PHARMACISTS WANT LEVEL PLAYING FIELD IN REFORM

Perhaps more than any other provider linked to the health care chain, pharmacists nationwide fear that President Clinton's proposals to reform health care will be more of the same.

More of the same for the pharmaceutical industry means a continuation of the widely disparate prices that drug companies are able to charge wholesalers and independent buyers.

Local pharmacists are no different: they want better deals on the drugs they buy from drug manufacturing companies.

"The major manufacturers refuse to negotiate with us," said Bill Smirl, owner of Bill's Family Pharmacy. "I want to see a more level playing field."

The net profits of pharmaceutical companies have gone down each year for the last 10 years, said George Oestreich, chief executive officer of the Missouri Pharmacy Association.

For every prescription, the average pharmacy makes 3 cents on the dollar. Meanwhile, drug manufactures make up to 20 percent on all prescriptions sold, Oestreich said

Independent pharmacists are charged far more for drugs than hospitals, health maintenance organizations, or HMOs and mail orders, which routinely get the best rates from manufactures, known as "exclusionary," deals.

In return for selling its goods at low-cost rates, typically, the manufacturer will be guaranteed that the buyer will use its brand exclusively.

The result is a wide disparity in the cost of drugs depending on the buyer. For example, Smirl says that he is likely to pay $38 for a set of 30 nitroglycerin patches. Meanwhile, hospitals are able to pay just 15 cents for 30 patches.

"If they can sell it to the hospitals or HMOs, they ought to sell to the buying groups for the same price," said Stephen Horst of Horst Pharmacy in Jackson.

Many independent pharmacists join buying groups, which purchase drugs in bulk. While that may lower the cost somewhat, the buying groups still are unable to get the same discounted rates as hospitals, HMOs and mail orders.

Independent pharmacists also lose out to customers who require prescriptions carried out over a long period of time. That's because insurance companies routinely require patients to buy their prescriptions from certain companies, if they want to be reimbursed.

Bill Carman, a Medicine Shoppe pharmacist, said: "People's insurance won't pick it up otherwise. It's not fair to the small guys. We would get shut out too if we weren't part of a major chain."

The Medicine Shoppe operates 37 chains in Missouri, and is seldom excluded from the insurance companies' list of pharmacies they allow customers to shop at.

But Smirl often sees his best customers and friends forced to buy their drugs from catalogs. "It excludes us from filling prescriptions of your regular customers. They're forced to mail-order," he said.

Smirl said that by limiting the places where people can purchase their prescriptions, "the insurance companies are dictating to people the kind of health care. The patient doesn't have freedom of choice of where to go."

Clinton's reform package purportedly addresses this issue. While the Clinton administration wants to encourage most Americans to join pre-paid health plans, where they could pay as little as $10 to visit a HMO, it would give people a fee-for-service option. That option would cost more, with higher deductibles.

"We're hoping the focus will be on letting the patients choose their pharmacists," Oestreich said.

The pharmacy association also is recommending that the health care system encourage the use of teams, which would incorporate the major health care providers including primary care physicians, nurses, pharmacists, mental health professionals, even dentists.

"The more you can integrate these people, the less overlapping of services you're likely to have," Oestreich said. "Ultimately, you get a better outcome for the patient."

(Some information for this story was provided by The Associated Press.)