The National Rural Health Association (NRHA) has endorsed three legislative solutions in the U.S. House of Representatives and Senate addressing major challenges facing community pharmacies, which are often located in rural communities where patients have limited health care options. The bills NRHA supports remove impediments to the financial viability of community pharmacies who endure slow reimbursement of Medicare Part D claims, pending cuts to Medicaid generic prescription drugs, and an inability to effectively bargain for fair contracts with the pharmacy benefit managers (PBMs) who administer prescription drug plans.

The official endorsement was indicated in a letter from George Miller, NRHA President, to Charles Sewell, National Community Pharmacist Association's (NCPA) senior vice president of Government Affairs. (To view letter go to here)

"The National Rural Health Association is dedicated to ensuring rural Americans have access to quality health care, including the vital role community pharmacies play in delivering prescription drug services," said Paul David Moore, D.Ph., P & C Management Company, president-elect of NRHA. "As a community pharmacy owner in Atoka, Oklahoma I am all too familiar with how misguided federal policies threaten my ability to remain in business and put my patients' health at risk. The only way to reverse this trend is for Congress to pass common-sense measures that restore fairness to our health care system."

NRHA supports H.R.1474, the Fair and Speedy Treatment of Medicare Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement Act (PhAIM) of 2007. These similar House and Senate bills fix the slow pharmacy reimbursement of Medicare Part D prescription drug claims by PBMs, which cause cash flow problems for community pharmacies that force loans in the tens to hundreds of thousands of dollars to be taken out. The bills require complete and accurate Part D claims submitted electronically to be paid within 14 days by electronic funds transfer, and paper claims within 30 days.

The House and Senate are also considering bills tackling the Centers for Medicare & Medicaid Services' (CMS) Medicaid generic prescription drug pharmacy reimbursement formula based on a flawed Average Manufacturer Price (AMP). While the approaches are slightly different, NRHA endorses the inherent goal of each bill: to limit the damage AMP would have on community pharmacies and the patients they serve. According to a Government Accountability Office study, community pharmacies on average will be reimbursed 36 percent below their acquisition costs for these drugs when the change is fully implemented in early 2008. H.R.3140, the Saving Our Community Pharmacies Act, establishes a new and fair pharmacy reimbursement benchmark reflective of what the actual retail costs are and includes provisions to drive generic drug utilization that increase taxpayer savings. While S.1951, the Fair Medicaid Drug Payment Act of 2007, is focused on improving the AMP formula criteria for determining the averages and raises the maximum amount of potential reimbursement.

In addition, NRHA backs the companion bills in the House and Senate-H.R. 971, the Community Pharmacy Fairness Act of 2007, and S.2161, which bears the same title. These bills tackle the ongoing problem of community pharmacies being offered take-it-or-leave-it contracts by the PBMs. They create a narrow exemption to current antitrust law that allows community pharmacists to negotiate contracts as a group, which is essentially the arrangement that the large, publicly-held chain drug stores already operate under.

"The National Rural Health Association's endorsements of these common-sense bills is vital to presenting a united front of organizations that Congress will respond to in the near future," said NCPA's Sewell. "The message should be loud and clear: if these bills are not acted upon, Congress will bear responsibility for the hardships and lack of services that community pharmacy patients will experience."

Moore added, "There is a heightened sense of urgency when it comes to the bills designed to fix the problem of slow payment with Medicare and low payment with Medicaid. The 2006 launch of the Part D program coincided with the closure of 5 percent of community pharmacies. The launch of the changes in Medicaid in 2008 could cause an even greater drop in the number of community pharmacies. This unfortunate development for rural Americans can be brought to a screeching halt, but Congress must act before they adjourn this year."

The National Community Pharmacists Association, founded in 1898, represents the nation's community pharmacists, including the owners of more than 23,000 pharmacies. The nation's independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines. To learn more go to

The NRHA is a national nonprofit organization, with more than 18,000 members that provides leadership on rural health issues. The Association's mission is to improve the health and well-being of rural Americans and to provide leadership on rural health issues through advocacy, communications, education, and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health. To learn more go to