The retirement system that serves Texas state employees has decided to balance a $140 million shortfall expected in 2011 on the backs of consumers who need health care. That means that when it comes time for office visits to doctors, co-insurance payments and buying prescription drugs, state workers and retirees will have dig deeper into their own pocketbook.

Over half of that budget gap -- $67 million -- will be filled by increasing co-pays for prescription drugs. The co-pays for Tier I prescriptions which are primarily generic drugs will move from the current $10 co-pay to $15. Tier II prescriptions, mainly preferred name brand drugs, will jump to $35 and Tier III, name brand drugs that often have cheaper alternatives, will go to $60 co-pays. The deductible for all prescriptions will remain at $50.

A spokesperson for ERS told TrueCare Thursday that the co-pays will be applied both to mail order and prescription drugs purchased from retail pharmacies. Community pharmacies have often been at odds with the ERS because of the plan’s push for its members to use mail order instead of buying at local independent pharmacies.

“We understand that action has to be taken to keep this fund solvent,” said TrueCare Government Affairs Director John Heal. “However, it has been shown that cost shifting to patients by increasing in co-pays for prescription drugs can affect medication compliance and have profound implications, especially for those with severe chronic medical conditions”.

In fact, in answers to questions from state workers about the new plan, ERS pushed its members to use mail order at the expense of community pharmacies. Then, it suggested members shop around for cheap generic programs at retail pharmacies to get their most commonly filled generic prescriptions filled there instead of in mail order.

The system also makes claims that using a PBM has saved the agency over $288 million but has not provided the transparency or the details to prove that claim.


For the average state worker the new changes to the ERS health plan will increase their yearly changes by $225. Employee groups weren’t happy with the increases but said they knew action had to be taken to decrease the growing deficit in the fund administered by the retirement system. Others said it would be like state employees having to take a pay cut.

PBA pharmacists are going on the offensive against Pharmacy Benefit Managers and working with local media to explain to consumers how the system works and why prescription drug prices may be going up.

Most recently, Mike Burns, the president of the PBA Health Board of Directors, and owner of Auburn Pharmacies in Kansas, was the focus of a story in the Sun, a newspaper serving the Johnson County, Kansas area. The newspaper called Burns to see how healthcare reform would affect pharmacy.

“I took the opportunity to first educate him on the industry, which of course, focused on how the PBMs have changed our industry forever,” Burns said.

The result was a story with the headline “Pharmacist explains medicine pricing issues.” You can read the story by going to the TrueCare Texas website at www.truecaretexas.com.

Texas Government Affairs Director John Heal said Burns is an example of how pharmacists need to become a credible source on health care issues for both the media and in advocating for pharmacy in the state and federal legislative arena.
“Mike was able to use his expertise as a pharmacist on the frontline of health care to explain how community pharmacies benefit their community by working with patients, and how PBMs affect the patients that they serve,” Heal said. “He did an excellent job of explaining a complicated issue in a credible and easy to understand manner.”

Burns said that keeping an open line of communication with local newspapers and media is as important as helping to educate legislators. “The difference is that news media really know very little about PBMs until they are explained by those of us affected by them,” he said. “And with news media we have a advantage because they don’t already have the PBMs trying to twist the truth. We have the credibility and can open up the discussion … the PBMs will be the second call and have to answer the tough questions.”

“I would encourage every pharmacist and pharmacy owner to contact your local newspaper and offer your insight into the industry,” Burns said. “Health care is going to continue to be an important topic and health care reform will remain a headline for some time to come.”

Click here to see the story.

The narrow margin of Texas Pharmacist Chuck Hopson’s victory is another example of how one election can make a difference in independent pharmacy’s ability to get its message to the decision makers of the future. We must be ready and able to work with both political parties and with a variety of different lawmakers to ensure that our voice will be heard. Today we must decide if we want to be participants, or spectators in the legislativeand regulatory arenas. Participants have a say in their destiny. Spectators watch from the sidelines and read tomorrow’s newspaper to find out what happened. We must be proactive, and not reactive.

In the past, many of you have shown a commitment to the future of pharmacy by supporting the Texas Pharmacy Survival Fund, which has been instrumental in protecting the interests of independent pharmacy. Today pharmacies continue to reap the rewards from the work of the Survival Fund as it expands its grassroots efforts to educate legislators, opinion makers and the general public on issues important to independent pharmacy. We need your help again. In January we will face another legislative session and we cannot afford to wait two months to begin getting out pharmacy’s message to new legislators and legislative leaders. There is much work to be done and pharmacy needs your help to ensure that we maintain our momentum. Our voices must be heard in Austin. Please make a contribution to the future of independent pharmacy through the Pharmacy Survival Fund. The stakes have never been so high.

Respectfully,

The TrueCare Legislative Council