David Work: GOP changes to state health plan shipping jobs out of state?

In the 2011 Session of the General Assembly several changes were made in the North Carolina State Health Plan. This is the state agency that provides health plan benefits for 680,000 state employees and 160,000 retirees. It is accurate to state that this office affects every state employee, their dependents and retirees. This includes prescription drug benefits of 10 million prescriptions per year with expenditures of more than $700 million.

Several significant changes were made - such as placing overall responsibility for operation in the Office of the State Treasurer and the creation of a new Board of Trustees. Some employee holdovers from the prior administration are still in place, at least on an interim basis, until The State Treasurer, Janet Cowell, makes final decisions on personnel, policies and future plans for this vital part of state government.

One very crucial proposal from the plan staff is to move the dispensing of a significant numbers of prescriptions to out-of-state pharmacists and pharmacies, primarily in New Jersey and Nevada. The drugs involved would be “maintenance medication”, those drugs used in the same quantities month after month, indefinitely. These would then be delivered to beneficiaries by mail.

Currently pharmacists are the most widely and evenly distributed health care professional in the state. There is a pharmacist or a pharmacy in every county. No other health profession can make such a statement. Many pharmacies, especially in rural communities, operate on very close margins. There are two counties in the northeast, Gates and Tyrrell, where one pharmacy serves the whole county. A cut as drastic as this would be could easily put their finances so far in the red that they could survive. What would happen to all their patients then?

The public may have the impression that the retail drug business is very prosperous, especially when they see two or three new drug stores at one intersection. It is natural to think that a lot of money is going into these locations, but the chain stores do not own that land or the buildings. The real estate is owned by a corporation listed on the New York Stock Exchange and Walgreens or CVS (or whoever) leases the property and pays rent.

There is no doubt that the loss of cash flow from pharmacies in this state - if maintenance prescriptions were shipped out of state - would increase the unemployment rate here in North Carolina. Even more ironic is the fact that premiums from our state employees would be used to improve employment rates in New Jersey and Nevada.

Relying on mail delivery for life sustaining drugs is a risky decision. Hardly a day goes by without a television advertisement from the postal workers union imploring Congress to bail them out of their financial plight. People have virtually given up on Saturday mail service. Is the next step Monday, Wednesday, and Friday?

Also, don’t forget about the future. I think this could be a first step on a slippery slope to Telemedicine. This is a practice where patients can get their vital signs (pulse, temperature, blood pressure, simple tests, perhaps even x-rays) at one location and this data is interpreted and a diagnosis is produced with treatment plan implemented at another location. All this for a much lower price than in the United States.
What is applied to one profession should also apply to others.

If you want to contact your legislator about this, go to the website for the General Assembly.

David Work is Executive Director Emeritus
The North Carolina Board of Pharmacy