Correspondence

Pharmacy Compliance with a Prescription-Drug Discount Program

N Engl J Med 2002; 347:146-147July 11, 2002

Article

To the Editor:

California Senate Bill 393 requires “presentation of a valid prescription for the patient and the patient's Medicare card” as the basis for discounted prices.1 Since the design of the study reported by Lewis et al. (March 14 issue)2 did not include the presentation of prescriptions, and since the “standardized patients” identified themselves only as Medicare enrollees, it is not possible to interpret the results as a measurement of compliance with Senate Bill 393. A more valid design would have included the presentation of both prescriptions and Medicare cards. Furthermore, it was inappropriately implied that pharmacists should be able to deduce patients' ages and Medicare-enrollment status solely by observation.

For pharmacies, the logistics of obtaining Medicare discounted prices are complicated. They involve entry into the computer of information about the patient obtained from the Medicare card and specific prescription information; electronic transmission of the information to plan-specific processors, with a charge ($0.15 to $0.25 per prescription); and finally, receipt of the discounted price. Without prescriptions and Medicare cards, obtaining discounted prices requires the creation of “dummy prescriptions,” completion of the procedures listed above, and payment of charges.

In addition, the authors fail to consider in their discussion the possible effects of the national shortage of pharmacists and the related recent surge in retail prescriptions on the findings.3,4

Katherine K. Knapp, Ph.D.
Anandi V. Law, B.Pharm., Ph.D.
Craig Hitchman, B.Pharm.
Western University of Health Sciences, Pomona, CA 91766-1854
kknapp@westernu.edu

4 References

1. 1

   California State Board of Pharmacy. Pharmacy law with rules and regulations: 2001 California edition. San Clemente, Calif.: LawTech Publishing, 2001.
   

2. 2

   Lewis JH, Schonlau M, Munoz JA, et al. Compliance among pharmacies in California with a prescription-drug discount program for Medicare beneficiaries. N Engl J Med 2002;346:830-835
   Full Text | Web of Science | Medline

3. 3

   The pharmacist workforce: a study of the supply and demand for pharmacists. Rockville, Md.: Health Resources and Services Administration, December 2000.
   

4. 4

   Industry facts. Alexandria, Va.: National Association of Chain Drug Stores, April 2002. (Accessed June 20, 2002, at http://www.nacds.org/user-assets/PDF_files/Prescriptions.pdf.)
   

Author/Editor Response

The authors reply:

To the Editor: We were unable to have the standardized patients present prescriptions at pharmacies for legal reasons. Nonetheless, we performed a valid test of whether pharmacies would offer the legally mandated discounts. As we stated in our article, both Title 16 of the California Code of Regulations1 and California Business and Professions Code 41222 “stipulate that pharmacies must provide prescription-drug prices when asked, whether or not the customer presents a prescription.”

We did not expect pharmacists to deduce the age of the standardized patients by observation. Pharmacies were considered noncompliant only if they failed to offer the mandated discount after the standardized patient had specifically asked for it and presented his or her Medicare card. We understood that the logistics of obtaining Medicare discount prices without a prescription are complicated and that pharmacies incur a charge. Therefore, pharmacies were considered compliant if the pharmacist stated that a Medicare discount was available but that he or she could not provide prices without checking the computer. In fact, pharmacists at 345 of the 372 compliant pharmacies stated that the discounted prices were available but failed to provide them.

The reasons for noncompliance are beyond the scope of our study. We certainly expect that a national shortage of pharmacists and a surge in the number of retail prescriptions can only make compliance with this and similar laws more difficult.

Joy H. Lewis, D.O.
Jose J. Escarce, M.D., Ph.D.
RAND, Santa Monica, CA 90407
joys@rand.org

2 References

1. 1

   California Board of Pharmacy. Sacramento: California State Board of Pharmacy, 2002. (Accessed June 20, 2002, at http://www.pharmacy.ca.gov.)
   

2. 2

   Official California legislative information. Sacramento: Legislative Counsel of California, 2002. (Accessed June 20, 2002, at http://www.leginfo.ca.gov.)