Washington – Pharmacists say they have been losing money under Medicare’s new prescription drug benefit, and they have taken their concerns to the White House, forcing the administration to confront political problems caused by the rocky start of the program.
In a meeting last week with Karl Rove, the president’s senior adviser, the druggists said many independent pharmacies might have to shut their doors because they were not being paid adequately or promptly under Medicare. In the past two months, they said, pharmacists have given away millions of dollars’ worth of medications for which Medicare drug plans should have paid.
The pharmacists who visited the White House were all from Texas.
Several have close ties to Rove and President Bush. But their concerns are shared by retail pharmacists across the country, who say Medicare drug plans are paying them less than it costs to fill prescriptions for the beneficiaries.
Bill Pittman, a former president of the Texas State Board of Pharmacy who is chairman of Pharmacists for Bush, a political fundraising group, arranged the meeting, held last Monday at the White House.
Richard Beck, one of the Texas pharmacists who met with Rove, said, “Pharmacies are losing money on Medicare.” Slow payment by Medicare drug plans has caused cash-flow problems for many pharmacies, he said.
Pittman said he told Rove and other officials: “If pharmacists don’t receive immediate relief, some will go broke. Others are hurting so bad that they will choose not to participate in Medicare and Medicaid.”
Bush has described the drug benefit as “the greatest advance in health care for seniors since the founding of Medicare” in 1965.
Administration officials said beneficiaries were saving large amounts of money because prescription drug plans had negotiated deep discounts with drugmakers and pharmacies.
The new benefit is delivered by private health plans subsidized by Medicare. The drug plans have contracts with pharmacies.
Medicare officials said they would help pharmacists enforce the terms of these contracts. But pharmacists said that was not enough because insurers typically offered the contracts on a “take it or leave it” basis.
The pharmacists underscored the political significance of their concerns in a report presented to Rove and Allan Hubbard, assistant to the president for economic policy.
“Most independent community pharmacists are small-business Republicans,” the report said. “Pharmacists want to be supportive of this administration, and they can play an active role in the midterm elections. But pharmacists need to be able to point to some corrective actions being taken by the administration.”
Trent D. Duffy, a White House spokesman, said: “From our perspective, it was a positive, productive meeting. We want to understand the concerns of pharmacists. They play a critical role in delivery of the drug benefit. At the same time, we want to make sure that seniors are getting the best possible deal.”
Even as pharmacists take on new duties under Medicare, they are discovering that they will be paid less than what they now receive under Medicaid, the program sponsored by federal and state governments for low-income people.
In February 2005, Bush proposed significant cuts in Medicaid payments to pharmacies. Many of those cuts were included in a deficit-reduction bill that he signed into law last month. In his 2007 budget, Bush proposed further cuts.
Critics called the cuts immoral. Bush replied, “It’s not immoral to make sure that prescription drug pharmacists don’t overcharge the system.”
His comment, in Manchester, N.H., on Feb. 8 this year, infuriated many pharmacists because it seemed to suggest they were cheating the government.
Druggists said they had no discretion in deciding how much to charge patients under Medicare and Medicaid. Those decisions are made by Medicare drug plans and state Medicaid programs, they said.