How did President Barack Obama’s promise of comprehensive health care reform get replaced in Congress by a bill to simply reshape the health insurance market? More importantly, why is anyone in the medical provider community supporting it?[IMGCAP(1)]More than 40 million uninsured Americans need help, but the failure of Congress to produce anything close to comprehensive reform is why the effort will be stopped in its tracks. Important participants in the health system, including physicians, drug manufacturers and hospitals, were early supporters of the process. One group conspicuously missing is pharmacists, and for good reason. America’s Affordable Health Choices Act (H.R. 3200) has no credibility with the thousands of pharmacists across the country who actually hear consumer frustrations and treat patients.From a pharmacist’s point of view, the bill should be defeated for three reasons. First, it fails to even mention the problem of patient access to prescription drugs. This is incredible, given that 3.5 billion prescriptions were written in the U.S. last year at a cost of $220 billion. The pharmacy community has offered several simple approaches to cut patient costs for prescriptions without imposing cost controls on manufacturers or sticking taxpayers with the bill. How can demands that small businesses and wealthier Americans pay more to cover runaway health care costs be acceptable when market-based solutions offered by frontline care providers are ignored? Second, the key provisions in H.R. 3200 that focus on transparency and access — critical elements to cut costs and improve outcomes — carefully avoid application to pharmacy operations. For example, the bill’s Physician Payments Sunshine Provision requires drug manufacturers to disclose every payment to physicians and requires physicians to disclose any financial interest in hospitals or other medical facilities. If this provision makes sense for manufacturers and physicians, it should also make sense for pharmacy benefit managers and pharmacies. Congress will find billions of dollars behind the nondisclosure agreements that PBMs force on drug manufacturers to hide rebates and on pharmacies to hide underpayments for the prescriptions that they fill. Why not apply the same “sunshine— standards to every participant in the system? More specifically, why protect the PBM industry’s practice of covering up its sources of revenues from government programs, and why let PBMs hide the payment terms that they impose as the government’s agents on pharmacies?PBMs claimed in Roll Call last week that “it would be a mistake, for example, to force PBMs to publicize the discounts they negotiate with drug manufacturers and drug stores— because disclosure would lead to higher prices. How does Congress buy into this logic? Can any Member of Congress cite a single example in any industry where increased transparency resulted in higher prices or reduced competition?Third, pro-PBM provisions in the bill will result in forced migration of millions of patients into mail-order-only prescription drug programs. That means that patients who rely on local pharmacies to help manage their prescription drug needs will be forced to wait for the postal service to deliver critical medicines from massive out-of-state, PBM-owned warehouses. Under the current system — where even getting an appointment with a doctor can take weeks — pharmacies are at the center of patient care. Local pharmacists know more about patients’ medical conditions, including how best to manage their medications, than any other care provider in the system. In addition, pharmacists are available on a walk-in basis every day in every pharmacy in virtually every community in the nation. Does anyone seriously believe that eliminating pharmacies will reduce rather than create delays and costs for patients?These provisions combined will transfer billions of dollars out of consumer and taxpayer pockets, and into PBM coffers. In the view of hometown pharmacists, a vote for H.R. 3200 is a final and full-throttled endorsement of PBMs over pharmacies. Why? Consider this: PBMs handled 60 percent of U.S. prescriptions in 2005. That number rose to 90 percent after enactment of the Medicare Part D program in 2007. Passage of the pending legislation will pave the way for PBMs to grab the final market share for prescriptions that they do not already control. There is no evidence that the PBM model has saved consumers and taxpayers one dime over what pharmacies can save, despite the claims by PBMs that protections against disclosure make impossible to measure.Congress is losing credibility with consumers when it comes to health care reform. Most independent pharmacists — those of us who actually manage the needs of patients every day — cannot accept a “reform— bill that blocks transparency, does nothing to reduce costs and forces patients out of personalized care into massive and centralized mail-order systems.There are ways to ensure patient access to medical care, improve quality and save consumers and taxpayers billions of dollars. But the solutions require transparency and scrutiny of anti-competitive practices by some participants that Congress refuses to consider. As a result, hometown pharmacies will form the final vanguard to protect patients against H.R. 3200. We are willing to bet that other care providers will begin to rethink their support for the bill when the effect on their patients and their ability to treat them is actually understood. Mike James is a practicing pharmacist and owner of Person Street Pharmacy in Raleigh, N.C. He is also vice president of government affairs for the Association of Community Pharmacists Congressional Network.