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Spencer Clairmont, Walhalla,N.D., Published January 18 2009

Don't kill the local pharmacy

My wife and I are pharmacists, and we own and operate a pharmacy in rural Walhalla, N.D. I read with interest The Forum editorial (Jan. 11) regarding North Dakota’s pharmacy ownership law.

The Forum’s political cartoon (Jan. 11) shows a mortar and pestle with North Dakota pharmacist ownership law in the mortar and North Dakotans for lower prescription drugs assaulting the mortar with the pestle.

If the law is repealed, another political cartoon that you could show would be a rural town with its pharmacy boarded up, and a dotted track going 50 to 100 miles down the road to the nearest big box pharmacy, which certainly won’t be locating any closer to rural North Dakota towns. Where, then, will seniors, families with children, etc., go for after-hours care? Where will seniors go to get assistance with navigating Medicare D? Where will people go to see a doctor?

If there is no pharmacy in a rural town, the clinic will generally end up closing. There will be no reason to go to the local clinic staffed by nurse practitioners because patients will have to leave town and drive 25 to 75 miles to get prescriptions filled.

I think a little more investigating of the $4-for-a-month-supply pricing would show that it is not that simple (what is?). When it started, it was $4 for every 30 tablets taken each month. If you take more than one tablet per day, the actual price would be $8, etc. It also would be interesting to determine who purchases only a 30-day supply of a generic medication, given the fact that the cheapest way to buy is in

90- to 100-day increments, which often are sold for less than the $12 for three months that the big box stores are advertising.

Even in rural North Dakota, more than 85 percent of prescriptions are sold to an insurance-covered patient. This is important because the insurance company offers a contract that dictates reimbursement on a take-it-or-leave-it basis. It wouldn’t surprise me if this percentage is higher in urban areas. It is also my understanding that these $4 drug offers do not apply to insured patients such as Medicare D, Medicaid, Blue Cross, etc.

Dennis Johnson, a Grand Forks, N.D., pharmacy owner, gave fascinating testimony to the legislative committee that recently had hearings about this issue. The information came from a study sponsored by the National Association of Chain Drug Stores, not necessarily a friend of independent pharmacy. (And, incidentally, which represents Wal-Mart, Walgreens, etc.)

This study indicated the following:

The average national price for a Medicaid prescription is $77.66. In North Dakota, it is $66.06 – $11.60 cheaper. Nationally, the overall average prescription price is $72.71. In North Dakota, it is $62.05 – $10.66 cheaper. These numbers would seem to indicate that the pharmacy ownership law has not caused higher prices for North Dakota customers.

Based on our store, I believe the average rural pharmacy employs seven to 10 employees who also spend their salaries locally and pay their taxes in North Dakota. Who replaces this when rural pharmacies disappear?

A pharmacist is often the first contact a patient makes when he or she is sick, especially in rural areas where a physician is not available every day. Pharmacies in North Dakota provide health care at a fair price, and comparing their work to selling groceries or gasoline is a poor analogy. Changing the pharmacy ownership law would damage rural North Dakota without significantly improving service or price in the urban areas.

H. Ross Perot once said of NAFTA that the sucking sound you heard would be jobs and businesses going south to Mexico. To paraphrase, the sucking sound you would hear with the change of pharmacy ownership would be the acceleration of rural pharmacies closing, as the big box stores skimmed the cream off of prescription sales.

The Clairmonts operate the Walhalla Prescription Shop Inc., in Walhalla, N.D.