The presidents of the state’s leading professional associations for pharmacists are concerned about the myriad of troubling issues facing independent pharmacists. For years they’ve faced long hours, demanding work, competition from chain drug stores and mountains of paperwork to comply with third-party payers and state and federal regulations. To that list has been added the burden of dealing with the massive Medicare Part D, a program that pays for prescription drugs for senior citizens.
Robert Salmon, president of the Mississippi Pharmacy Association, hears the concerns of members and experiences them first hand as owner of Southern Discount Drugs in Charleston.
“For over 75% of our customers — and for some pharmacists 90% — the patient does not pay; a third party pays,” he says. “That means that all prices we receive are set by a third party. When I first started as a pharmacist, we marked our prices like any other business. Now we do not have control.”
Jerry Morgan, president of the Mississippi Independent Pharmacists Association, points out that pharmacists also face slow pay from third parties in addition to low reimbursements.
“A prompt pay bill for Medicare Part D has just passed and will help us,” he said. “We worked with other groups to get it passed. We’re also trying to get a bill passed that would allow us to negotiate with pharmacy benefit managers (PBMs). They’re managed care middle men and that doesn’t save anyone any money; it’s added costs to patients. At the moment, PBMs send us take-it-or-leave-it contracts.”
Salmon also laments the use of PBMs who try to get patients to use certain drugs. “There’s money being made that we never see, but it affects the bottom line to patients,” he said. “The drug companies and PBMs are able to make deals in an unregulated way. No one negotiates on behalf of patients and hospitals.”
The federal government can’t even negotiate with drug companies for lower prices.
“It’s hard for patients to understand, and we’re on the firing line to try to explain it to them,” he said. “It’s obvious these companies are making $15 or $20 on medicine that we’re making $1.50 on, and the only control the government has is to cut our fees.”
Proposed fee cuts in the state Medicaid program are now on hold because the two professional organizations are suing the Mississippi Medicaid Commission. “They would have cut us so much it would have put some pharmacists out of business,” Salmon said. “Since the suit is on hold, we’re taking a breath right now.”
Salmon graduated from the University of Mississippi School of Pharmacy in 1967 and was the first director of pharmacy at Parchman State Penitentiary before going into private business. He laughs that three pharmacists and three technicians took has place.
“When I graduated, most drug stores were independent, but now many towns have no independent stores,” he says. “That’s a sad state in my opinion.”
Chain stores, however, are not likely to open in small towns where pharmacists still take calls after store hours. As independent pharmacists retire and close their stores, Salmon predicts that some towns will not have any drug store, creating a hardship for some citizens to drive the 20 or 30 miles to a pharmacy.
Morgan has been in the profession 36 years and owns Okolona Drug Company in Okolona where he’s beginning to see some fallout from the slow economy. “Our accounts receivable are going up and more people are charging than at this time last year,” he said. “Sales on other items remain fair. It hasn’t been booming, but it’s not disastrous.”
The independent association has 140 members. He says those with competition from chain stores are holding their own. “Good independent pharmacists do an excellent job,” he said. “I think our patient-oriented and personal service set us apart.”
Salmon isn’t seeing much impact from the economy since a high percentage of payments come from third parties. “All our prices are fixed, so we must operate within those guidelines,” he said. “We have the prices and reimbursement schedules and have to figure out how to stay within that and still make money. Now we have to fill more prescriptions for less money.”
However, rising fuel costs and surcharges on delivery do affect these professionals who for the most part must order supplies every day. The associations are also working with the state Legislature to get sales taxes removed on medical equipment such as wheelchairs. There is also an ongoing fight with Medicaid for not reimbursing pharmacists for generic drugs.
“We’ve been fighting all these battles,” Salmon said. “We were keeping our mouths shut for a long time but were being smothered. Now we’re starting to squeak like other healthcare professionals.”
Pharmacists, he notes, have been voted the most trusted profession in the nation for nine straight years. “Pharmacists are some of the best educated yet most underutilized professionals because we have no time to consult with patients,” he said.
The state’s only pharmacy school at Ole Miss graduates 70 to 80 professionals each year. It takes six years to become a pharmacist and that is going to soon become seven years.
Women in the profession have been growing for the past 15 years. Salmon says he must tread softly when he proclaims that the profession needs more men. “That’s because men are more likely to own stores, and we need more independent stores, especially in rural areas,” he said. “Women like pharmacy because they can work restricted hours, if they choose, and combine the profession with raising a family.”
Contact MBJ contributing writer Lynn Lofton at firstname.lastname@example.org.