FAINT PRAISE FOR BUSH'S MEDICARE RX PLAN

Stephanie Loughran

WASHINGTON -- Closer, but no cigar.

Retailers are pleased that President Bush's latest Medicare prescription drug proposal gives more recognition to retail pharmacies, but supermarket executives polled by SN agreed that the plan is far from a level playing field.

The framework for Bush's Medicare reform plan includes 10% to 25% savings on the cost of prescription drugs for those recipients who choose to remain in the traditional Medicare program. The plan would offer catastrophic drug coverage for those with the most costly drug needs. More extensive coverage would be available for seniors who entered an HMO or private health plan.

Pharmacy associations, like the National Association of Chain Drug Stores, Alexandria, Va., and the American Pharmaceutical Association here, along with major supermarket chains like Albertsons, Boise, Idaho, conditionally praised the latest version of the president's plan.

These industry sources said that, unlike Bush's initial proposal, the revised version acknowledges retail pharmacies as a choice in providing prescription needs for seniors. However, the industry seeks a solution that is more retailer-friendly.

"The president's Medicare blueprint suggests an appreciation of the important role community pharmacy plays in the delivery of a nationwide drug benefit," said Larry Johnston, Albertsons' chief executive officer and chairman of the board, in a prepared statement.

Craig Fuller, president and chief executive officer, NACDS, commended Bush's efforts to "provide seniors with a wide choice of where to meet their prescription needs, and that includes the right to use their local pharmacies," he said in a written statement.

Bush's initial plan would have provided no drug assistance for seniors who stayed in traditional Medicare, according to published reports. The new plan still favors third-party providers like prescription benefit managers, said industry sources.

"Either plan does not provide adequate reimbursement to pharmacies," said Barry Katell, director, pharmacy operations, Ingles Markets, Asheville, N.C.

It may be more beneficial if manufacturers would administer their own plans providing reimbursement directly to the pharmacies, he said.

"Both plans encourage mail order, which does very little to monitor compliance for an age group than needs this feature more than any other age group," he noted. "Mail order may reduce costs, but does not improve health care for this population."

George Pappas, manager of pharmacy operations, Big Y Foods, Springfield, Mass., said he was glad Bush modified his first proposal, but the president's retooled plan "encourages seniors to enroll in private health plans, and I would be opposed to [it] if those private plans mandated the use of mail-order pharmacies."

However, "payment for pharmacists' service is essential for the plan to work," said Susan Winckler, group director of policy and advocacy, APhA. This component has not been articulated by the Bush administration, she said, but the pharmacy association looks forward to working with the administration to "provide patients with access to medication and access to service."

Jeff Maltese, director, pharmacy, Shoppers Food Warehouse, Lanham, Md., stands by the NACDS approach to senior drug benefit coverage, which supports market-based prescription benefit programs like TogetherRx, the Pfizer Share Card and Lilly Answers manufacturer discount cards.

"There are other options before we push seniors toward mail order," he told SN. "If seniors read into what the plan offers, they would be disappointed if the plan was passed today."

Maltese called for NACDS' deeper involvement in this debate to "to get all forms of community pharmacy involved to compete with PBMs."

Other alternatives include preferred drug lists and differential co-payments, which steer customers toward generic drugs by providing less expensive co-pays on generic medications compared to co-pays on brand name drugs, Maltese said. "These provide real benefits rather than phantom benefits like 10% discounts," he said.

The cost of the Medicare overhaul would be $400 billion over the next 10 years, according to published reports.