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The Tony Gill Show, WAIC.com

Date October 17, 2002
Time 04:00 PM - 05:00 PM
Station WAIC.com


TONY GILL, host: And we are joining Steve Northrup to talk about long-term care. Our issue is pharmacy. We're talking essentially about keeping away from Jane the reimbursement rate for prescription drugs. And--and it does make sense because we do remember--Rich Innes is--is in studio with me now, and you recall the--Rich--the awful, awful angst that seniors were put in as a result of the--the threatened cutbacks that essentially would have lowered the rate for the reimbursement. And a bunch of pharmacies, including CVS, wanted to pull out. And so you have all of these, you know, seniors in high dudgeon because they knew that if, you know, the pharmacies pulled out and out of the program that they would end up instead of paying, what, anywhere between 50 cents to--to--to $40 to $50 or so; they'd end up paying for the entire prescript, and that's, you know, essentially not what they were used to and certainly on--on fixed income would become a catastrophe to budgets, to household budgets and that kind of a thing. And so, to that end, we invite Stephen Northrup. Steve, how are you?

MR. STEPHEN NORTHRUP (Long-Term Care Pharmacy Alliance): I'm good, Tony. How are you?

GILL: I'm well, thank you. Talk about your organization and what you're trying to do. You're not part of the same group that threatened to pull out. We're talking about pharmacies as individuals trying to pull out or corporate individuals, as opposed to this group now which is acting proactively to stay out of that stink box where we found ourselves back in August.

MR. NORTHRUP : Well, that's correct, Tony. My organization is the Long-Term Care Pharmacy Alliance, and the companies I represent fos--focus exclusively on serving residents of long-term care facilities, nursing home patients, patients in assisted living, hospice, those types of environments. We're very different from the retail pharmacies. We serve a completely different type of patient with--with special needs.

GILL: Tell me something about, you know, essentially what the state wants to do, because I--I'm not--I'm never sure and I don't think the state is sure, you know, between Fenneran (sp) and Jane, and I find myself between Tweedledee and Tweedledum.

MR. NORTHRUP : Well, I think the state, like most states, is experiencing a difficult budgetary crisis and they're looking to save money anywhere they can. And one of the areas in which states are experiencing tremendous growth in their budget is in pharmacy. There are a lot of new drugs on the market now that treat conditions that were previously untreatable or treat conditions better than the older drugs, and the newer drugs tend to be more expensive. The challenge is, is cutting reimbursement to pharmacy really going to solve that problem? Because pharmacies don't set the prices. Those are set by the pharmaceutical manufacturers. Nor do we write the prescriptions. Those are written by physicians. So pharmacies are trying to provide key services to--to help patients manage their drug regimens, and, you know, unfortunately, if our reimbursement is cut, it makes it difficult to do that. And it's particularly problematic when you're dealing with the population that we are, which is the frail, elderly and disabled. These are not people who can drive down to the local drugstore and pick up their own prescriptions and manage their own drug regimen. These are people who, you know, need help, they have--they need constant nursing care and they need a pharmacy who can come in and provide them a much higher level of service than you would expect from a retail drugstore, because these people are so sick and--and take, you know, anywhere from 8 to 10, if not more, drugs at any one time.

GILL: Tell me something about the price. If one did not have the--the--the benefit of Medicaid and Medicare, what exactly are we talking about in terms of an outlay and household budget in terms of a range of drugs that are unique to people who are elderly and--or to people who are--you know, they have a condition, whether we're talking about diabetes, high blood pressure, or--or conditions that are a part of a weight-loss regimen or whatever.

MR. NORTHRUP : Well, you're raising a big issue, Tony, the--the--the cost of drugs. And the patients that we serve will have, you know, five or six different medical conditions that each require pharmaceutical care. And it's the pharmaceutical care that--that keeps them alive, keeps them out of the hospital. So the typical nursing home resident is taking around nine medications at any one time, and, you know, it's--it's expensive. I--I won't--I won't disagree with you there. And that's why you have so many people who live in nursing homes on Medicaid. Seven out of 10 nursing home residents in the commonwealth are Medicaid beneficiaries. And part of the reason for that is that long-term care is expensive and pharmaceutical care is expensive. But it's what keeps these people alive and keeps their quality of life as good as it is.

GILL: Well, let--you know, I understand that there's a health benefit attached to all of this. Even though it may extend life, it may cut back on some of the complications as a result of--of having a condition of one kind or another, keep the kidneys from shutting down and to maintain eyesight, whatever--and I understand there's a tremendous benefit and that people are going to pay whatever it takes, especially when you start talking about the expense undertaken by older Americans to take advantage of some of these prescription drugs. But the problem is, is that in some cases, in states like Vermont and states like Massachusetts, you are going to have folks who are--who literally have to make a decision as to whether they're going to eat or they're going to try to stay alive a little longer because their doctor prescribed a drug that will keep them from suffering from complications form a condition. I mean, what do you say to someone who has, let's say, hypertension? You know, if they don't take the drug, they--they could stroke out. If they have, for example, maybe a mild case of diabetes, if they don't take ACE inhibitors they are going to--they're going to have kidney complications because, while they're not dependent necessarily on insulin and that is not the drug that is given to them by the doctor, they may find themselves slowly, slowly edging toward the abyss because they're not taking a prescription drug.

MR. NORTHRUP : Oh, I agree. It's a--it's a terrible situation when someone has to be forced to choose between, you know, daily needs of living such as food and shelter and making sure they can afford their prescription drugs. You know, I--my grandfather has--and my grandmother are both Medicaid--or Medicare age and my grandfather has been kept alive, basically, for the last 20 years by a variety of regimens of--of heart drugs. And it's--these are crucial, crucial drugs for people who really need them. And I think that's why you see a lot of people and a lot of organizations such as our organization, who support creating a Medicare prescription drug benefit so that people who have catastrophic health care costs can have some peace of mind that--that they're not gonna be forced to make those decisions. But right now they are and it's because we've--we don't have, as a--as a society, a policy solution to take care of people who are faced with those sorts of predicaments.

GILL: Let's talk about, you know, the people who have to have a certain amount of prescription drugs to be able to ta--maintain the regimen that a doctor put them on and it may--if they don't have it, it may have that person, especially members of the--of the aged, becoming blind, perhaps becoming disabled. Perhaps they, you know, suffer from a condition over time, perhaps only months could keep them from having to--to end up on dialysis and so forth, or a more expensive treatment, in which case we've become penny-wise but pound foolish. What are we talking about here? We're talking about many millions of people who are on, let's say the--the--the federally funded, the state and health insurance programs where they have prescriptions taken care of for them, at least a certain portion of it taken care of so they don't go broke trying to keep their health up--I've given, you know, a very broad umbrella, but can you--can we be rather specific with the kinds of needs that people have under this program?

MR. NORTHRUP : Well, the--the kinds of needs that--that we see in long-term-care pharmacies and serving, you know, the frail elderly, the disabled and people who--who reside in nursing homes, we--you know, we see they have a variety of needs. They have multiple medical conditions and the challenge of--of treating these patients is in treating people who have multiple conditions and therefore need multiple medications and, as a result, as you know, there are--one of the problems that we have with drug regimens today is that because you have people on so many different drugs and that these drugs interact with each other, you've got to be very careful and particularly in this population. We serve the frail elderly. There are certain older classes of drugs that have side effects that are--that are frankly dangerous for older people; you know, hallucinatory side effects with some of the older anti-psychotic drugs. And the newer drugs have fewer side effects and they're more beneficial for these--for these older patients. And one of the things that our organizations do is to try to work with physicians and nurses within the nursing homes to--to optimize those drug regimens, make sure that the patients are not taking drugs that are--that are dangerous for the frail elderly and really working as part of--you know, our pharmacists really work as part of interdisciplinary teams within the nursing homes who work directly with the nurses, directly with the physicians to try to make sure that the patients are taking the right drugs, they're getting the right doses at the right time. And that's what my member companies are all about, making sure the patients have appropriate pharmacy care.

GILL: Well, I--yeah, I got to tell you that, for the most part, you know, when I hear of elderly people who have reached a certain age, I'm always amazed at how well they look and that they're ambulatory--that is, on their own two feet--and out shopping and waiting for their spouse, who is about the same age and--and then, you know, I--I do recall that--and--and this is a number of people, because I've lived in the area now for 10 years and most of these people I've known before I--I left home and--and went out elsewhere--I've lived in the Midwest for a number of years--I--I see them and they're looking as well as they do, I think, partly because, you know, they--they do have the expensive prescriptions that keep them alive. I know one person who--he goes out and he walks and he--he's 80 years old. You would never know. He was my neighbor back when I was eight, nine, 10 years old. He was my neighbor and--and he looks as good today as I recall him looking at when I left some 20 years ago. And he finally got to the part of his conversation when he says `I don't travel as much as we would like.' And so I asked him why because I knew he had a terrific job. He sat on commission after commission, he presided over a very important private institution for many years and he's worked in the private sector. And I thought that the guy was loaded. I mean he left the neighborhood because he was making more money and we lived in a terrific neighborhood. Guess what? He said that they don't travel because of all the medicines that they have to pay for. So we're really talking about people who will be placed in an extremely disastrous, financial position aren't we?

MR. NORTHRUP : Oh, we are. And, again, it's back to the point we discussed earlier. There needs to be some sort of protection for--for those people. You shouldn't have to make a choice between food and--and clothing and--and--and even travel. I mean a person works their whole life and hopes to have a relatively comfortable retirement and to be able to do some of the things that they worked their whole life to put themselves in a position to do, and, you know, oftentimes through no fault of their own, through some, you know, genetic situation or--or--they'll be forced to take drugs to deal with a--with a medical problem that they can't deal with without drugs to be able to continue to have at least some quality of life. And that's what a lot of the--the newer drugs are aimed at, not just keeping people alive but keeping them alive with a--with a decent quality of life. But you raise a--yeah, a very difficult issue that, you know, members of Cong--Congress right now are struggling to--to figure out how to pay for which is providing some sort of Medicare prescription drug coverage for seniors that at least protects those who are faced with catastrophic costs and protects them from having to make those difficult choices.

GILL: Funny that you mention that Congress is struggling to find a way to pay for it but the Massachusetts Legislature's struggling to find a way to not pay for it. It's an absolutely amazing turn of events around the People's Republic of Massachusetts. Thirty-four minutes past the hour now and we are engaged in a conversation about the--the danger and/or the prospects that Veto Jane may make as part of her--her reduction of the state budget, the--the reimbursement rate that deals with prescriptions for people who are under the federal and state jointly funded programs. Of course, we will continue this discussion with Steve Northrup and deal with this issue of the pharmaceuticals and the possibility that Veto Jane would consider--at least consider the exemption from these cutbacks for prescriptions so that people can live their lives and not face financial disaster. Thirty-five minutes past and we're back at the desk. * * *

GILL: So let's get back to Steve Northrup and Steve, thanks for holding on.

MR. NORTHRUP : You bet.

GILL: You're basically going to tell us how to--because this happened in August, this business of reducing the reimbursement rate for prescriptions--and as you already indicated, Walgreens and CVS were the leading companies to threaten to pull out of Massachusetts, out of that program should they reduce that rate. And, you know, they finally d--came--came to terms with all of us when all the other pharmacies said, `Hey, we're pulling out too.' I mean, isn't that the way it went?

MR. NORTHRUP : You--you're exactly right. I think that the governor thought that if CVS and Walgreens and Brooks all pulled out, that there were enough independent pharmacies out there to serve the Medicaid beneficiaries in the Commonwealth. But I think it became quickly clear to the governor and her staff that if those big pharmacies pull out, how are the smaller pharmacies that don't have the same buying power, going to be able to serve Medicaid beneficiaries at the same reimbursement rate?

GILL: How do you feel about Shannon O'Brien's proposal to--to buy in bulk because they're not able to change the price of prescriptions? Prescription drugs are horrifically expensive; if one was an individual to be able to--to have to, rather, buy drugs of any description and--and not have the help of these programs, would find themselves in financial ruin. And so the question really, you know, has to do I think, Steve, with Shannon's prospects as a governor. Does she have the right approach in her proposal to--to--to buy in stock and try to get the--the pharmacies to work on one thing or the other?

MR. NORTHRUP : Well, I think that--that in the question of--of--of buying drugs is different the question of delivering drugs and if the state buys in--in bulk, you've still got to work with the pharmacies to--to deliver the drugs. And the pharmacies actually have developed a very efficient system of purchasing drugs and distributing drugs. And, you know, CVS and Walgreens and Brooks and other national pharmacies are pretty efficient purchasers of drugs. So I think the issue is not necessarily the rate at which pharmacies can--can buy drugs from. I think, of course, the state would be a big buyer too but, you know, CVS and Walgreens and those types of national pharmacies have been in this business for a long time and know about how to negotiate the best rates that they can. The problem is if you're trying to negotiate a rate with a pharmaceutical manufacturer and they've got the only drug--the only patented drug on the market for a certain condition, you know, they're in the driver's seat. And there are new drugs coming out all the time and, you know, I think it's less an issue of, you know, the rate that pharmacies can pay vs.--or buy drugs at vs. the state--the rate the state can buy drugs at. That's more an issue of, you know, who is going to deliver the crucial services and is the state essentially going to, you know, nationalize--I shouldn't say nationalize--but is the state essentially going to take over the degree of pharmacy services in the--in the Commonwealth. That doesn't seem to me to be a--a great use of state resources. I think the state should--should focus on--on other ways to try to control drug spending, work with pharmacists and empower pharmacists to--to do the types of things that we do, frankly, in long-term care pharmacy. We're actually the state's best deal. Our--the typical per-prescription cost in long-term care pharmacy is about 20 percent less than you'd find in retail pharmacy and it's because we, you know, aggressively substitute generic drugs wherever possible. And we also try to substitute lower-cost brand drugs for higher-cost brand drugs that treat the same therapeutic conditions. And we negotiate, you know, the best rates we can from the pharmaceutical manufacturers. So in a long-term care pharmacy, I can say that we're already efficient buyers and we're already the state's best deal.

GILL: Well, I've got to, you know, thank you, Steve, for your time. Basically we are up against time and for the minute or so that we have left, let's talk about how people in Massachusetts can take control of this prospect of "Jane the Knife." Kind of sounds like a song, doesn't it, like "Mac the Knife?" But Jane, who obviously is going to have to further cut back on the expense here in Massachusetts, may be eyeing prescriptions. You guys want an exemption. How do you convince the lawmakers? Do you--do you ask people, especially people who are--who are young, perhaps in their middle years, taking care of their elderly parents, to go ahead and make--make telephone calls or to ask active, elderly people to telephone their legislators to--to make them friendly and amenable to making the exemption for these cuts and cutbacks and reductions of--of rates? They--they--they want this exemption and if they want to support you and your organization, they're going to have to make those calls to their reps.

MR. NORTHRUP : Yeah. People need to--people need to talk to their representatives, they need to talk to the governor, they need to talk to their policy makers who are in a position to make these decisions. The legislature actually exempted us from the pharmacy cutback in August and the governor decided to veto that exemption and--and--and treat long-term care pharmacies the same as retail pharmacies would be treated, despite the fact that we treat a very sick and a very frail population. And that costs us about 50 percent more per prescription to serve them than it does for a retail s--pharmacy to serve the typical patient in off the street. So I think peop--you're right, Tony, people need to call their--the governor, need to call their legislators. You, fortunately, in your listening area have some great champions: State Representative Keenan who chairs the House Special Committee on Medicaid from Southwick, Senator Lees from Longmeadow, Senator Kannapic (sp) from Westfield, were all great champions of ours in the legislative process. And they also need to hear thanks from their--their constituents as well. You know, legislators like to hear praise too, just like the rest of us.

GILL: Well, you know, I've got to say, that--you know, you've listed mostly Republicans there. Are the Democrats going along with this?

MR. NORTHRUP : The Democrats are going along with it too. We had some great support from Democrats as well. You know we had great support from Chairman Rogers (sp) who chairs the House Ways & Means Committee, so it was a bipartisan issue.

GILL: Well, I was hoping you were going to tell no so that we could invoke more Republicans in this. You've got to have those--

MR. NORTHRUP : This issue really, Tony, was a bipartisan issue.

GILL: Turn the state back into a two-party system. Absolutely. You know, it's a shame that--very quickly now--going into the 21st century that prescription drugs has become now a bread-and-butter issue, especially as one retires and moves to a fixed income and could be financially ruined by the--the enormity of the expense of these drugs. Hey, listen, it's time for us to get going, Steve Northrup. Why don't you stay in touch with us? We'll continue to go through this with you as you--as you're able to make yourself available.

MR. NORTHRUP : Will do.

GILL: It was a pleasure. Best of luck to you.

MR. NORTHRUP : Thank you.

GILL: All right.

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