Congressman Joe Pitts (R-16th Dist.) visited Longenecker Pharmacy in Parkesburg this week to discuss legislation regarding drug reimbursement through the Medicaid program.Along with Thomas Tillett, District Chief of Staff, Pitts met with Dick Brown, president of the pharmacy, and several other members of the pharmaceutical staff on Tuesday.
Brown discussed with Pitts the high cost of generic drugs to the pharmacy. The Pharmacy receives a payment from the state Medicaid agency based on the state's formula for approximating the cost of acquiring and dispensing the drug. The Average Manufacturer's Price (AMP) of generic drugs is calculated by averaging the price that companies pay when buying in bulk at the Average Wholesale Price (AWP). "I cannot buy at those prices," said Brown.
According to a testimony given by Douglas Holtz-Eakin, director of the Congressional Budget Office, "The AWP is essentially a sticker price and does not directly correspond to any actual market transaction. As a list price, it offers the advantage of being readily available. But it suffers the drawback of being an imperfect representation of the true cost a pharmacy faces when acquiring a drug. In practice, the AWP is usually higher than actual market-transaction prices."
"If AMP would continue to go the way it is," said Brown, "I would lose money on most of the prescriptions we use under Medicare D. If you're being paid less than your cost, there's no benefit to filling the prescription. I'm not here to loose money."
Brown suggested a solution that could potentially benefit everyone involved with the Medicare prescription process. "For every one-percent that you raise generic usage on Medicare Part D drugs, Medicare would save $500 million. If we would use generic prescriptions just three to four percent more, we would save Medicare over $1 billion."
"But if we end up getting money taken away," said pharmacy technician Michele Brown, "it's hard to push generics."
Rep. Pitts asked Brown what he suggests the government does to increase generic prescription drug use. Brown said the need is to "raise reimbursement rates to pharmacies for generics."
"I can convince a patient that a generic prescription is safe and just as effective as a name-brand drug, but there has to be incentive," Michele Brown said.
"You've got to come up with a proposed legislation to solve these problems," Rep. Pitts said to Tillett.
Tillett said if the newly implemented rules regarding AMP continue, CMS (Centers for Medicare and Medicaid Services) will take another look at it and see what they can do.
Jodi Muldoon, a Medicare consultant at Longenecker Pharmacy, told Rep. Pitts that there is a big need for seniors to have direction when dealing with healthcare options and prescription information. Her job is to work with seniors through one-on-one appointments in finding the best plans for them. Rep Pitts joked that Longenecker's should market this idea and hold workshops. In reference to Medicare Part D, Muldoon said, "It's a good plan, but if definitely needs some kinks worked out as far as accessibility."
"We're practicing well-care, instead of sick-care," Michele Brown said. "Well-care means controlling the disease before the disease controls them. Insurance can offer wellness programs, but the premium has to go up. Employers are always looking for the lowest dollar. There is no motive for employers to invest in someone's longtime healthcare when they could only be at that company for a few years."
Brown briefed Rep. Pitts on the inter-workings of the Pharmacy, informing him that all of Longenecker Pharmacy's technicians are certified, based on national testing, which is currently not required by the state.
Brown explained that when the pharmacy technicians process prescriptions the data is electronically saved in the patient's profile. The pharmacy has a "robot" that is capable of filling 100 prescriptions per hour. The machine fills the bottles and attaches the labels. Before capping the bottles, the pharmacists manually verify the contents and information. A pharmacy technician then re-checks the prescription and reviews the patient's profile for possible allergies or drug interactions that may make a newly prescribed drug unsafe.
The order goes through at least three checks before being placed in the hands of the patient. If it is a new prescription, the pharmacist will be sure to speak to the patient about instructions, side affects, etc., and will take the time to answer any questions the person may have.
"We staff heavily to give our pharmacists time to interact with the patients," said Brown. "Our job is to make sure they understand a new drug, the biggest issue in healthcare today is compliance," said Michele Brown. "Pharmacists in my opinion are the most underutilized profession in healthcare. There is a mandatory six years of schooling for a pharmacist to graduate."
Brown said that a large portion of prescription orders are now being sent to the pharmacy electronically, through email. Aside from decreasing mistakes, a recent study has found that 11 percent more prescriptions are being filled as a result. The probable reason is that the customer will not have to bring in an order slip and wait for the order to be filled; the order will be there waiting for them when they arrive at the pharmacy.