Commission and is working to ensure that small business concerns are addressed in reforms being considered by the commission. In part because of Pryor's recent initiatives addressing discriminatory pricing, some are attempting to label Pryor as anti-small business a charge that is completely false, as reflected in the Council's award. - Senator David Pryor's approach to his responsibilities as a U.S. Senator exemplifies what we believe is the appropriate approach to the public policy process." said the SBLC chairman during the award ceremony. out advice and counsel at the earliest stages of a debate from all parties, including small business. "He seeks "More importantly," the chairman said, "the Senator has consistently demonstrated a willingness to undertake the sometimes difficult task of finding a solution that will address the particular concerns of small business within the context of a broader public policy debate. While we could point to specific accomplishments, this award is given on the basis of an individual's commitment to a public policy process that ensures small business' voice is heard, considered, and represented. "For this commitment to small business, we have conferred upon Sen. David Pryor our Small Business Advocate Award." A SENATE LEADER Pryor is a veteran politician. After serving three full terms in the House of Representatives, he was elected to the first of two terms as governor of Arkansas. In 1979, he was elected to the Senate. Ten years later, he was elected chairman of the Democratic Caucus in the Senate--making him arguably the third most powerful lawmaker in the Senate. While serving on the Senate Finance Committee, Pryor wrote "The Taxpayers Bill of Rights." It was enacted in 1988 and ensures that the nation's tax collection and penalty system is fair and equitable to all citizens and businesses. Last year, Pryor played a leading role in helping small business during the battle to repeal Section 89 of the tax code, which would have placed onerous new burdens on small businesses. He also helped pass legislation allowing sole proprietors and self-employed people to continue taking a 25 percent health insurance deduction and wrote a bill providing a tax credit to small businesses that spend money to adapt their facilities for the disabled. In Throughout his career, Pryor has been honored by various small business groups for his contributions. On several occasions, he has earned the National Federation of Independent Business' "Guardian of Small Business Award." 1987, he received the Small Business Council of America's "Congressional Award" for outspoken efforts on behalf of the small business community on tax matters. It's readily apparent that Pryor, who was the founder and publisher of a weekly newspaper, the Ouachita Citizen, in Arkansas, is sensitive to the needs of America's small businesses. he makes sure that members of his staff are aware of those needs as well. And, Pryor, during the first August recess in his first term as senator, shipped staff members home to Arkansas with instructions to take at least two jobs in areas where they had never worked before. Pryor's staff worked in small rural banks, gas stations, grocery stores, feed stores, local cafes, and other small businesses--learning about the concerns of America's small business owners and how they can help represent those interests in Washington. Our own organization expressed its gratitude at our Annua] Convention in Nashville, Tennessee, October 1990, when our House of Delegates unanimously approved the following resolution: The National Association of Retall Druggists through WHEREAS, the chairman of the Senate Aging Committee has educated Congress, the national media, and the public about the negative impact of multitier pricing on American consumers; and WHEREAS, the chairman of the Senate Aging Committee undertook an extraordinary effort to begin to pay pharmacy restitution for the confiscation of earned discounts since 1985, and to establish a moratorium on action by HCFA until enactment of reimbursement reform, including NARD's marketplace pricing standard; and WHEREAS, the chairman of the Senate Aging Committee withstood a most vicious, political, and personal attack for his effort to help consumers and pharmacists: BE IT RESOLVED that NARD especially recognize the unprecedented bipartisan effort by Senator David Pryor of Arkansas on behalf of independent pharmacy in the United States; and BE IT FURTHER RESOLVED that NARD recognize the authors of the companion equal access bill in the House of Representatives, Rep. Ron Wyden of Oregon and Rep. Jim Cooper of Tennessee. Contact: John M. Rector, Esq. General Counsel The Practicing Pharmacists Advisory Council (PPAC), similar to the new HHS Medicare Council for Practicing Physicians, the PPAC would assume that HHS policy members on both Medicare and Medicaid issues have the views of practitioners actually involved with the two programs. This will complement the regular flow of information from think tanks, academics, nonpharmacists chain executives, pharmacists employed by the industry, and others who may know little or nothing about the actual pharmacy practice setting and how it is important to Medicare and Medicaid policy. MEDICARE In addition to the points expressed, we urge vigorous enforcement of the Medicare Prompt Payment provisions and sufficient funding for Medicare contractors to enable them to provide vital, timely assistance to providers and beneficiaries. MADPA My statement expresses concern about the effort by a few to undermine this landmark law. We will submit for the record our assessment to Senator Chafee on this matter. The best price standard is a marketplace standard and a fair one. Given the global economy, its arguable that Medicaid as the poverty program should receive the best price established for a particular product anywhere in the world. Similarly, especially as the North American Trade Agreement is finalized, a sound argument can be made to substitute the best price in Canada or Mexico for the current statutory standard. As we have stressed to the Senator from Rhode Island, neither Medicaid nor Medicare currently benefits from the price discrimination in our market. In a Kansas City investigation by a federal grand jury, it has been alleged that members of a so-called "organized crime" family purchased prescription drugs at the discriminatory nursing home price, involving reductions as much as 90% off the acquisition price to our members. While such alleged criminals enrich themselves through resale of the products, neither Medicaid nor Medicare enjoys the benefits of such pricing when the products are used legitimately. (See enclosed Kansas City Star, May 11, 1991, page 1, for article entitled "KC mob boss, 4 associates are indicted Anthony Civilla linked to plan to divert drugs meant for nursing homes, by John T. Dauner and Joe Stephens.) Mail order pharmacies also receive discriminatory prices when they purchase prescription drugs. Such pharmacies and their out-of-state, unregulated pharmacists were determined by Congress to be ineligible under recently repealed Medicare Catastrophic Act. That was the correct approach for Medicare and is precisely the correct approach for Medicaid. It is important to protect consumer choice of pharmacy and pharmacist. IT is equally important to assure that any pharmacist practicing in a jurisdiction providing assistance to Medicaid recipients is subjected to the laws and regulations of the state in question. Presently, laws regulating the private sector reach only the out-of-state entity. In fact, consumers are far more substantially protected from the consequences of an out-of-state truck than they are an out-of-state pharmacy. An out-of-state pharmacist is totally unregulated, thus leaving consumers in-state unprotected. We are pleased with the enactment of the NARD moratorium. I hasten to add that many members of the subcommittee have supported the NARD moratorium and rebate or "lower of" concepts since we proposed them to the Subcommittee in early 1985. We were disappointed when in 1989, soon after being confirmed as Secretary, Dr. Sullivan rejected the NARD moratorium proposal. The MADPA moratorium provisions, effective November 5, 1990, prevent the reduction in reimbursement for pharmacists in the Medicaid outpatient drug program, which in effect are the nation's independent pharmacists. Our members dispense nearly 90% of the Medicaid prescriptions. The moratorium through 1994 will allow sufficient time to enact the NARD marketplace pricing (MAPP) standard. The enactment of MAPP will at long last express fair reimbursement in the law, not in HHS regulations that can be changed administratively and arbitrarily in response to pressures to address the product cost of prescription drugs. Please note the full page ad in Monday's Roll Call, thanking the 101st Congress for the passage of MADPA (See copy enclosed). The electronic claims processing provisions of MADPA hold great promise. The special 90-10 match is salutary. In the future, it is our hope that electronic claims processing and adjudication systems will be used for direct payment to independent pharmacists in the Medicaid outpatient program. Likewise, it has a potential for curbing inappropriate prescriptions for controlled drugs. We do caution the |