What will Trump mean for retail pharmacy?
Tuesday, January 17, 2017
As Donald Trump assumes the role of president of the United States, there may be no bigger issue on the minds of Americans than the question of how he will tackle the rising cost of healthcare.
We have heard the campaign slogan related to the Affordable Care Act (ACA), that he will "repeal and replace" it. But few seem to have a clue about what exactly that will mean. Even lawyer David Farber, partner in the FDA who practices law in Washington, D.C., wrote recently that "it is impossible to predict what the president-elect and his new team will do."
Retail and community pharmacists like myself are curious about how the new administration will impact the real-life practice of community pharmacy. We have seen, for example, how the current ACA program expanded the number of people who had access to insurance coverage. Exactly how many people gained access is a matter for debate and discussion — certainly less than the 32 million predicted back in 2010.
But access is one thing; affordability is another. And in 2016 we watched as health plans like Aetna and others withdrew from participation in Obamacare because it wasn't financially stable.
Retail pharmacy thrives when more people have access to coverage, as long as that coverage provides affordable copays and deductibles and premiums. Trump claims his replacement package will do just that.
"We're going to have insurance for everybody," Trump told The Washington Post. "It will be a much simplified form. Much less expensive and much better ... It'll be another plan. But they'll be beautifully covered. What I want to do is take care of people."
A lot of attention has been given lately to the high cost of prescription drugs and how to make them more affordable. In an interview, Trump commented on the escalating drug costs and said manufacturers are "getting away with murder."
This focus has caused a stir among pharmaceutical stock prices, sending many of them downward as the industry braces for the unknown. The impact of reduced prices for pharmaceuticals hits community pharmacy in the form of smaller margins. This is a frightening consideration given the fact that retail pharmacy operates on slimmer margins than almost any branch of healthcare.
Hopefully, the focus on prescription drug prices will be approached cautiously, as spending on medications is really just a small portion of our overall spending in healthcare. There are certainly more savings that could be accomplished by looking more closely at hospitalization costs, the running of unnecessary tests and burdensome paperwork.
Another factor in how retail pharmacy will be impacted is the Medicare D coverage package, including the notorious "doughnut hole" gap, which is slowly being closed over the coming years. Trump appears to be advocating for the ability of the federal government to bid on drug prices like any other insurer.
Historically, drug manufacturers have understandably lobbied against this practice, but if allowed it would certainly drive down drug prices. The savings could be used to make premiums and copays more affordable for beneficiaries, which would be a good thing for pharmacy and for patients.
As a pharmacist working on the front lines of community pharmacy, I think one of the best things Trump could do for both patients and retail pharmacy would be to broaden the scope of practice for community pharmacists by allowing them to be reimbursed for services designed to help patients manage their medications. When this happens, patients get well faster, and it reduces hospital admissions and readmissions.
For now, we watch and wait. I'm proud to be a part of a profession that has worked hard to keep costs under control while delivering great patient care.
I would argue that retail community pharmacy is one of the most transparent, most accessible and hardest-working career paths for pharmacists today. Expanding our role in the communities we serve would be a win for healthcare all around.
Hopefully, our new president sees that as well.
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