I might be the most anti-political person you could ever meet.  To be blunt, I hate politics.  But as I grow older I am coming to the frustrating realization that politics in fact does matter.  And for the profession of pharmacy (and the entire healthcare system) politics matters a lot.  But it seems like so many of us within the profession either don’t realize that fact or we don’t act on that realization.  Either way we should all realize by now that political decisions and government policy changes can affect our profession in ways that are fundamentally key to our survival or destruction.  

Don’t believe me?  I come to you today with a story out of Ohio (why are there so many pharmacy related stories coming out of Ohio recently?) that will demonstrate my point.  Because policy decisions in that state have dramatically affected the retail pharmacy business there in a negative way.  And what is happening in Ohio is just an example of what our entire nation is facing. 

I came across this story from The Columbus Dispatch written by Alan Johnson.  In it Johnson describes recent changes in the way Ohio pays pharmacies for filling prescriptions under the state’s assistance or Medicaid programs.  The most dramatic change, made permanent earlier this year, cut the reimbursement rate for the state’s Medicaid prescriptions from $3.70 by 56% down to $1.80 per prescription.  What was originally a temporary reduction measure last year to save Medicaid dollars in cash strapped Ohio has now become a permanent reduction in the fees paid to pharmacies for filling Medicaid prescriptions. 

On top of that there is often a delay between the time a prescription drug price increases from the wholesaler until the time the state raises their reimbursement for the cost of the medication to the pharmacies for filling an individual prescription.  So if a drug’s cost increases by say $5.00/bottle from the supplier to the individual pharmacy it could be months before the state will respond by raising their reimbursement rate by that same $5.00 to account for the increase in cost.  And that gap means the pharmacies filling prescriptions for patients will eat that loss.  And many pharmacies simply can’t afford to do business under these conditions. 

To demonstrate the effect this kind of reimbursement policy has on pharmacies you must only look at the number of independent pharmacies located in Ohio and see the trend in their numbers over the last 15 years.  According to Johnson’s article there were 1200 independents and small chains in the state of Ohio in the year 1995.  Now that number has dropped to 580 and continues to fall.  These small community pharmacies can’t afford the money they are losing every month.  It gets to the point where it isn’t financially viable for pharmacies to even serve Medicaid patients. 

This “slow and low” phenomenon for prescription reimbursement has resulted in a margin squeeze for the little guys.  The chains can survive on lower margins simply using their size as an advantage for increased purchasing power.  Plus, the big chains have the advantage of having stores located in other states with more generous reimbursement rates.  They are less vulnerable to negative policy decisions being implemented in any one state in the country because they have a business presence in several states.  The corner independent drugstore doesn’t have these advantages to help combat what are now pathetic prescription reimbursement rates.  And that is why they are a dying breed.  And it is only going to get worse. 

And political influence and government policy were at the core of the problem for independents in the state of Ohio.  And that is what pharmacists everywhere need to wake up and realize.  Politics matters and it can have a huge impact on your livelihood and your ability to do your job.  Yet somehow it seems that in general there is little to no political involvement by most pharmacists within our profession.   We seem to be a very hands off group when it comes to political involvement. 

I’d like that to change for all of our sakes going forward.  Sure, there is some involvement by the larger pharmacy organizations that represent the profession.  But there needs to be much more involvement.  And individual pharmacists need to become involved.   We can’t wait any longer to see if things will work out for us.  And it isn’t fair to sit on the sidelines and expect an organization to fight for our best interests.  We must become more active on our own and get involved. 

This Ohio story is just one example of the widespread problem we have in the profession of pharmacy where we don’t fight negative legislation hard enough.  We shouldn’t be expected to fill prescriptions at a loss simply because the states our pharmacies are located in struggle financially!  And I’m not picking on Ohio.  This is a nationwide problem.  Other states will look at Ohio and think “why can’t we cut those rates too?”  And that is assuming they haven’t taken similar action already! 

This is wake up time everyone.  I don’t want to sound like the end of the world radio host before May 21st but for our profession and the survival of thousands of pharmacies across the country it is crunch time.  Sitting and waiting for the government to do the right thing usually means the right thing never comes. 

I think we need a stronger political footprint for the profession.  If a state even considers such a reimbursement cut for pharmacies there should be a massive campaign against such action.   We can’t survive on negative profits and quite frankly we shouldn’t have to.  It is unreasonable to expect any business to continue to operate and serve the public when that business is perpetually losing money.  This isn’t about greed or power but simple survival. 

So click and read Alan Johnson’s story if you have a moment or find one of the many other stories like it from all across the country.  I hope you realize what I have realized: politics matters.  And that is saying a lot coming from a most unlikely source: the guy who really hates politics and would never want to be involved in the political arena in any way.  Even I’ve come to learn the hard way what happens when bad government policies are implemented.  There is too much at stake for our profession to sit back and not take action.  We need to finally address the fact that politics does matter.  But don’t take my word for it.  Find an indepenedent pharmacy owner in Ohio and ask them!

The Redheaded Pharmacist

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