APhA’s Menighan testifies before Senate on drug pricing

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Gag clauses, lack of provider status hinder cost-effective care, importation is no solution, APhA CEO says

APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, testified in a hearing about drug prices held by the Senate Committee on Health, Education, Labor and Pensions today, driving home the frustration pharmacists often feel when they devote their time to “chasing administrivia” rather than providing care to patients.

Menighan said that complex payment and coverage hinder the full potential of community pharmacists’ education and training from being realized, as much of their time is spent on the phone with insurers. Menighan added that APhA supports a transparent pricing framework that would eliminate mechanisms like hidden discounts as well as post point-of-sale price fees imposed on pharmacies.

“These policies generally result in higher prices at the point of sale and higher beneficiary copays,” Menighan said, later adding that rebates are used to drive market share and are “not necessarily to the benefit of patients.”

Menighan reiterated APhA’s position against legalizing the importation of non–FDA approved drugs, saying that pharmacists shouldn’t have to worry about diversion and counterfeits and that ultimately the practice would do more harm than good.

“We have great concern regarding importation’s impact on patient safety and continuity of care and believe it is in direct conflict with recent efforts by Congress to secure the U.S. drug supply and improve patient safety,” Menighan said.

In his opening statements, Menighan requested the Senate’s support in passing S. 109, the Pharmacy and Medically Underserved Areas Enhancement Act, which would give pharmacists provider status. “Not only will access increase, it will help improve beneficiary outcomes, particularly those impacted by medications … Ultimately the most expensive medicine is the one not purchased, not taken, or not used correctly. Pharmacists stand ready to help.”

During a question-and-answer Menighan said “gag clauses”—clauses in programs negotiated by pharmacy benefits managers that prevent pharmacists from telling patients their medications would cost less if they paid out of pocket instead of using their insurance—are a hindrance to providing care. “Pharmacists are incredibly frustrated. Providing care should not be this difficult. [Pharmacists] have no negotiating power.”

In response to statements by Sen. Tim Kaine (D-VA) about how one in four Americans report difficulty with affording prescription drugs, Menighan said that the pharmacy is often the first place where patients confront the dilemma of affordability. “The doctor says they want a certain drug [for a patient], and the pharmacist has to tell the patient ‘We have it, but for $500’ and the patient can’t afford that.’”

At the end of the hearing, Menighan again referred to the lack of provider status for pharmacists, saying that they “operate as uncompensated agents” in maneuvering through complicated regulations and rules of insurance coverage.

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