GOVERNMENT and LAW

WHAT NEXT?

Old priorities put aside as Congress confronts new realities

The political landscape in the capital has changed as much as the Manhattan skyline. All the previous assumptions, predictions, strategies, and tactics came crashing down on Sept. 11. New ones are yet to emerge from the gloom, anger, and uncertainty.

The aerial suicide attacks terrorists unleashed on the premier symbols of America's economic and military might, the Twin Towers of the World Trade Center and the Pentagon, compelled President Bush and Congressional Democrats to shelve their partisan wrangling—at least for now. Congressional leaders hope to adjourn by the end of the month (October), leaving scant time to consider domestic issues that once were flash points.

"The new bipartisanship may mean not doing anything [controversial]," said John Coster, v.p. of federal/state programs for the National Association of Chain Drug Stores. Rep. Marion Berry (D, Ark.), the only R.Ph. in Congress, said, "The important issues we're working on won't disappear; Congress will resume consideration of them when the time is appropriate."

Congress will focus on antiterrorism legislation, a military response to the shattering attack on America, and repairing the devastation, its leaders have pledged. Funding bills for all federal agencies also must be passed before recessing until January. "I think they'll just do all this crisis stuff and appropriations and go home,'' said John Rector, the National Community Pharmacists Association's senior v.p. for government affairs and general counsel.

Susan Winckler, the American Pharmaceutical Association's director for policy and legislation, said it's less likely a comprehensive Medicare drug benefit will become law now. "It's more likely there'll be some type of interim, patchwork, do-something [approach] in the appropriations process," Winckler said.

The prescription drug discount card and importing drugs from foreign countries both fit that description. But a federal court derailed the Bush Administration's fast-track plan to have pharmacy benefit management firms offer senior citizens Medicare- endorsed drug discount cards. U.S. District Court Judge Paul Friedman last month granted a motion by NCPA and NACDS for a preliminary injunction to halt the program Bush unveiled in July. "There is a strong public interest in any government agency only operating within the authority granted it by law—and they haven't done that," said Friedman.

Tom Scully, administrator of the Centers for Medicare & Medicaid Services, said the Administration would appeal the decision. Sen. William Frist (R, Tenn.) said he would introduce legislation to give the President's program legal backing.

In July, Sen. Chuck Hagel (R, Neb.) reintroduced his own discount card plan, which also includes stop-loss coverage for catastrophic drug expenses.

The other possibility, reimportation, is further along, but its already-uncertain prospects were not improved by the September attacks. The House has approved a measure that would allow reimportation for personal use. Sponsored by Rep. Gil Gutknecht (R, Minn.), it was easily approved on a 324-101 roll call in July. Its fate will be decided by a House/Senate conference.

Sen. James Jeffords (I, Vermont) has been considering offering an amendment that would permit pharmacies and wholesalers to import drugs if it can be demonstrated that the drugs were made at a facility registered with the Food & Drug Administration, either here or abroad. Sen. Byron Dorgan (D, N.D.) has been drafting narrower legislation that would allow pharmacies and consumers to import drugs from Canada.

But investigations already are under way into three instances this year of counterfeit injectables entering the drug supply, and border inspections are being tightened in the wake of the terrorist attacks. It seems less likely now that a majority in Congress would want to raise questions about the security of the nation's medicines by allowing more imports. There also is likely to be an effort in Congress to crack down on rogue Internet sites, especially foreign ones, sending drugs to Americans.

If Congress does adjourn this month, the outlook for legislation not focused on terrorism or existing government programs should be clearer when it returns next year. Measures to deal with the pharmacist shortage and reporting of medical errors might get a good look, but a lot will depend on how much discretionary money is available after making long-term commitments to the campaign against terrorism and rebuilding from the terrible toll of Sept. 11.

Michael F. Conlan

Mike Conlan. Old priorities put aside as Congress confronts new realities.

Drug Topics

2001;19:49.