John Clark, Fledgling Lobbyist.

This week the NC Senate created a budget that included a 5% reduction in Medicaid payments to pharmacies. I put forth a semi-gallant effort to convince the NC Senate not to include this cut in the budget by calling Senators Marc Basnight, Tony Rand, and Kay Hagan. My sales pitch consisted of the following:

“Hello, I’m John Clark, a pharmacist in Concord, NC calling to voice my concern about the proposal to cut Medicaid reimbursement from AWP minus 10% to AWP minus 15%. This type of cut may jeopardize the rural poor’s access to medications and cause an increase in poor health outcomes.”

Of course, I didn’t voice my concern as fluidly as you read my concern. In fact, I repeatedly found myself struggling to maintain subject/verb agreements because I felt like I was hurting my cause by being the guy who calls only when I need something. I probably also hurt my cause by calling Senator Hagan by her first name, Kay, when leaving a message on her voice mail. I can see her saying to herself, “If only John Clark would have shown some respect by calling me Senator Hagan, then I would have considered his request.”

But seriously, this cut in funding bothers me for 3 reasons:

1. I hate the helplessness you feel when third parties decide to cut your reimbursement due to political expediency or a desire to increase their bottom line if the third party is a private payer like Medco or Caremark. You can be the best pharmacist operating the best pharmacy in the world, but you still get paid what an actuary in Nashville, TN thinks you are worth rather than letting the patient decide the fair market value of your services.

2. I lack influence in Raleigh. Sadly, most politicians make their decisions from people they know and if they don’t know many pharmacists then they aren’t going to take their ideas seriously when they only offer their suggestions in the face of an immediate threat to their bottom line. The remedy is in developing relationships with decision makers by supporting their other causes when times are good for pharmacy and more importantly, an annual campaign contribution. Hopefully that will cause them to be more likely to embrace your cause the next time they propose cutting Medicaid reimbursement.

3. Reducing reimbursements by 5% to pharmacies does not solve the larger problem of big drug companies creating demand for costly brand name medications via direct to consumer advertising and MD detailing. Why not take a multifaceted approach that cuts reimbursement for costly brands, increases reimbursement for low cost generics, and assign ‘Medicaid reps’ to various regions of the state to counter detail physicians on their prescribing habits. Medicaid has a copy of all prescription claims adjudicated to their plan so they can see which doctors write for the most expensive medications and how often they write them. Target those doctors for interventions and encourage them to write for equally efficacious but less costly medicines.

Fortunately, not all is lost yet. The NC House decided to maintain Medicaid reimbursement at AWP minus 10%. The next step is to repitch my grievances to whoever will work on reconciling the differences in the House and Senate budgets and to begin alloting my resources (time, money, ability to grovel) to creating a community pharmacy majority.

ADDENDUM: The original title of this post was ‘Participatory Democracy.’ I changed the name because The Boggs Blog, which I recommend and read on a regular basis, already had a post entitled Participatory Democracy. Think Elaine from Seinfeld unknowingly reproducing a Ziggy cartoon.