Drugstores in Pennsylvania fight rise of mail-order pharmacies

In the last four years, Jim Reginelli, an independent pharmacist, has watched the number of prescriptions his stores fill drop by 30 percent.

He chose his profession after developing a close relationship with his neighborhood pharmacist as a boy while picking up prescriptions for his father, who had multiple myeloma. Now 45, Reginelli wants to give that kind of personal service to customers at his four stores, the best known of which is Nisenholtz Pharmacy in the Northeast.

He thinks a relationship with a pharmacist increases the odds that patients will take their medications correctly and avoid dangerous interactions. He also thinks the realities of modern drug purchasing unfairly jeopardize that relationship.

He blames mail-order pharmacies - more accurately, insurance companies that force or strongly encourage subscribers to use mail-order - for eroding his profits.

"I'm treading water," he said. "It's tougher and tougher."

Reginelli and other independent pharmacists are stepping up efforts this month to pass bills in the Pennsylvania Senate and House - H.B. 511 and S.B. 201 - that would, in their words, "level the playing field." The bills, sponsored by local Republicans, were reintroduced after stalling in the last session. They would ban financial incentives such as lower copayments that channel subscribers to mail-order drugs as well as insurance rules requiring customers to use mail-order. Local pharmacists would get the chance to accept the same terms.

The bills also would require pharmacy benefit managers - companies that set the terms of insurance drug-coverage programs - to disclose payments from drugmakers for inclusion in formularies. Requiring those companies to take those payments into account could lead to higher reimbursement levels for brick-and-mortar pharmacies.

The House version of the bill has advanced to the Appropriations Committee; the Senate version is still in the Banking and Insurance Committee. Sean Moll, legislative assistant to Sen. John Rafferty, the bill's chief sponsor, said it was too early to tell how the bill would fare in this session. In the last session, it died in Appropriations. Gary Miller, a spokesman for Gov. Corbett, said that the administration was not inclined to support the bills in their current form, but that it valued community pharmacies and was open to discussion.