A growing number of employers require that prescriptions be filled by mail order. This trend signals serious challenges for consumers, physicians and community pharmacies in Michigan.

How to avoid an economic and healthcare setback
Unless Michigan pharmacies are allowed to compete on a level field, jobs will be lost, pharmacies will shut, consumers will pay more for prescriptions and patients will lose access to one of their most trusted health care advisors.

These dire outcomes can be avoided. People overwhelmingly prefer to fill prescriptions at their neighborhood pharmacy. Services offered by community pharmacists make them the most accessible health professional, often the only person who can help patients manage multiple medications.

Only the large, out-of-state Pharmacy Benefit Managers prevent pharmacists from filling 90-day prescriptions for one co-payment. Each of the four largest PBMs runs a mail division. This lets the PBMs administer the plan and sell drugs to the plan through their mail order sites -- clearly a conflict of interest. Physicians are not allowed to own drug stores lest identical conflicts arise.

Michigan's 2,000 pharmacists strongly support efforts to contain health care costs in order to reduce business expenses and increase productivity and global competitiveness. Forcing shoppers to deal with predatory, monopolistic, out-of-state "pill mills" is not the answer, however.

To help educate Michigan residents and decision makers on these issues, a coalition of concerned professionals have initiated a public awareness campaign.

These are the key points to understand:

Bad for Michigan's economy
Mandatory mail-order prescription programs could cause financial devastation for community drug stores. It's not that the corner drug store cannot compete with mail-order fulfillment houses it isn't allowed to.

Druggists' hands are tied by pharmacy benefit managers - or "PBMs" - large companies that specialize in the administration and management of prescription benefit programs. Drug manufacturers pay the PBMs "rebates" to steer healthcare plans and consumers to costlier drugs. The PBMs pocket these "incentives," forcing health care plans and consumers to pay inflated prescription drug prices.

One PBM - Medco Health - will manage pharmacy benefits for the whole auto industry. Its mail-order division will fill all mail-in prescriptions for UAW members and retirees, even though your neighborhood pharmacies could supply the same medicines just as economically.

Unless Medco and other PBMs are prohibited from discriminating against retail pharmacies, hundreds of Michigan community pharmacies could be forced to close, weakening the state through lost:
* Jobs
* Single business tax revenues
* Business property taxes
* Personal property taxes
* Income taxes
* School funding

The potential losses are significant; Michigan's 2,000 drug stores employ more than 120,000 people and pay almost $1.2 billion in state and local taxes

Bad for consumer choice
Mail prescription mandates eliminate the right of consumers to choose where they buy maintenance medications such as insulin, Zocor, Prozac, Inderal and Prilosec. Retail pharmacies want to dispense 90-day supplies of maintenance medications for one co-pay amount - and they could do so just as cost-effectively as mail-order facilities - but are prohibited from doing so by the predatory out-of-state prescription benefit managers.

Consumers deserve the right to be served by local pharmacies when they fill maintenance prescriptions for ongoing conditions such as diabetes, high blood pressure, high cholesterol, acid reflux or depression - a category of medicines that account for about 40 percent of all U.S. prescriptions.

Specifically, Michigan retail pharmacies should be allowed to
* Dispense a 90-day supply at once
* Have customers submit one co-pay for the entire supply

Michigan pharmacists are vital members of their local communities - trusted, involved, dependable and available when needed. Faceless, distant mail setups, by contrast, have drawn consumer complaints, federal lawsuits and other government action. Issues involve questionable pricing, reliability and safety -- with reports of switching drugs without authorization from prescribing physicians and using costlier brand-name medicines instead of generic versions to secure manufacturer "rebates."

Bad for Healthcare
The PBM problem isn't just a matter of economics; its potential impact on quality healthcare is even more serious.

For example: If there is a question about a prescription filled at a retail pharmacy, the consumer can speak personally with his or her local pharmacist to resolve the matter. If there is a question regarding a prescription filled by an out-of-state mail-order provider, on the other hand, the consumer must to deal with an anonymous phone clerk hundreds of miles away.

For many people, their local pharmacist is the most knowledgeable and accessible link in the healthcare chain. Right behind the counter are the solutions to a frantic parent's questions about a toddler's earache, an elderly person's uncertainty about how soon after a meal a certain pill should be taken, and a physically challenged person's difficulty open child-proof bottles.

The mail-order business model requires a healthy retail network to dispense acute medications, but many retail pharmacies will not be able to survive by dispensing just these medicines for short-term problems. Problems with mail-order prescription mandates will only worsen as the practice spreads to other labor/management contracts.

Michigan's 2,000 pharmacies are essential to the state's economic health. For many people, especially senior citizens and the disabled, they are the essential links to quality healthcare.

To continue their vital role, our state's pharmacies don't need tax breaks or rebates or special exemptions. They simply need to have their hands untied so that they can compete toe-to-toe with the giant out-of-state mail-order facilities.

The Coalition for Quality Healthcare was formed to:
- Help reduce healthcare costs in Michigan.
-Uphold high standards of locally based healthcare.
-Ensure consumers a full range of prescription-filling options.
-Preserve the strong contributions of local pharmacies to Michigan’s economy.

The Coalition for Quality Healthcare seeks to protect the right of consumers to fill prescriptions wherever they wish, while supporting efforts to reduce healthcare costs for employers and patients. It is a not-for-profit 501c6 organization and all contributions are tax deductible.