion in 2003, according to CMS' proposed rule.

Whichever way CMS wants to spin its Rx discount card proposal, the agency still lacks the authority to establish such a program, according to the National Association of Chain Drug Stores and the National Community Pharmacists Association. The two groups had joined forces last July to go to court seeking an injunction to stop the original Rx card proposal on the basis that the Administration had no legal authority to promote the cards without legislation to back the move. A federal judge granted the injunction, halting the program, but granted a stay to allow the government to submit a new proposal.

Following the announcement of the new version of the Medicare-endorsed cards, NACDS and NCPA filed a motion asking the federal judge to issue an order enforcing the original injunction, because the new program violates that original injunction. The contention is that CMS failed to show statutory authority for the program.

"It's basically the unsuccessful argument they made before," said John Rector, NCPA senior v.p./general counsel. "They've added a few bells and whistles, but they [still] lack the legal authority to implement this program. It's like an old, recalled bad medicine in a new container."

Instead of wasting time with discount cards, the Administration should put a true Medicare Rx benefit on the table for public debate, according to NACDS. The group favors the Emerson-Ross bill (H.R. 3636), introduced in the House of Representatives to give seniors a comprehensive pharmacy benefit. The bill would let seniors choose their own pharmacy and pay a flat 20% co-pay on all drugs.

"NACDS favors taking this idea to Congress, where seniors, pharmacies, doctors, and drug companies can engage in a reasoned debate with lawmakers, resulting in a workable solution that the President can sign into law," said NACDS CEO Craig Fuller.

Not surprisingly, the new card program won high marks from some drug manufacturers and pharmacy benefit managers (PBMs). Several PBM executives stood shoulder-to-shoulder with President Bush last summer when he unveiled his first Rx discount card plan. For example, AdvancePCS, which helped shape the first Bush proposal, said the latest incarnation was a "positive step forward" to help seniors better afford their medications. And the PBM said it intends to analyze the proposal to assess its potential role. At the same time, the Pharmaceutical Care Management Association, which represents PBMs and mail-service pharmacies, said the Medicare-endorsed Rx cards would give seniors "savings on their medications similar to those currently offered in the private sector."

In the meantime, Eli Lilly became the latest drug company to announce a discount program covering its own products. The LillyAnswers card charges eligible low-income seniors $12 per month for each company drug they are taking. Lilly is the fourth drug maker to unveil a discount card program in the past nine months.

While applauding Lilly's desire to help seniors, NCPA executive v.p./CEO Bruce Roberts restated independent pharmacy's opposition to manufacturer-specific cards: Offering a separate card for each drug company will create confusion for both patients and pharmacists. He also urged adoption of a true Medicare Rx benefit that includes fees for pharmacist services.

The 168-page CMS proposed rule can be found on the Web at www.cms.gov/discountdrugs/. Click on "Proposed Rule: Medicare-Endorsed Prescription Drug Care Assistance Initiative." The proposed rule includes a 60-day period for comments.

Carol Ukens

Carol Ukens. Community pharmacy gives thumbs down to Bush Rx card.

Drug Topics

Apr. 1, 2002;146:33.