HONORING AMERICA'S PHARMACISTS

Floor Speech

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Mr. AUSTIN SCOTT of 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 Nation's
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 over-the-counter drugs, and help with late-night
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 gentleman's child got sick
and they needed a prescription filled. So they went to the local big
box pharmacist or pharmacy, and they wouldn't 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 gentleman's
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 in-network 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 manufacturer's cost. It is not a manufacturer's 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.

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