AMMO & Uncle Scrooge

Hey Kids, ever been hunting? Getting up early in the morning to go into the woods before daylight so you can bring home the deer bacon?  Well, New York has gone into the woods and bagged a big ole mouse.  What, a mouse?  New York just passed a bill prohibiting mandatory mail.  Sounds good, but the problem is that it exempts government plans AND union negotiated plans.  What's left?  Not very much I could guess.  Why in the world when pharmacy organizations try to do the right thing they don't stick to their guns and fight for what's right.  You hear, "well, we couldn't get it passed without making concessions and this is better than nothing."  Congratulations New York, you've gone hunting and with your AMMO and all you can bring home is a mouse. You left the big game in the woods.  May your next hunting trip turn out better.  Now for Uncle Scrooge.  We all have an Uncle we hate to see at our family reunion.  He may be the guy who always gave you noogies or smelled bad.  One of independent pharmacy's uncle is our local government.  Recently around our state the county and city governments have been giving out discount cards for local residents.  These guys have been wooed and swayed by those sweet talking PBM discount card folks.  The government agencies are just trying to help the underprivileged folks in their town (they say).  Bless their hearts, they really do care.  NOT..just another way to line their coffers.  You see for every dollar spent on the card the agency gets a REBATE and the pharmacy who accepts the card gets SCREWED !! As long as there has been pharmacy there has been compassion for the poor and no one cares more about folks getting their medication than your local independent pharmacy.  The caveat is WE determine to who and when we want to give away OUR discounts.  I bet the local government agency never asked the PBM discount card folks how much they negotiated with the local pharmacy to determine the discount.  I bet they didn't talk with their local pharmacy to determine if this was a program in which they agreed to participate. I think that when they heard how much their government could potentially make off the backs of their own neighbors (the pharmacies) all thought of compassion went out of the window.  SHAME on the league of municipalities and the association of county governments.  You guys are hurting your own local business owners.  Did you even try to talk with your local guys about developing a program that accomplishes the goal of taking care of the poor without the PBM discount card folks?  No, I bet that when the dollar amounts started flowing your little heads had visions of sugar plums.  Now, I know times are hard (especially at independent community pharmacies) and our local governments need all the revenue they can get to keep county and city services running smoothly.  I have an idea for you.  When we do (rarely) accept a new insurance plan we have to provide the plan with tons of info.  Pharmacy license, proof of liability insurance, DEA license, etc.  Guess what they provide us with?  NOTHING !!  The PBM's have record profits (they almost have a license to steal) and they don't have to register with ANYONE.  My question and suggestion is this.  Why not?  If I have to have a state license, a county license and a city license to fill prescriptions in a business I own, then why not the PBM's.  Their profit is derived from contracts they have with payers whose employees get prescriptions at the local pharmacy.  So governments, where is their business license?  If I can't do business without one, how can they?  I would suggest that if all local governments made the PBM's buy a business license they would make many many times the money they would on offering a discount card to residents.  Just think, if a pharmacy has a million dollars of payment from say, Medco, then why wouldn't Medco pay a business license based on the million dollars of sales that they generate?(We don't generate the sales, we don't negotiate the contract with the payer and we don't issue the insurance card)  If Medco had to pay a business license based on sales,(let's say 2%) then that million would turn into about 20 grand for the municipality.  Now, multiply that by the number of pharmacies that are in your county and city and the number of PBM's that do business in your county and city.(a very large number)  I say, if PBM's are giving away my discounts and claiming my sales and inventory as their own, then let them pay for the same things for which I have to pay.  Make them pay for a city business license, a county business license and a state business license.  Since they claim they are such a big part of pharmacy (re: the new Health Springs ad on TV and how they prevented an interaction) make them register with the board of pharmacy and the medical board.  These companies are all in top 100 Fortune 500 list.  If they do business locally then make them pay locally.  The only way the PBM model works is because the PBM's are not regulated, hence, not taxed and properly licensed.  The way I look at it, PBM's are paying independent pharmacies rock bottom fees to perform a service for them, so anything we can do to help our local governments collect their fair due from the PBMs should be on our New Years resolution list. We should suggest that the government agencies start with their own PBM plans. Maybe someday soon the PBM's will be required to send us their license before we can fill their prescriptions. Sounds kinda nice doesn't it.  PBM's are constantly hiding behind contract law so I say let's use contract law to make them play fair. Let's get them licensed and registered. When Medco/Express Scripts, Caremark, and other PBM's all have to have licenses in every city, county and state in the country, it may not be such a profitable business model after all...
Kris