The Issues

For patients across the country, our nation’s healthcare system is continuing to evolve with new frameworks for determining how we all can access the proper treatments to meet so many of our growing needs. In many ways, these development are driven by lawmakers in Congress, federal agencies, and leaders in all 50 states.

The systemic changes that lawmakers and leaders have been and will continue to consider regrettably stand to impact underserved populations by reducing their provider choices and limiting their access to prescriptions and other important services.

Within the often complex health care industry, one segment of the system that must not be overlooked are the local community-based pharmacies that bring tremendous value to patients everyday through the products and services that they are able to provide.

Community pharmacies often allow for the most cost-effective delivery of everyday health services. With this in mind, it is imperative for leaders at the national level and in each state to carefully consider and guard against potentially harmfully policies and provisions that will inhibit choice and competition for patients to obtain the treatment regimens that are most appropriate for them.

Neglecting to preserve a system that supports a fully-functioning and transparent network of community pharmacies could ultimately result in increased costs to the state and all of its citizens by forcing patients towards exorbitantly expensive points of care or leaving them without any care options all together.

Improper legislative and regulatory changes could force quality health service providers from the marketplace, reducing competition, and ultimately the cost-effective delivery of pharmacy services to patients. Enacting such changes could be detrimental or cause significant confusion for millions of patients and especially for the most vulnerable populations.

Pharmacy Choice and Access Now (PCAN) is fighting to protect patients’ access to provider choices, prescriptions and other services.

Your Health Your Local Pharmacy

PCAN seeks to advance the positive solutions that help independent and community pharmacies to thrive and be in the best position to provide the care you need.

Failure by our leaders to act could put many patients in danger and also cause Medicaid recipients to lose access to prescriptions drugs that they depend on daily in order to stay out of hospitals and emergency rooms.

Practices that are more thoughtful and accountable to the patient should be made available at the federal and state level, and should be fully considered. These well-conceived ideas, which are all designed to reduce costs, while at the same time maintaining quality of care, will help states balance their budget more sustainably, without putting your neighborhood pharmacy “out of business.”

Some ideas like Medicaid managed care pharmacy “carve-in’s,” may look good on paper, but in practice often cause duplication of administrative effort and waste millions of tax dollars at a time when states cannot afford any further losses.

Similarly, the middlemen between drug manufacturers and health payers, known as pharmacy benefit managers, or PBMs, should be carefully monitored as they impact prescription contracts in community-based pharmacies and determine reimbursements for medications dispensed to patients. To achieve proper transparency, PBMs must openly share their pricing mechanisms and notify pharmacies of any changes as they happen in order to ensure their ability to maintain availability of services to those who need them.

Who Is Impacted

For too long, lawmakers in some states have been rushing to judgment and proposing to make ill-advised changes to health services before fully considering the impact on patients and how they can best access pharmacy services.

Furthermore, taxpayers face further increased challenges on account of costly middlemen who are taking advantage of the budget crisis by strong-arming their way between you, and community pharmacy providers. As states consider moving Medicaid pharmacy benefits into managed care, the following policy recommendations should be adopted to ensure that Medicaid beneficiaries retain access to vital prescriptions at the lowest possible cost to the states.

  • Open Networks
  • No Mandatory Mail
  • 90-day Retail Fills
  • Prompt Pay
  • Pass-through Pricing
  • Audits
  • PBM regulation

PCAN ultimately supports the best solutions for all, including: patients with health care and pharmacy needs; anyone who shops at, or is employed by local pharmacies; and all of the nation’s taxpayers. For the sake of each of these individuals, let’s meet the challenges of our increasingly complex health care system and work to provide better access to quality care and services.