Reformers promise level playing field

Drug Store News, Sept 27, 1993 by Ken Rankin

SAN DIEGO -- The Clinton Administration's health care reform program will "level the playing field" for the drug store industry by prohibiting pharmaceutical manufacturer price discrimination against community pharmacies, First Lady Hillary Rodham Clinton told execs here at the 1993 NACDS Pharmacy Conference. (More show coverage pg. 6.)

In outlining the prescription drug coverage provision of the White House health reform package, Mrs. Clinton revealed that "policy approaches" are being hammered out within the Administration to ensure that chain and independent community pharmacies receive "the same discount" on pharmaceuticals that are offered to HMOs and hospitals.

"We recognize that many manufacturers don't offer you the same discounts they offer to other large purchasers," the First Lady said in a live TV satellite feed from the White House to the San Diego conference.

Noting that these discriminatory pricing practices have "put you and the patients you serve at a disadvantage," Mrs. Clinton told chain pharmacy execs that "we are developing policy approaches that ensure that discounts are given for true economic reasons rather than just the class of trade the purchaser represents."

The First Lady's public commitment to curb the pharmaceutical industry delighted drug chain pharmacy directors at the NACDS meeting, but it outraged representatives from several pharmaceutical manufacturing firms at the conference.

For their part, NACDS staffers said they were not shown the text of Mrs. Clinton's remarks in advance, but they were pleasantly surprised by the detailed support she expressed for their position on pricing.

The Administration's stand on pharmaceutical pricing differentials was developed largely in response to an intense campaign by NACDS and NARD to influence the shape of pharmacy coverage under the Clinton health reform initiative. Indeed, eliminating such discriminatory pricing activities is the centerpiece in a series of fundamental principles for health care reform agreed to by the new "Community Retail Pharmacy Health Reform Coalition" formed earlier this year by NARD and NACDS.

Retail pharmacists heard

In her address to the chain pharmacy meeting, Mrs. Clinton praised the efforts of that coalition and of NACDS president Ron Ziegler and NARD executive vice president Charles West.

"Both of them have been ... very helpful in the work we have been doing," she said. As a result of that work, "we're on the brink of really being able to deliver quality health care reform to our nation."

Significantly, Mrs. Clinton made no mention of another of the coalition's principles--a demand that patients be given freedom of choice of pharmacy and that all pharmacies have free access to participate in the health reform program. Earlier at the conference, however, White House spokesman Glen F. Aukerman, M.D., told chain execs that the President's emphasis on cost containment through "managed competition" will make such freedom of choice rules "difficult."

The First Lady, who chaired the White House task force responsible for developing the president's new health reform package, told the meeting that pharmacists "are too often under-utilized in our health care system," and that the Administration's new program "will call for integrating pharmacy services as much as possible into the health care delivery system."

Noting that the new health reform plan will include both "a Medicare drug benefit and a universal prescription drug program," Mrs. Clinton predicted that "more Americans--particularly older Americans--will be coming into your pharmacy to have their medication needs met."

Price inflation addressed

Although she made no mention of pharmacy reimbursement levels or prescription price controls, Mrs. Clinton made it clear that she does not hold community pharmacists responsible for rising prescription drug prices. "We know that you are not to blame for skyrocketing medication prices that have increased three times the rate of inflation for the past 12 years," she told the attendees.

The First Lady also called on drug chain execs to support the Administration's plan because it represents "an extraordinary opportunity" for pharmacy."

"Many in our country may see health reform as a threat," she said. "We will need you to join together with us to support the changes we will need for our businesses, for our communities and for the country."