National Health Care Discount information, tips and advice

"One of the features of the program is to work very closely with retail pharmacists and technicians, so that the enrollment actually takes place in stores," NACDS president and chief executive officer Craig Fuller, explained late last month. "That's where the relationship is with most of these people who are cash-paying customers and don't have a benefit. We know they already come into the stores asking questions about the [new Medicare] program.

The Pharmacy Care Alliance--formed by NACDS in 2002 to unite drug manufacturers and pharmacy groups on behalf of seniors in need of drug benefit information--will be restructured to provide for equal control y both organizations.

Express Scripts serves more than 50 million Americans via about 16,000 client groups. Its willingness to ally with NACDS--which long opposed the concept of a Medicare-endorsed discount card because of the potential clout it handed to PBMs--signals a growing recognition that neither side can work alone to make Medicare drug benefits work.

"We are coming together because we are both dedicated to making the Medicare drug discount card program work for America's seniors," said Fuller and Barrett Toan, Express Scripts chairman and chief executive officer, in a joint statement. "We believe the best way to do this is by being very inclusive of other organizations who share the goal of a nationwide program."

Under terms of the pact, Express Scripts' principal role will be to provide PBM services on an outsourcing basis to the Pharmacy Care Alliance, including the negotiation of discounts from individual retailers and pharmaceutical manufacturers. Although chain and independent pharmacists would be called upon to enroll seniors in the program, other groups--including seniors' organizations, health plans and even employers--also could co-market the discount card and sign up members.

For Express Scripts, the alliance offers both a newfound link with pharmacists at the point of contact with patients, and perhaps a chance to compete more effectively as the No. 3 national prescription benefit manager against the two largest PBMs, Medco Health and AdvancePCS.

"We look forward to working together with pharmacists to lower drug costs by encouraging the use of less expensive generic drugs and lower-cost brand drugs," said Toan.

Toan added that seniors could influence physicians overall prescribing habits as they use less costly drugs with the discount card, "thus helping to lower drug costs for patients of all ages."

For retail pharmacy, the alliance offers a ready-made network of potential subscribers, a networking infrastructure and the chance to offer patients whatever discounts Express Script can provide through bulk purchasing. It also offers the chance to participate in a national Medicare card program on a more level playing field, under the kind of conditions that NACDS and its members fought for in the negotiations leading up to Medicare reform and the establishment of a federally subsidized card program.

Thus, the deal offers a fully transparent business model, a level playing field, a choice for patients about where they get their prescriptions filled and protection of a pharmacy's patient records. Equally important, it precludes Express Scripts from doing anything to steer card-holding patients away from community pharmacies and into mail order for their chronic-care medications.

A rapid rollout

For Medicare patients themselves, the benefits of a prescription discount card can also be substantial, said Fuller--particularly if the Pharmacy Care Alliance can link its card program benefits with those many drug manufacturers already offer with their own card programs.

That certainly includes opportunities for low-income seniors living at or under 135 percent, of poverty level, said Fuller, "to have a $600 benefit this year in their discount card, and another $600 next year.

At the NACDS Foundation's Medicare Prescription Drugs and Reform Conference Jan. 3, Fuller took the opportunity to address some of the questions surrounding the Pharmacy Care Alliance card. Among them: how patient information collected by pharmacists who take the card is used, and where that data resides. "Express Scripts and we agreed that the names and information generated by the enrollment process by retail pharmacy as part of the co-marketing program ... belongs to the retail pharmacy. It goes to the Pharmacy Care Alliance ... to run the program. If for any reason we decide we're not going to continue with the Alliance ... the partners, Express Scripts and NACDS, have no rights to the data. It goes nowhere," Fuller said.

Fuller also addressed the question of trust between the two partners. In negotiations leading up to the card program, he said, Express Scripts quickly agreed to let the alliance conduct an audit to ensure full transparency about the flow of cash from cardholders.

>From here, said the NACDS president, "the timetable is very, very rapid" as the alliance works to gain authorization from the CMS and begin enrolling Medicare recipients as members in time for the government's planned June kickoff of national card-based drug discounts.