Date: 2015-10-20
Speaker: AUSTIN SCOTT (republican)
Chamber: H
State: Georgia

Thank you. Mr. COLLINS and Mr. LOEBSACK. I appreciate your being here. This is certainly a bipartisan issue and gets to the heart of some of the challenges in health care in our country right now. I certainly rise today in support of our Nations community pharmacists and our pharmacies which play a critical role in our healthcare system. Many of these independent businesses operate in underserved areas like the ones that I represent in rural Georgia. 24 counties. In areas where a doctor may be many miles away. local pharmacists deliver flu shots. give advice on overthecounter drugs. and help with latenight drugstore runs for sick kids. Many people see their pharmacists much more often than their doctor. and there is a very personal relationship between these community pharmacists. patients. and the physician. They are community pillars. and they contribute greatly to the economies. It is crucial that these pharmacies have a level playing field when trying to run a successful business in a challenging and complex environment. As you know. Mr. COLLINS. I was an insurance broker for many years. I thought I might tell a very personal story about one of my clients who. shortly after their contract was issued. the gentlemans child got sick and they needed a prescription filled. So they went to the local big box pharmacist or pharmacy. and they wouldnt fill it for them. Even when I. as the agent. could provide evidence that the person was insured without the card. they simply would not fill the gentlemans prescription. The local community pharmacist was the one that filled the script. Now. the irony of it and what we are talking about here and where the real problem comes in is that. when the person got their insurance card because of the PBMs. they could no longer use that community pharmacist that was the only one that would provide the service that they needed when they actually needed it. So it is extremely important that. when we have these business models. we keep those local community pharmacists where they are able to run a successful business and stay in business. During the August district work period. I stopped by another drugstore. a small drug store in Quitman that had been there many. many years. Generations of people have continued to rely on them for their services. While I was there. I watched one of our senior citizens. a lovely lady. come in. The owner called her by name. They caught up on family and friends and what was going on in life. and she had some questions about the medications. And let me tell you that pharmacist knew the answer to every single one. He knew her history with those medications and was able to answer those questions that she asked. She left there with a smile on her face knowing that she knew what she needed to take. when she needed to take it. and what she needed to take it with. As I stopped at these local community pharmacies like the ones I visited in August. I continued to hear concerns from them about what is happening in the pricing structure and that. if the price on a drug goes up. the insurance company has the ability and takes several months to change the rate when the price goes up. But if the price comes down. as happens in free market sometimes. they immediately reduce the price that they reimburse to the pharmacist. There should be no excuse for the difference in the timeframe in which the reimbursement occurs. If it can be done when the price is changing to the downside. it can certainly be done in the same time limit when the price is changing to the upside. A lot of things we have seen lately in pharmacy. We saw where a venture capitalist purchased a drug and raised the price of that drug several thousandfold overnight. That has been happening. and local community pharmacists have expressed concerns with this issue for many years. It has happened with nitroglycerine tablets. for example. that has been around for decades and decades. They have gone from 8 cents apiece to $8 apiece. Digoxin for a heart condition. doxycycline. the same thing has happened with these drugs. How is this happening? And who is going to help us fix this if not for the ability to get the information from their local community pharmacist? They are the ones that care the most. and they are the ones that are willing to help resolve the challenges with the higher drug costs in this country. So one would ask: How is it that. in many cases. our local pharmacists are kept from being able to participate in the networks? Well. in many cases. the networks that are blocking out the local community pharmacists are actually owned by the big box pharmacies. If you want to talk about a conflict of interest. that is about as conflicted as it gets when your big box pharmacists own the network that actually can determine who you can get your drugs from and they box out their own competition. Quite honestly. I think it would be a wonderful issue for the Federal Trade Commission to get involved in and to bring competition back into that area. One of the things that I think would help is H.R. 793. the Ensuring Seniors Access to Local Pharmacies Act of 2015. I want to thank my colleagues that are here that are also cosponsors for it. This bill allows community pharmacies that are located in medically underserved areas or areas that have health professional shortages the ability to participate in Medicare part D in the preferred pharmacy networks so long as they are willing to accept the contract terms and conditions that other innetwork providers operate under. This is reasonable. This is patient choice. This keeps the small business owner out there. Let me ask you to make no mistake about it. This is big business versus small business. One of the other things that I want to talk about is MAC. the maximum allowable cost. Pharmacists are often reimbursed for generics by this MAC list. You have heard BUDDY CARTER talk about this earlier. He certainly knows more about it than I do. This list is created by the PBMs. but nobody knows how they create this list. As patients. we have a right to determine how the costs are derived for the drugs that we are going to take. And understand this. It is not a manufacturers cost. It is not a manufacturers cost. It is a maximum allowable cost. When the lists are updated. certainly it should be done in a timely manner. I am happy to have cosponsored H.R. 244. and I certainly hope to see that bipartisan bill pass. With that. Mr. COLLINS. thank you for taking the lead on this issue. Our local community pharmacists are extremely important to our healthcare system. There is a way to create a scenario under which the patients have more choice and that requires keeping that local community pharmacist in business.