“Oh, you can't always get what you want, aaaahhwaw
But if you try sometimes, you just might find
You get what you need.”
But if you try sometimes, you just might find
You get what you need.”
A long decade ago an important pharmacy-practice-related
windmill presented itself… just ripe for the tilting. Some years previous to this, several large
Pharmacy Benefits Managers, (PBM s), had implemented a new policy of mandatory
pharmacy mail-order participation for prescription insurance enrollees. The threat to pharmacy practice, and the
potential negative impact upon patient access to important pharmacy services,
loomed large and clear.
A telephone query to a dean at the University of Michigan
Law School put a potential response into play.
The dean decried the monopolistic implications of the practice of
forcing patients to utilize any given prescription dispensary against their own
personal choice. He recommended that
organized pharmacy respond quickly and decisively by soliciting a federal
antitrust lawsuit against the offending insurers; and he opined that the legal
effort would likely succeed. The actions
by the insurers walked like a duck, and quacked like a duck. They still do… even to this very day.
Organized pharmacy, (then, as is the case now), proved to be
less-than-organized. A clarion call to
action fell on mostly deaf ears. State
and professional pharmacy associations played their part by raising rallying
cries… but the organization member pharmacists were having little of it. The pharmacy associations spun and spun the
issue… but could gain little traction with pharmacists at large. Ironically, pharmacy associations are
currently blamed by revisionist historian-pharmacists for snoozing at this
particular switch. Nothing could be
farther from the truth.
The pharmacy association in Michigan chose to raise awareness of the
problem by supporting a petition drive that proposed creation of new state law
that would allow but regulate mandatory mail-order practices. The law would define ways that patients could
opt out of mandatory dispensing requirements that might create barriers to
patient access to pharmacy care, or that might unreasonably inflate the cost of
providing pharmacy services to insurance enrollees. The strategy was not to malign the insurers,
but was rather to ensure sensible cost effective patient access to pharmacy
care.
A modest number of pharmacists responded well to the
petition effort; but overall response was under-whelming. The biggest barriers to participation were
disinterest and apathy. The national
pharmacy associations were terrific boosters of the Michigan cause, but the drum roll of their
support banged equally unheard.
A surprising number of pharmacists actually opposed the effort: some pharmacists hoped to form their own
little PBM to seize a business advantage from a monopolistic mandatory
dispenser benefit, the big-box chains had recently embarked upon a PBM buying
spree and also coveted the mandatory dispenser benefit, and some pharmacists
refused support because the effort to legislate did not lean far enough toward
punishing the evil prescription insurers and seemed toothless.
Petition efforts require millions of dollars in financial
support in order to succeed. That’s just
a fact. This effort had only tens-of-
thousands of dollars to spend, and it got soundly and predictably trounced by
richer opponents. The project died a
pauper’s death, and the funeral was sparsely attended.
The main goal of galvanizing pharmacists to rally behind an
organized effort to regulate mandatory mail-order prescription benefits, and to
pursue federal litigation against the monopolistic tactics of prescription
insurers went unrealized.
“But I tried didn’t
I? Goddammit, at least I did that,”
barked Randall McMurphy in the book, One Flew Over the Cuckoo’s Nest. Easy to relate.
The current effort to gain support for federal legislation
to create Medicare provider status for pharmacists has reeled this cautionary
pharmacy tale gasping and struggling back to the surface. The parallels are strong and worrisome.
The pharmacy associations are once again leading the charge
into battle, all the while struggling to rally troops behind them. Apathy and indifference are again playing a
familiar role, while some pharmacists even devise reasons to oppose the fight. Déjà vu.
The needs of the many are at risk of being outweighed; by the inaction
of the most, and by the wants of the few.
That’s the cautionary twist in this fable, the moral of the story.
You can’t always get what you want. If laws are indeed made like sausages… then
their casings are the slippery stuff of compromise. Sweet surrender holds everything tautly in
place. Compromise dictates that
everybody gets something, and that nobody gets everything. Everybody wins by graciously losing. Pharmacists would be wise to learn how to embrace
grace and loss.
A frank refusal to yield guarantees that nobody gets anything. Apathy, inactivity, contrariness, and obstinacy
are venalities… that cashier the same wages as do all other sins. Willingness to settle for what you can have is
the only reliable way to demonstrate that… positive anything is better than
negative nothing.
The current push to gain limited Medicare provider status
for pharmacists might not offer all-pharmacists-all-things-all-of-the-time… but
this grounded approach is certainly worth the try. And if you’ll try sometimes, you just might
find… you’ll get what you need.
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