[Congressional Record Volume 159, Number 107 (Wednesday, July 24, 2013)]
[House]
[Pages H5040-H5044]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHALLENGES FACING INDEPENDENT AND COMMUNITY PHARMACISTS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2013, the Chair recognizes the gentleman from Georgia (Mr.
Collins) for 30 minutes.
Mr. COLLINS of Georgia. Well, it's good to be here at the end of a
day in which there's been a lot of excitement here on the floor, a lot
of voting going on, a lot of debate, which is what we're up here for.
One of the things that I have committed to, as we talked about a
little bit last week, is pointing out some things that may fall a
little bit under the radar but actually matter a great deal to the
people of not only the Ninth District, but to the people of the United
States.
Up here, we can get, many times, lost in what I'll call the big
picture items or the latest of what's hot, so to speak, and tonight I
want to talk about our local pharmacists.
I have a little pharmacist I go to. We have several, but one of the
main ones I go to is Woody's Pharmacy, Kevin Woody. And I go in there
and I know that when I ask him about the drugs for myself, for my wife,
my kids, he gives me answers. He helps me know why they interact, what
goes on. We've got pharmacists in all kinds of settings that do that
every day for folks. But our local pharmacies, and especially our
community pharmacies, right now are under attack.
I'm going to be joined, hopefully, here in a little bit by the
gentleman from Pennsylvania to talk about the challenges facing
independent community pharmacies. You see, local pharmacists play a
vital role in America's neighborhoods and communities, particularly in
the more rural areas of northeast Georgia. They provide unparalleled
guidance, assistance, and resources for families, including my own. I'm
committed to protecting access to independent and community pharmacists
and helping to level the playing field through effective and robust
oversight of pharmacy benefit managers, or PBMs.
It's a tough enough task to survive in this economy, and the
overregulation by the administration is only making it more difficult.
I am committed to working with my colleagues, particularly the
gentleman from Pennsylvania, to promote legislation that will provide
consumers with greater choice of pharmacies, require fair standards for
PBM pharmacies, support access to diabetes testing supplies, protect
traditional pharmacy compounding, and ensure that our military families
can enjoy the many benefits that community pharmacies provide.
In many cases, independent and community pharmacists have dedicated
their careers to providing quality patient care. However, they've been
continuously cut by unfair reimbursements, overbearing audits, and a
take-it-or-leave-it approach to contracts. Over the next 30 minutes, I
look forward to discussing the challenges facing independent and
community pharmacists and the important role they play in the lives of
many of our constituents.
Although we cannot sufficiently cover these issues in the next half
hour, I hope this will be the first of
[[Page H5041]]
many conversations on this floor about this important topic. And this
is what I mean about ideas and topics that may not make the headlines,
they may not bring the stories on the opening of the evening news, but
they affect us daily in our lives and they're often overlooked.
When we deal many times on this floor, and I have spoken of it
before, is how do we deal with and what is the cost of regulation and
how they are affecting our everyday lives, this is one of the areas,
especially with our community pharmacists, that they're affecting right
now. It's affecting how they do business.
As one community pharmacist told me recently, that if something
doesn't change soon, that in my area of northeast Georgia, which has a
vibrant community pharmacy along with PBM pharmacists and others, that
within 10 years there may not be a community pharmacist left in
northeast Georgia. That's a scary thought, Mr. Speaker.
When you think about that for a second, when you look at an industry
that many of us grow up and you have stories going back to when many
pharmacists had soda stands; they had just a full-service place where
you could go. Even my pharmacist today still has the scoops of ice
cream. One of the ways my kids want to come with me to the store is
they say, I'll go with you if you're going to Woody's because I want a
scoop of ice cream.
So it's a family place. It's something that I think brings back a
sense of Americana, but it also hits at the very idea of what we'll
just take as just good old-fashioned entrepreneurship--businesses that
mean something to our community but also provide a service that is
invaluable. Right now I think those are under attack, and those are the
things that just concern me.
When we look at that possibility, as the pharmacist told me, he said
that there possibly may not even be community pharmacists in our area
within the next 10 years, that really struck my attention; and it's
made me, before I was even elected, begin to look at what are the
problems and how can we address those as we go along.
{time} 2100
I can give examples. And I bet almost every Member here on both sides
of the aisle can come in and talk about their pharmacist, wherever they
may work, but a community pharmacist who they can call on and ask
about. My parents--I have watched them grow up and they get older, and
when we have questions about their medicines I know that I can call my
pharmacist and ask him questions. I know that many of you--and maybe
even you, Mr. Speaker--have that person that you can talk to about the
drugs and the issues that just keep us healthy.
One of the things that they also help us do, and community
pharmacists do, is provide that preventive care that keeps us from
getting into these long-term illnesses which drive up the health care
costs, which is talked about so much on this House floor. And really
from my perspective the tragedy of ObamaCare is: let's get back to the
very roots of medicine. And as the doctors were speaking earlier
tonight on the floor, talking about how we can do preventive medicine
and make sure that the health of our constituents is taken care of,
community pharmacists do just that.
One of the first challenges facing our local pharmacists I want to
discuss here tonight relates to diabetic testing supplies and the
competitive bidding process. Earlier this year, I wrote the Comptroller
General Gene Dodaro expressing concern about the impact that the
Medicare Competitive Bidding Process will have on patient access to
diabetic testing supplies.
Seniors in northeast Georgia, and across the State, rely on their
ability to get the testing supplies from their local pharmacists. Many
have written to me expressing their concerns that applying
competitively bid pricing to independent community pharmacies could
negatively impact their access to these essential supplies.
In more rural communities, such as northeast Georgia, an independent
community pharmacy may be the only available option for seniors. Their
local pharmacist helps them properly use their test strips and meters
and provide much needed resource and guidance in managing their
disease.
A 72 percent reduction in reimbursement for retail pharmacies that
are currently supplying these items to Medicare beneficiaries was
announced on January 30, 2013. This reduction in reimbursement took
effect on July 1 of this year.
Here are some of the feedback that Georgians have given about the
impact that this reimbursement reduction is having on their quality of
life and access to care. We've heard things like: ``I've had difficulty
finding a new provider; my product of choice was unavailable; I've been
forced to change providers; the quality of my care and services is
poor; my cost has increased; I've experienced poor communication from
CMS; I'm confused about the changes.''
Independent community pharmacists typically sell diabetic testing
supplies to provide a service to patients, not to make money. Even
before the reduction in reimbursement rates, the profit margins on
these supplies were very low.
Now, pharmacists have to choose between keeping their business open
or giving their patients the supplies and care they need. This isn't a
choice they should be forced to make. In an area and a time in which
our economy and jobs are suffering, this is another example of a
business that is fighting against the world, so to speak, to stay in
business and to employ those 3 or 4 or 5 or up to 10 or 15 people that
take care of the people in our communities, Mr. Speaker.
This is something we need to take care of. This is something when you
hear the feedback from folks who are calling our office and writing our
office and calling their pharmacist and saying: ``I'm having difficulty
finding a new provider; I can't make sense of this; I'm forced to
change my provider; and the quality and service are poor.'' We need to
take a look at what's going on.
Another pressing issue from my local pharmacists is the lack of
oversight and transparency when it comes to the pharmacy benefit
managers. PBMs are actually one of the least regulated segments of the
health care market, yet they are the cause of numerous frivolous audits
that local pharmacies are subjected to.
Now, supporting strong PBM transparency requirements is key to
delivering real savings to patients. Unlike my local pharmacist, and
those across the Nation, PBMs do not have a real relationship with
patients. In fact, it is not uncommon for them to secretly retain most
manufacturer payments--e.g. rebates, discounts and other fees--instead
of passing the savings on to patients.
Additionally, PBMs have been known to switch plan members from low-
to high-cost drugs and manipulate generic pricing. At the end of the
day, the data points to the fact the PBM market is broken. I can speak
to this from my own personal experience. As I've shared before, I
believe when we talk about problems, we need to relate it to what
people can understand. For this, I can understand it through my family,
but also through my parents, who have talked about how their drugs have
been changed, or they've been given short notice of changes, or when
they get them from their doctor, who gives them the prescription to
take them to their pharmacy, they have a problem because they're not
going to be certified because there's been a change just in the last
little bit in what drug the coverage will make, and the PBMs have had a
large part in that.
What I believe is, their conduct is anticompetitive and anticonsumer,
and independent community pharmacists are often left vulnerable to
their market power.
But there are solutions to this problem. For example, allowing the
smaller to collectively negotiate will help level the playing field.
The threat of antitrust liability in the status quo prevents these
collective negotiations, and I believe an antitrust exemption is
appropriate and consistent with past exemptions enacted by this
Congress.
It is with that that I am proud to be an original cosponsor of what
is known as the ``Protecting our Hometown Independent Pharmacies Act of
2013,'' which I believe achieves this goal.
The author of this bill, Mr. Marino, and I have had several
conversations discussing his examples and what brought him into an
understanding of
[[Page H5042]]
what is going on with our community pharmacists and the problems that
have developed here. And I want to applaud, and I want to take out and
highlight Members who have brought forward pieces of legislation that I
believe matter to our constituents and they matter to the American
people.
This is a conservative piece of legislation that brings forward and
highlights a problem with our community pharmacists, who are reliable
businessmen in their communities. And by doing so and taking that part,
Mr. Marino has helped bring forth a piece of legislation that I am glad
to support and look forward to moving forward, hopefully through the
committee process and onto this floor and eventually signed into law.
Now, understand, there's a lot of discussion that needs to be had
here. PBM takes their fair share of blame, and there are a lot of
problems in this situation. It is something that we need to discuss
because it matters to the people back home, it matters to the very
essence of health and health care, which we come down to this well and
we talk about all the time. We talk about costs, we talk about the
problems with access. This is an area where I believe we can continue
to move forward.
There's also another pressing matter facing independent community
pharmacists, particularly in northeast Georgia, and that is abusive
audit tactics. I believe, like many Americans, that pharmacy audits
should be focused on uncovering actual fraud and abuse. Audits play an
important role in ensuring high-quality patient care and services.
Unfortunately, PBMs are leveraging their power to abuse the auditing
process. They're singling out expensive drugs and using typographical
and other trivial errors to recoup from pharmacies significant amounts
of money--not to return to Medicare, but to line their own pockets.
Now, this is where I'm going to use an example that I had a few
months ago. I had a number of pharmacists, my local pharmacists all
over northeast Georgia, came in and they met with me. All I did was, I
sent out a note because I had been hearing about this from my local
pharmacist and from others, and I said, come talk to me about what
you're experiencing.
Like a lot of times--and Mr. Speaker, maybe you've done a similar
thing with businesses--you expect maybe three or four people to show
up. In my conference room I had a full house. Pharmacists who left and
drove, some as many as 2 hours, to come to that office to sit down and
talk about the problems that they were facing. What that told me in the
middle of the day was that the issues and the problems that they have
were more important to them than spending time at their shop that
morning, and were finding somebody to cover their shop so they could
come talk about this because it's affecting the very quality of their
existence.
Now, as we look at this, they began to give me examples. For example,
let's say your local pharmacist fills a $500 prescription for you that
you called in over the phone or you had called in from the doctor's
office. The pharmacist dispensed the correct drug in the correct amount
and provided you the correct directions for taking the drug. Mr.
Speaker, do we have a problem at this point? I don't think so. You're
getting the right drug in the right amount in the right container with
the right label. Everything is there on what your doctor had wanted you
to have.
But if the pharmacist makes a mistake in his personal records in his
checking off--instead of checking the ``called in over the phone'' box
he checks ``the faxed in'' box--a PBM could then during their audit of
the pharmacy find the mistake and take back the entire $500. Not just
the copay, and not just the profit the pharmacy received; they take
back the entire cost of the drug.
Now, I've said before, there are a lot of things that make me scratch
my head. This is one of them. It's one thing to come in and be audited,
it's one thing to find a mistake in which there's a clerical error--and
there needs to be some correction to that clerical error. But let me go
back, Mr. Speaker, and remind you that it was dispensed properly in the
correct amount with the correct drug and the correct facility with the
correct directions on there. But, however, on the paperwork on how the
call came in, how they took the prescription down, they were audited
and deemed for that, and they were not just deemed for the amount of
their copay or their profit even; they were deemed for the entire
amount of the drug.
What's really interesting about this is I've also had several of my
pharmacists say it is eerily interesting to them that when they're
audited, it's not the generics that are audited, it is the brand names
that seem to be audited, the higher cost drugs that find their way onto
the audit list. I think that's really interesting because what happens
is if one mistake comes, you're talking about a major cost for these
pharmacists. This is not something they can continue to eat.
Now, it can be said they can appeal it, and they can go through the
process, but it is something over and over. They don't get to appeal it
and hold the money. They have to send the money in and then appeal.
Now, does that sound fair? I don't think so.
I think what we've got to do here is begin to look at this problem in
its entirety. The PBM could pocket the entire cost of a correctly
dispensed drug, even what the pharmacy paid wholesale. This leaves me
baffled. Obviously, an auditing measure should be in place, but for
transparency and accountability, not to financially penalize one's
competitors.
Oh, by the way, some of the PBMs are actually involved in the
competitors to the local pharmacies in which they audit. Just a small
reminder.
I can stand here all evening and tell you story after story of the
unfair and almost unbelievable auditing practices that my local
independent folks have had to deal with.
One local pharmacist told me about how they had already been audited
three times that year, and they were preparing for their fourth. Mr.
Speaker, do you know when he told me that? March. He had been audited
three times, getting ready for a fourth, and it was January, February,
March. This seems to be a problem.
Interestingly enough, the audits don't focus, as I've already said,
on generic drugs. The audits typically look at administrative errors on
high-priced drugs.
This comes as no surprise. We know that the PBMs are looking to take
money, line their pockets, and not care for patients. They don't
sponsor baseball teams, they don't participate in chili cook-offs, and
they sure aren't going to any tomato festivals. Patient care takes a
back seat to profit margins.
I believe that Congress should take a closer look at PBMs because, in
the status quo, after a pharmacy has been audited, recoupment funds go
back to the PBM. This is unacceptable. In other words, you're auditing,
and the fines that you get, the penalties that you get, go to you.
Again, there seems to be an incentive problem here. You're dealing with
the high-cost drugs, you're missing the generics, you're looking for
clerical errors on correctly dispensed drugs. The patient never had a
problem, but yet the pharmacist was deemed.
I'm committed to working with my colleagues to make sure that
Medicare is getting its fair share of funds back. There is one word we
hear a great deal on this floor. No matter the debate topic it is bound
to come up at least once. And that word is ``transparency.''
But there are few areas in which this concept is more important. You
see, transparency saves money and helps markets work better. It helps
it work as it was intended to work.
Transparency allows plans and payers, including large corporations
and governments, to confirm that a PBM is, in fact, providing the
service it was hired to do: to secure low drug costs.
Now, remember, in this world of regulation--and for those who know me
in my short time up here in Washington, this is one of the issues that
I have focused like a laser on, regulation. In fact, tomorrow morning,
I encourage Members if they are not busy and they want to come to a
regulatory reform caucus breakfast, come see us. We'll have breakfast
there for them, and we're going to discuss the effects of regulatory
reform and why this matters.
Many times, we in the elected office, we talk about regulatory reform
and
[[Page H5043]]
why it matters, and it's going to make sense. I believe tonight we've
shown how it affects local community pharmacists, and that's something
that needs to be looked at.
{time} 2115
But again, what were the PBMs supposed to do? They were supposed to
secure low drug costs. They were supposed to secure a better way for
our Medicare savings. This is not what is happening.
Unfortunately, under today's policy, the plan's sponsor has no way to
verify that their PBM is sharing manufacturer rebates or that the PBM
is negotiating the lowest possible cost for specific drugs. In fact,
recent data indicate the exact opposite is occurring. For example,
TRICARE anticipates a savings of $1.67 billion by negotiating its own
drug prices and rebates for its 9 million beneficiaries rather than
going through a PBM. Let me state that one more time, Mr. Speaker.
TRICARE anticipates saving $1.67 billion by negotiating its own drug
prices and rebates for its 9 million beneficiaries rather than going
through a PBM.
I happened to be on this floor for the last couple days and in that
chair, listening to discussions on our DOD appropriations and on the
struggles that we're having with our funding for our vital services in
our defenses. Don't you think that this is something that we can
afford, not only in defense, but in other areas as well? I believe it
is. The State of Texas estimates it could save $265 million by
switching to a transparent PBM contract. This is no chump change we're
talking about here tonight.
Although my time draws to a close, I am pleased that the
conversations are just beginning. The challenges facing independent
community pharmacies are great, but the important role they play in our
towns and States is even greater. It is coming to a time and a place
like this in which we can look forward to solutions that matter. I did
not come to Washington, D.C., simply to watch things happen and to
wonder why. I came to be part of a solution. Like you, Mr. Speaker, we
are part of a freshman class that came here believing, as I've said
before, that this is a place to which people still look to make this
country continually the greatest country on Earth, and people look to
us for solutions and answers. The way they do that is by looking at
commonsense legislation. They look at commonsense solutions that affect
them every day.
For many, many people in this country--and especially in my home of
northeast Georgia--local pharmacies are a place that sponsor those
football teams and baseball teams. They are the places where senior
citizens go as I have watched many times in the pharmacies that I go to
whether it be my own pharmacy or not.
Just the other day, I went in and saw a sweet little senior citizen
lady I'd pastored for 11 years. In my first church, I actually had 45
senior adults. They were all that was there. I was 28 years old, and
all of a sudden, I gained all of these grandparents. So, for me, it was
something I learned a great deal from. When I watched this sweet old
lady come up to the counter, she asked Kevin about some issues that she
was having with her drugs. She was trying to figure out what was going
on, and Kevin took the time to talk with her and to explain, No, this
is not what's really happening. This is what you need to do, and this
is the medicine you need to take. He took the time to care.
Pharmacists all across this country--and I want to make this very
clear; this has nothing to do with pharmacists individually.
Pharmacists, whether they work in large shops or small shops, in
community stores or large box stores, are wonderfully dedicated
professionals who do a wonderful job. They work hard in helping their
customers, and they work hard at helping those who have come in
between.
When we deal with this kind of environment, we make sure that our
local pharmacies are the ones that can have a chance to continue to
grow and to prosper in their communities. When we have our community
pharmacies operating as they should, then we are going to be able to
continue the process of making sure that our communities have the
pharmacies that they can depend on and also a transparency that comes
with dealing with these PBMs and with the auditing practices which have
been really tearing apart our pharmacies and community pharmacies as a
whole.
I go back to that one statement that my local pharmacist said to me.
He was sitting there, and he was looking across, and he was explaining
what I've talked about here tonight about the auditing practices. He
said that, if this doesn't change, our pharmacists will be out of
business, that there won't be any pharmacies left in the community
world. For northeast Georgia, that would be a tragedy.
I am pleased tonight to also see my good friend from Pennsylvania
(Mr. Marino), who has been a real leader in this area, and I am a proud
cosponsor of his legislation, the Preserving Our Hometown Independent
Pharmacies Act of 2013. I would love to yield to him now to share
further on what we've experienced during this time.
Mr. MARINO. Thank you.
Mr. Speaker, today, independent pharmacists are facing an increasing
number of challenges that threaten their very livelihoods. These are
the independent mom-and-pop pharmacies that all Americans have come to
know and to love. They are the neighborhood staples that you have come
to rely on. They are where you can go for basic medical advice, and
they are where new parents can have their children's prescriptions
filled. On average, independent pharmacies fill over 200 prescriptions
every day, provide immunization, durable medical equipment, diabetes
training, and other vital services. Unfortunately, these independent
pharmacies are more vulnerable than ever and are having to lay off
workers at an alarming rate.
As more independent pharmacies are forced to close their doors, I am
increasingly concerned about the impact that this will have on American
families, especially on those in rural areas like my district in
northeast Pennsylvania. Not only does their closure jeopardize the
local drug supply, but it also has dangerous consequences for the
surrounding areas' medical providers--that's right--dangerous
consequences for the surrounding areas' medical providers.
One of the biggest dangers to local independent pharmacies is the
pharmacy benefit managers industry, or PBMs. Over the past few years,
the PBMs' power has become concentrated in the hands of a few, enabling
them to dominate over their competition. Independent pharmacies are at
a competitive disadvantage, which prevents them from providing their
customers with vital prescriptions at a reasonable cost.
I have heard from a number of pharmacists that PBMs have an
incredible market power over independent pharmacists. Even worse, the
political power of only a handful of companies has enabled them to grow
and to swallow their competition, which is only expected to intensify
if ObamaCare is fully implemented.
This is why I, along with my colleague to my right and Judy Chu of
California, introduced H.R. 1188, the Preserving Our Hometown
Independent Pharmacies Act of 2013. This bipartisan, commonsense
legislation provides a limited exemption for independent community
pharmacists from antitrust laws. My bill would level the playing field
by enabling the mom-and-pop pharmacies to work together in order to
negotiate better contract terms from the large drug companies and
pharmacy benefit managers, or PBMs. The unchecked practice of PBMs has
gone on for too long, and it's time we passed H.R. 1188 in order to
stop these harmful practices.
Mr. COLLINS of Georgia. I appreciate that.
As our time draws to a close tonight, I am pleased that we can begin
these conversations. That's what I want to have with the American
people and with our body here, bringing out and highlighting
legislation and the work that I believe is being done here, because I
believe there are great things that can happen when we pull together
and when we find the things that matter to Main Street. When we do
that--Congressman Marino and others as we pull forward like this--we
are actually bringing ideas to the forefront that help and build our
economy, that talk about those jobs, that keep those jobs in the
community, and provide a great public service.
[[Page H5044]]
When we are looking at a health care situation and an aging
population, our community pharmacists need to be a vital player in that
market, making sure that our health and our well-being are taken care
of in a kind and caring and compassionate way. The challenges facing
independent community pharmacists are great, but the important role
they play in our towns and States is even greater still.
I want to thank the gentleman from Pennsylvania for his leadership,
and I want to thank him for joining me here tonight and for being a
part of discussing real solutions and real answers of why a
conservative agenda is important to America, because it matters to Main
Street, because it matters to real people in everyday life situations.
Mr. Speaker, with that, I yield back the balance of my time.
____________________