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The current policy challenges for community pharmacy in the USA!

Ron Lanton
Ron Lanton

are a healthcare and life science firm that gives our clients advocacy and intelligence. We were invited to serve as a guest blogger and thought that we would describe a few issues that we are working on for our community pharmacy clients in the United States. For those that are encountering similar issues, perhaps these can give you some insight into how to approach those in opposition to community pharmacy policy.

In the United States, we are happy to see community pharmacy taking aggressive steps forward to take back the profession from insurers and pharmacy benefit managers (PBMs). While many understand the fight is long, there have been three issues in Congress that are at the forefront of community pharmacy.

First generic drugs have been skyrocketing in price recently while insurers/PBMs wait months to accurately update reimbursement for community pharmacy. This forces pharmacies to operate at a loss per prescription until reimbursement is rectified. While there are many arguments that can be made to explain why generic drug prices are increasing, many advocated here feel maximum allowable cost (MAC) legislation is the answer to help stem this issue. An example of this Congressional bill can be found here.

Secondly, insurer networks continue to become more and more restricted as insurers/PBMs want to push more commercially insured and Medicare beneficiaries to mail order pharmacy. This takes away from the continuity of care that community pharmacy has with its patients, and severely jeopardizes a pharmacy’s desire to operate. Congressional legislation is pending that would allow pharmacies who are in medically underserved areas to be allowed to participate in Medicare Part D pharmacy networks as long as pharmacies accept the contractual terms and conditions offered by network providers.

Third, pharmacy is fighting to be recognized as a health care provider where the pharmacy can be reimbursed for their hard earned clinical knowledge. An example of this can be found in the state of Oregon where the Governor has signed this issue into law.

We are the co-host of a show called the Pharmacy Podcast Show; a podcast dedicated to the business of pharmacy. We discuss policy trends that impact the profession and would love to speak with interested stakeholders overseas to get a sense of how pharmacy is being impacted by the changing market. Feel free to contact us with additional information at Additional information on the show can be found here.

Ron Lanton is president of True North Political Solutions in Manchester, New Hampshire, and co-host of the Pharmacy Podcast

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