Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
I’m just old enough to remember when independent pharmacies had the ability to order branded and generic pharmaceuticals directly from the manufacturer. In fact, we’d often do so back at Humma’s Drug Store in Metropolis, IL, particularly because we could get quantity discounts.
Clearly, by the late 1990s, direct-to-pharmacy sales were all but a thing of the past. Our drug wholesalers completely took over this responsibility out of convenience—think about it: It’s much easier to deal with one wholesaler rather than 10,000 pharmacy customers.
We are currently learning about the Trump administration’s solutions to the rising costs of medications. On the surface, “most favored nation” status for drugs paid for by the U.S. government makes perfect sense. Why should the U.S. taxpayer foot the global bill for pharmaceuticals? We shouldn’t. But the challenge with this approach to awarding the best prices is that our complete system of distribution of pharmaceuticals is far more complex than just getting the manufacturers to agree to capped prices. Our entire supply chain for pharmaceuticals will need to adjust.
For pharmacists in local community pharmacies, we are most interested in simply being reimbursed for the product at a reasonable profit so that we can provide the care the patient needs in order for the medication to work. Medications without care providers are typically worthless. We all know the data on abandoned prescriptions, the need to avoid drug–drug interactions, and nonadherence.
President Trump’s plan also implies that consumers should be able to purchase drugs at this cheaper price, and if the “middlemen” interfere with that proposition, then the manufacturers are ordered to sell products directly to consumers. Unfortunately, this plan comes with a serious adverse consequence: a lack of a local, trusted, and personal pharmacist to ensure medications are used safely and effectively. Patients trust their personal pharmacist.
So, if the drug distribution system were to change so drastically as to go directly from the manufacturer to the consumer, is there a situation in which that would be acceptable?
Potentially, but only if, simultaneously with this change in distribution, the U.S. government agrees that payment of pharmacists as primary care providers is also required to ensure consumers in local communities do not lose access to care.
If pharmacists were routinely compensated to take care of patients, ensure their medications are dose-adjusted to match the desired therapeutic outcome, and assist patients in their health journey, then changing the distribution system is a distinct possibility.
Time will tell how radically this system of product distribution will change. But make no mistake, it will change. And APhA will be here fighting to ensure consumers have access to the trusted care services of our nation’s medication experts, their pharmacists. ■