09/05/2009 05:12 am ET | Updated May 25, 2011

Independent Pharmacists Battle Big Pharma On Health Care

The prospect of a wholesale overhaul of the health care system is bringing a new face to the Capitol Hill lobbying scrum. The National Community Pharmacists Association (NCPA), a network that represents independent pharmacists across the country, is spending much more money than it ever has before in an effort to make its voice heard.

But in a legislative fight that has drawn record amounts from all parties, the pharmacists could be drowned out all the same.

Until 2006, the NCPA spent from $100,000 to $300,000 on lobbying per election cycle. But during the 2008 election they laid out almost $1 million and they've spent an additional $830,300 since November.

The reason the pharmacists felt the need to spend so much will sound familiar to many of those who have been following the debate: They worry that the legislation will overly reflect the massive clout of the insurance and pharmaceutical industries.

Their goal is to establish themselves as stakeholders in the health care debate -- and defend their revenue from better-moneyed members of the industry.

John Norton, Associate Director of Public Relations for the NCPA, said pharmacists would like to play a more active role in the reform debate. If patients have better relationships with their pharmacists they can better comprehend and adhere to their medication regimens and potentially avoid complications related to non-compliance, he said. Such changes would significantly contribute to cost reduction.

The initial impetus for NCPA to join the lobbying fray was the Medicare Modernization Act of 2003, which came into effect in 2006.

The legislation placed processing and payment of prescription drug claims into the hands of large third-party administrators known as Pharmacy Benefit Managers (PBMs).

The PBMs adjusted the reimbursement schedule so that pharmacies were being reimbursed less regularly. "That created a lot of cash flow issues" said Norton. He noted that at the time of the shift about 5 percent of independent pharmacies went out of business.

"Because they're so massive, they enter into contract negotiations with us and we are given 'take it or leave it' contracts, where essentially we're told take this contract or lose access to the patients," Norton said.

The NCPA is at present seeking an antitrust exemption to be able to collectively bargain with the PBMs, and the group is lobbying on current legislation to adopt a different reimbursement mechanism on any public option plan.

When asked about their position on the prospect of a public option, Kevin Schwears, NCPA's vice president of public affairs said they were "advocating that any so-called 'public option' insurance plan doesn't disadvantage community pharmacy." But on whether or not there should be a public option at all, the group remains "agnostic."

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