Guest Post: Efforts To Reform North Dakota’s Pharmacy Law Seem To Have Fizzled

PHARMACY-010SA

Over the last five years or so, the subject of North Dakota’s unique pharmacy ownership law have been debated in the Legislature as well as the public.

During the 2009 and 2011 legislative sessions, bills were introduced in the state House of Representatives, which would have removed the requirement of state law that a pharmacy must be at least majority-owned by a licensed pharmacist in good standing. Neither bill got far, as both were voted down by state representatives, following do not pass recommendations of the House Industry, Business and Labor Committee.

Following the legislative setbacks, two separate initiated measure efforts were undertaken to change the law. Both met with embarrassing defeats before they even made the ballot. The 2009-10 initiative made it as far as the secretary of state’s office when the petitions were filed. Unfortunately, the organization which had spearheaded that effort, North Dakotans for Affordable Healthcare, had neglected to attach a list of the names and addresses of the sponsoring committee members onto each petition booklet. That oversight was a direct violation of state law, thus causing Secretary of State Al Jaeger to reject the petitions. This kept the measure off the 2010 general election ballot. The group appealed to the North Dakota Supreme Court, which unanimously upheld the secretary of state’s ruling, and the measure was out.

A second effort by the group really never got off the ground. Former Republican U.S. Senate candidate Duane Sand of Bismarck spearheaded another initiated measure effort on the pharmacy ownership law, following the 2011 legislative session. When Sand left the pharmacy ownership initiative effort to concentrate on a primary election bid to wrestle the GOP nomination for the U.S. Senate away from now-former Congressman Rick Berg, his departure pretty much left the pharmacy ownership law petition drive flapping in the wind.

With no leadership or direction to speak of following Sand’s departure, what was left of the North Dakotans for Affordable Healthcare group decided to let the petition filing deadline pass; and the measure did not appear on the 2012 general election ballot. The group decided to suspend its efforts, citing a lack of financial support and petition signatures.

There were no bills on the subject of the pharmacy ownership law filed in either the state House of Representatives or the state Senate for consideration in the current legislative session. It would seem that most lawmakers have grown weary about the subject. The bill that was introduced during the 2011 legislative session by Rep. Thomas Beadle, R-Fargo, only got 35 yes votes on the House floor when it came up for debate and a vote.

Will there be yet another initiated measure effort launched on the subject of the pharmacy ownership law? It’s anyone’s guess at this point. No individual or individuals or groups of individuals have come forward as of yet with plans to mount another initiative effort. In the interests of full disclosure, I was a member of the sponsoring committee of both initiated measure efforts in 2009-10 and 2011-12. I was an active volunteer with North Dakotans for Affordable Healthcare. The group to the best of my knowledge more or less went out of existence in 2012 following the failed petition drive effort.

From a personal standpoint, I certainly hope some individual or group of individuals will come forward and mount yet another initiated measure petition drive to once and for all get rid of this anti-competitive law. In the other 49 states of the country, this is not an issue; and the big box retailers and the small independently-owned drug stores compete with each other and get along just fine.

Yet, North Dakota refuses to get with it when it comes to this subject. Competition is healthy. Presently, North Dakotans cannot take advantage of the much-advertised discount prescription price offers of a number of national retailers.

Clarence "Rick" Olson

Clarence F. “Rick” Olson of Fargo is is a regular contributor of commentary and opinion articles to publications across the state, most namely, The Forum of Fargo-Moorhead. He is a 1989 graduate of North Dakota State University, Fargo, where he majored in mass communications. Following a brief journalism career with stops at a weekly newspaper in Dodge Center, Minn. and at WDAY Radio in Fargo, Olson relocated back to Fargo which has been his home since 1979.

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  • Roy_Bean

    This issue is a very good example of why the left always wins. They never quit. They have an agenda to turn the US into a socialist country and probably have the patience to get it done. They don’t see this as 49 normal states and one oddball, they see this as 1 down, 49 to go. The last thing they want to do is to open the door to free enterprise in any field of health care because that would undercut to whole purpose of Obama Care which is socialized medicine.

    The mistake that the “right” has made is compromise. The left couldn’t get all of society to agree to the Marxist plan “from each according to his ability to each according to his needs” so they did it “just for the elderly” and called it social security. They couldn’t get all of society to agree to socialized medicine so they proposed medicare, but only for the elderly. Then they expanded it to Medicade, but only for the needy. Now we have Affordable care for all.

    They knew they couldn’t ban all guns so they only banned fully automatic weapons. Then they banned mail order weapons. Now they want to ban scary looking weapons. They will pick off one at a time until they have them all.

    When the time is right the left will brush aside the pharmacists who enjoy the protection that this law affords them now and we will all be buying from the government pharmacy. More correctly we will be picking up the drugs that some panel in Washington decides that we are allowed to have. This issue needs to stay on the ballot. If it never actually passes it will at least occupy the time and efforts of the left and slow their relentless march towards the Marxist country that they want us to be.

  • The Fighting Czech

    You know why this anti pharmacy bill gets no traction, even with the support of the walmarts of the world? Because the vast majority of the people are happy with the way it is. I believe it was brought up for a vote a few years ago… and no one voted for it. Move on….

    • Rick Olson

      It was voted on in the 2009 and 2011 legislative sessions and defeated each time in the House of Representatives. Neither initiated measure effort in 2009-10 and 2011-12 ever made it to the ballot. So, this issue has not been voted on as a ballot measure in North Dakota. If this ever did get on the ballot, I predict that it would pass. However, my gut feeling tells me that the status quo on this subject will continue and this law won’t change anytime soon. I have my hopes that it will, but the deck just seems too stacked against those who want to see this law change.

      • The Fighting Czech

        I really dont think anyone cares.. the two of the major population centers in this state live right on the MN border, so If this is that important of an issue to them, they are already getting drugs at Walmart. and basically everyone one else that doesnt live with in 20 miles of a Walmart type place want care anyway. and actually would tend to be against the bill, because of fear that their pharmacy could end up going under.. . and then they would be forced to drive a longer distances to get the drugs. No, I personally think your betting on a dead horse.

        • Rick Olson

          That’s partly to blame. However, in my research of this issue, I haven’t seen any instances of an independently-owned pharmacy closing up and going under, just because that there is a big box store or stores with a pharmacy nearby. It seems that the independently-owned drug stores and the big box stores peacefully co-exist with each other.

          The problem here in North Dakota just doesn’t have to do with competition and patronage of its customers. It has to do with jobs. NDSU turns out hundreds of pharmacy school graduates with their newly minted Pharmacist degrees. The vast majority of those students have to go out of state to find work in their profession; because despite what the opposition says, the job opportunities for pharmacists in North Dakota really aren’t all that great. Also, what kid fresh out of college with student loans to pay would even dream of owning his own pharmacy right off the bat?

          When the older pharmacist owners retire, they really have no choices as to who they can sell their business to. Thrifty White is about the only choice the way the current law is written. So, unless there is another pharmacist who is willing to purchase the retiring pharmacist’s business; then the business will likely die with the pharmacist’s retirement. A lot of those family owned pharmacies have been in those families for generations and have been passed down from one family member to another.

          • The Fighting Czech

            why couldnt Walmart take one of those kids that just graduated from pharmacy school and Set him up with a pharmacy in their store. Im sure they have lawyers that can make the kid the owner, yet give him absolutely no control over the business. But still comply with this law…

            Until recently North Dakota’s population was on a down hill slide. and I dont think the big Box stores were really worried about getting the pharmacies into ND. Now. I think it might change.
            If there is real money to be made, there will be lawyers hired to get around any law thats in the way…

          • Rick Olson

            That’s been discussed at length. Why the big box retailers haven’t done this always comes back to a liability issue and the fear of exposure to lawsuits. As long as whichever retailer — be it Costco, Kmart, Target, Walgreens, Walmart/Sam’s Club or whoever can demonstrate the pharmacy is at least 51 percent owned by the licensed pharmacist; all should be good, correct? However, why those companies aren’t doing this ultimately boils down to a liability issue as I mentioned above. Most of those company’s business models simply do not provide for piece mealing portions of the business out like that. For the sake of discussion, let’s say Mr. Smith comes in to get a prescription filled by a big box retailer’s in-store pharmacy. God forbid Mr. Smith gets very sick or dies from the prescription he obtained. Mr. Smith’s family isn’t going to go after and sue the pharmacist who sold him the prescription. They’re going to go after the deep pockets of the big box company and sue the company, wouldn’t they? At the same time, they would likely go after the pharmaceutical company which manufactured the drug, correct? “Law School 101: Always go after the deepest pockets!”

          • The Fighting Czech

            I guess I dont follow this…. are you saying that if a 51% of a pharmacy is owned by an individual, and he gets sued, those sharp lawyers out there will sue the big guy as well???
            But if the box store owned the same store, and sold those some tainted drugs… wouldnt they still get sued???

          • Rick Olson

            Given the very limited context of your question, and the fact that I am not an attorney, I shall attempt to answer your question from a layman’s perspective. Yes, no matter where the prescription was purchased from — the small town drug store or a big box retailer; there could be grounds for a lawsuit under these sorts of circumstances. So, it would seem to me that no matter who owns the pharmacy, they would potentially be liable in case of an injury or death, resulting from such causes. Since a pharmacy must be at least majority-owned by a pharmacist, it would be my uneducated opinion that the owner would be liable under such circumstances. Be it the independent owner of a drug store, or a multibillion dollar corporation like Walmart…whoever sold the drug in question to the person who became ill or died, could potentially be liable.

          • The Fighting Czech

            you got what i was saying… When I was in the cities, The Feds would hand out road contracts to Minority companies only, So some companies would pay a minority to start a company. he didnt have to run it. he didnt have to do anything. he just had to sign bids once in a while. and basically everything else was taken care of…
            Why dont the Walmarts of the world, Get a new, or better yet, a retired pharmacist, Per his contract with Walmart, he has to lease everything from walmart, he has to buy all his drugs from walmart, he even has to hire his labor from walmart… Basically you have a privately owned pharmacy in a walmart. that is “owned”, and operated by walmart.
            And sorry about the limited context. I dont like long winded entries.
            so I try to keep things short.

          • Rick Olson

            Actually, there wouldn’t be anything against such a set-up. It would be similar to setting up an LLC. “Walmart Pharmacies of North Dakota, LLC” with one of the Walmart pharmacies in the state serving as the address of domicile. Unfortunately, the big gigantic behemouth Walmart is, they want to control everythig from the top down. Therefore, you would never see this sort of an arrangement. The only exception I am aware of is that in one of the Walmart stores here in Fargo, the pharmacy space is leased out to an independent pharmacist who operates it as a leasee. It’s called the Prairie Pharmacy. In that case, they are leasing the retail counter space from Walmart for a pharmacy. However, it is not a Walmart-owned pharmacy.

          • The Fighting Czech

            I would think those wonderful lawyers could set up the whole lease agreement so they actually control the who thing. Bob the pharmacist want to set up in a walmart. Bob signs a lease that Walmart provide everything Bob needs for the business. in return Walmart gets to manage his business, hire the employees. do all the accounting, charge what they decide to charge. etc… in return Bob agrees to sign an occasional document if needed, and collect a check. Plus Bob can be available to sign more paperwork to open “BOB’s bouncing Yellow Tennis ball pharmacy in every Walmart in ND.

            I worked for Northwest airlines for over 20 years. You wouldnt believe the number of little companies that airline consisted of…. All stuff done on paper, all to cash in on the assets the airline had.

          • RandyBoBandy

            North Dakota law states that a lease agreement cannot exceed 5% of total sales. It was hypothesized that anything beyond 5% would propose a risk of money laundering or false ownership.

          • Rick Olson

            Interesting point that, up until now, I was not aware of.

          • The Fighting Czech

            You mentioned else where, that your involved in retail… Besides cheaper drugs, how would changing the pharmacy law affect you, or your employer’s business?

          • Rick Olson

            Changing the law would level the playing field, and that’s all I think anyone is asking for here. To be allowed to compete. No matter the company. Of course, if the big box stores could offer an in-store pharmacy in their stores in North Dakota; it should increase their respective businesses.

          • The fighting Czech

            Well, judging by your non answer, Ill assume your associated with one of the big retailers. and since your health insurance doesnt include any pharmacies in this state, Its not Target, but another company based out East, or South.

            Yes competition is a GREAT thing Especially on a level playing field.
            When I was young, my town had 3 car dealerships, Chev, Dodge, Ford. It was a good thing. good rivalry, good competition. The manufactures decided to give the bigger, neighboring dealerships a bigger discount for selling more cars because they didnt like dealing with all those small ones. So some people bought from these bigger dealers, because they thought they were getting screwed by the local dealer because his prices were higher, others still bought local for the convenience and service. Eventually the loss of customers was enough to eventually shut down all 3 local dealers.

            Well, as the years continued, the manufactures decided they need to eliminate more “small” dealerships. so the discounting continued to the MEGA dealerships, So we end up in the situation we have now,

            We went from having a 3 car dealer town, Where you went into the office to talk about purchasing a car when you needed a new car, When it needed service, you dropped the car off, and they would check it out, and if they figured it was going to be kinda expensive for your pocketbook, they would call you and let you know. To having to go to a MEGA dealer whose salesman assend like a pack of coyotes after a wounded rabbit, when they see you checking out a car.When I need to take the car back to get some recall work done, They tell me I need a new belt. They can take care of it for $100. and that my battery terminals are really corroded, They could take care of that for another $35. Well I had just changed that belt a month before, So being a little skeptical, I just told them to leave it. when I got the car home, I checked the battery, there wasnt a speck of corrosion on the battery terminals, and the belt was like brand new yet, Im still waiting for the survey card in the mail, asking me what I thought of their service…My point being is that i either take my car for service work there, or I drive another 80 miles down the hiway to more then likely experience the same treatment over there.

            I had a friend who worked in the Twin Cities, He worked for a small 10 man company that produced some kind of specialized electronic circuits for industrial use. apparently they were quite good at it. and considered the best, even over large corporations who produced the same items, but just couldnt get the quality this small outfit had attained.

            One day one of these large corporations made the owner of this small shop of about 10 people, an offer he couldnt refuse. Accept this generous offer, or we’ll discount you out of business…of course they stated it more eloquently then that, but the message was received and the offer accepted. One former owner is living in Fat City, 10 employees looked for new jobs, and an industry who require these specialized electronic circuits are now paying top dollar for sub-standard equipment.

            competition isnt the problem, its a great thing. Its that illusive “level playing field” that causes all the problems.

            Would you even attempt to tell me that if the Walmart pharmacy types of companies got into ND, they wouldnt do everything they could to tip that “level playing field” as far as they could get away with, to their advantage?

            the only problem with your arguments of competition is reality.

          • Rick Olson

            I can only speak from what I have seen in the Fargo-Moorhead area. Over in Moorhead, there is one independently-owned drug store in the Moorhead Center Mall which seems to be flourishing. While the grocery stores including Cash Wise Foods as well as CVS, Target and Walmart and Walgreens (2 stores) have pharmacies over there.

            There is also a Sam’s Club being built over there, which in all likelihood will offer a pharmacy. With all that competition, given your line of reasoning, you’d think the small drug store in the mall would be struggling. It seems that business is as good as ever there.

            Also, none of the independent pharmacies in Fargo and West Fargo have shut down just because Cash Wise Foods, Kmart, Target and Walmart over in Moorhead and Dilworth, Minn. have pharmacies. I honestly think there are a lot of holes in the arguments about the “big bad” big box stores.

            However, to answer your question, yes, I am employed by one of the big box retailers. Also, I can use my insurance at any pharmacy, independently-owned, chain store pharmacy or wherever.

            However, I am forbidden by company policy from disclosing which one in a public forum such as this one is. It could cost me my job if I do tell you which company I work for.

            I merely wrote this as a “think” piece…I honestly am not aware of any efforts to mount another initiated measure campaign on the pharmacy ownership law.

          • The fighting Czech

            OK, you work for one of the big box stores that would benefit greatly from repealing this law. So I understand where you come from….. I didnt ask for your employer’s name, I used to work for one of those big corporations, I know your expected to sit down bound and gagged when ever in public. and these kinds of discussions come up…

            The reality a $100,000 local company can compete with the multi-billion dollar company. as long as the ground rules are the same. Im very impressed with Speedee delivery, being able to compete with the big boys. But the reality is, If the Big Boys dont want to compete anymore, Speedee could be priced right out of business.

            I have a friend in Minnesota who services fire extinguishers, it just a one man show, and he competes with two larger companies… and they all survive. and everyone in that area that get fire extinguishers serviced wins. My friend is nervous. one of his competitors had just been bought out by a very large out of state company that is expanding rapidly. This same company made an offer to a fire extinguisher shop owner located in Colorado, He was told that if he didnt sell, he will be out of business with in 2

            years, Well he decided not to sell. when the new company went into business, they offered Free service on all the dry chemical Fire extinguishers, The small shop had to close up after 18 months, with nothing….. Like I said, my friend is nervous. He is just a small mobile shop. If they target him, He doesnt know what he will no next….Plus, that community that once had 3 companies vying for your business, could very likely have only one company who will charge what ever they want.

            Ya competition is great, it is the only way to live, But somehow, someone has to figure out how keep that playing field level. to keep it working as it should.

            As a “Think” piece, you got a lot of mileage out of it, dont you think?

          • Rick Olson

            Yeah, bound and gagged is a good way to describe it. A company’s public perception is created from the top down. They don’t want to do anything to go off message. If they let the little people do the talking like us, they just couldn’t handle that, huh?

          • The Fighting Czech

            Hadnt heard of that one before… But I still believe, they havent made a law yet that a Lawyer, and enough money, cant bend, twist, or just plain yield it impotent. if thats whats wanted bad enough.
            When “depends what your definition of “is” is. actually gets discussion time in a court room.. anything is possible

          • Hal801

            I hope you are mistaken. That would be way over the top for a state to get that involved in private lease agreements. Could you imagine if the same percentage was used to determine residential rental rates with regard to the renter’s income?

          • Justin

            Makes sense cause I believe the gross on prescripitons is around 20%.

          • Visitor

            Well, the pharmacy that is located in the Walmart on 13th Ave. S. in Fargo is a completely independent operation. The owner of Prairie Pharmacy merely leases the pharmacy box space from Walmart, and otherwise operate his own business from there. None of the employees who work at Prairie Pharmacy are employed by Walmart. They are employed by Prairie Pharmacy.
            Though, I do agree with you that it would probably be as simple as Walmart setting up an LLC (limited liability company) and setting up a pharmacist as the 51 percent majority owner on paper. They would make the Fargo pharmacy location the location of domicile for “Walmart Pharmacies of North Dakota, LLC.” Then Walmart would set up everything that’s needed to run a pharmacy, manage the pharmacy, hire the employees, do all the accounting, decide what they charge, etc.
            The reason why Walmart and the other big box retailers don’t do that almost always comes down to liability issues. Besides, they don’t want to pay someone like that if they don’t have to.
            The megalomaniacs which run Walmart want to control every last thing. They micromanage everything from the top on down.

          • Rick Olson

            Particularly considering the booming growth in the western third of the state out in the Bakken Oil Patch, you may be right. There are people out there who are transplanted from other states and simply are not used to the North Dakota way of doing things. I’m sure a lot of those folks think we’re just plain crazy because on and off sale liquor establishments are not open before noon on Sunday. That most retail businesses are not open until noon on Sunday. That you can’t buy a prescription at Walmart.. etc.

          • RandyBoBandy

            “NDSU turns out hundreds of pharmacy school graduates,” please check your, “sources,” because NDSU’s pharmacy class size is a maximum of 85 students per year. Nice hyperbole though.

          • Rick Olson

            Perhaps not hundreds of graduates in one year. Over the span of five years — you do the math 85×5=425. That indeed is hundreds. Stop being nitpicky.

          • Justin

            I am a pharmacist that graduated from NDSU and moved to Minneapolis to get a job in pharmacy. I got paid better and despite having “corporate watching over me” I ran the pharmacy how I believed served our customers the best and lead to better outcomes. I find it hard to believe that pharmacists in North Dakota care more about patients just because they own the pharmacies. Unless they care about the patients more because the profit statement have a direct impact on their bank account. I would love to move back to North Dakota and continue being a retail pharmacist but evertime I have seen an opening the salary is 25% lower than jobs in Moorhead.

          • Rick Olson

            Not surprising. Indeed, this is the independent pharmacy owners looking out for themselves. So far, they’ve got a pretty strong ally in keeping significant competition away. The pharmacy ownership law. No matter how hard people have tried, it’s been one tough nut to crack. Several attempts in the Legislature and even a court case which made it all the way to the U.S. Supreme Court. Then the two ill-fated initiated measure campaigns.

            It seems there’s this big hand hovering over North Dakota on this issue. Naturally, the independents don’t want the law to change. Meanwhile, Thrifty White Drug sits up on that pedestal of theirs as the only drug store chain that can operate statewide because of the fact that it’s employee-owned by virtue of an ESOP agreement; and thus can demonstrate that each of its locations in North Dakota is indeed at least 51 percent owned by a pharmacist.

            Meanwhile, CVS Pharmacy is locked into the six store locations it purchased from Osco Drug, which was in business in 1963 when the law was first enacted. They are therefore grandfathered into the law. CVS can’t expand past the six licenses it already possesses because of the law.

            If the law said no corporate pharmacies in North Dakota, period, we wouldn’t be having this discussion. Since CVS and Thrifty White, both corporate owned drug store chains can do business in North Dakota, then what would be the problem with allowing the other big box retailers from doing the same?

            For goodness sakes, Walgreens — the nation’s largest Drug Store chain — cannot operate a pharmacy in its lone North Dakota store in Fargo because of the law.

            I also understand the argument that if the big box retailers really wanted to, they would find a way to comply with the law. They could, but for many various reasons they simply will not. However, the respective company’s business models simply won’t allow them to piece meal out a part of their business like that.

            As I’ve stated before, it’s not that they wouldn’t want to; but this always comes down to a liability issue for the companies in questiion. Be it Costco, Kmart, Target, Walgreens, Sam’s Club/Walmart; or whoever.

            I’m sure you would agree with me that the independent drug stores which aren’t part of a franchise group like Health Mart, ValuRite or the others have to pay more for the prescription drugs they sell to their customers; and therefore have to mark up scripts in order for the store to be profitable.

            Those stores that are a part of a franchise group probably have better buying power and can afford to pass along the savings that their better buying power gives them on to their customers.

      • ec99

        ” If this ever did get on the ballot, I predict that it would pass.”
        Maybe. But the pharmicists have already learned that they’d have success with the campaign slogan “Keep It Local”.

  • nimrod

    It would be unfair to the one chain that is grandfathered in to change the law now. Osco Drug was already in place when the law was created, once they sold, I’m sure they sold at a premium, because no other chain can legally operate in the state without the pharmacist owning at least 51% of each store.

    • Rick Olson

      Why is this an issue in North Dakota? It’s because a good segment of North Dakota’s population is reluctant to accept change. They want things to stay the way they are. Personally, I think the problem lies with the fact that most lawmakers are hidebound to the people who elect them to office. Among those people, of course, are the independent drug store owners.

      Thrifty White Drug and CVS Pharmacy are allowed to operate under the current law. Thrifty White is employee-owned by virtue of an ESOP agreement; and therefore, the company can demonstrate that all of their pharmacy locations in North Dakota are indeed at least 51 percent owned by a licensed pharmacist. Therefore, Thrifty White is in full compliance with the law.

      CVS Pharmacy purchased Osco Drug in a merger of the two companies over a decade ago. Osco Drug was in business in 1963 when the pharmacy ownership law was first enacted. Therefore, the current six locations of Osco Drug, which have since been acquired by CVS Pharmacy were allowed to remain in business, in that they have been grandfathered into the current law. Yes, I’m sure Osco sold to CVS at a premium for their six North Dakota locations because of this law.

      In fact, I met a CVS district manager in passing a number of years ago, and he said they almost didn’t get the merger approved. It seems the Board of Pharmacy was going to dig its heels in, but they wound up allowing CVS to acquire the licenses of the six Osco Drug locations. In other words, the Board broke the law by doing this!! A strict interpretation of the pharmacy ownership law as it is written would not have allowed a non pharmacist-owned company like CVS to purchase a pharmacy in North Dakota.

      For now, efforts to change the state’s pharmacy ownership law appear to have fizzled. Such a shame. Hopefully, a new effort will come about to once and for all get this law changed.

      • dakotacyr

        you really wrote this? ” Personally, I think the problem lies with the fact that most lawmakers are hidebound to the people who elect them to office.” As opposed to out of state big business who wants to close down the mom and pop local pharmacies. I will stand with them anyday!

        • Hal801

          But will you stand for freedom and free enterprise any day?

          • dakotacyr

            Sure, as long as it is fair. next question, Hal?

        • Rick Olson

          No one wants to close down anyone. Here you guys go with the “Sky is Falling” bit again. We’re no where near seeing this issue come up again as no group has stepped forward to mount another initiative campaign. Yet, you guys are circling the wagons already! How paranoid can you get?

          • The fighting Czech

            IN all fairness, your the one that wrote this article arent you? I get the impression from your comments, that this wont be a dead issue. So why shouldnt people argue with you? isnt this what this blog is all about?

    • Rick Olson

      Well, Nimrod, CVS Pharmacy seems to be doing a very brisk business in the six stores that they acquired from Osco Drug. I don’t see that changing any in the event the pharmacy ownership law gets changed. If anything, it will allow CVS to open more locations elsewhere in the state. As it stands now, they are not allowed to expand beyond the six pharmacy licenses they currently hold. The only restriction would be that North Dakota Board of Pharmacy regulations prohibit a pharmacy owner from owning more than two pharmacies in the same city.

  • ec99

    Another example of the “citizen legislature” doing the “people’s work.” I’m waiting for them to pass a law declaring only Dakota Maid flour may be sold in the state.

  • RandyBoBandy

    Repeal of the ownership law will not lower prescription prices, create competition, or improve pharmacy access for North Dakotans. Prescription prices are DICTATED by insurance companies and pharmacy benefit managers (PBMs). The market on prescription prices is not as elastic as you may believe. You need to seriously read the fine print with the, “discount offers,” from national retailers. Most of the alleged discounts pertain only to a very short and strict list of formulary of drugs. For example, you would not be able to only pay $4 for Advair or insulins at Walmart. The only competition that will exist if this law is repealed would be predatory insurance competition. You will receive notice that your copay at JohnDoeRx for your simvastatin is now $50, but only the original $5 if you drive 35 miles to the hypothetical Walgreens in Bismarck. However, once JohnDoeRx is out of the picture, your copay WILL INCREASE. The aforementioned scenario would be orchestrated by insurance companies or PBMs; true competition of providing a service has nothing to do with it. Lastly, North Dakota is a rural state and many of the rural drug stores will go under if this law is repealed, thus reducing pharmacy access to North Dakotans. Do you think CVS or Walgreens will put more than seven stores each in ND (Fargo, Grand Forks, Jamestown, Bismark, Dickinson, Minot, and Williston)? Hell no. Some of those towns I listed as possibilities probably don’t even have the prescription volume now to warrant a big chain setting up shop. Independently owned drug stores are quite rare nationwide, unless you live in North Dakota or Florida. The world of healthcare is determined by bureaucracies and red tape, not true competition.

    • Rick Olson

      One man’s opinion. Our research indicates otherwise.

      • RandyBoBandy

        Please cite these sources because my seventeen years in the pharmacy world and dealing with insurers have prove true in 49/50 states.

        • Rick Olson

          Thank you for revealing the nature of your employment. Naturally, you are in favor of the status quo. I get that. You and many of your colleagues see changing this law as a threat to your jobs. I honestly don’t think that should be a worry. If anything, the added competition will simply force you not to rest on your laurels and will force you to do your jobs even better. If your clientele relies on your good, personal service; then you’ll have to do that even better, right? Competition forces all of us to do our jobs better. Trust me, I have plenty of competition working in the retail industry. This forces myself and my colleagues to be on top of our games, to treat each customer with courtesy and respect and let them know that their business is appreciated. I don’t think anyone has discussed insurance prices and copays for prescription drugs, Under most plans, I agree, a person would pay the same copay most anywhere. A big box pharmacy or an independently-owned drug store. What was being discussed was the variances in the cash price for the same prescription (both quantity and strength) between an independently-owned drug store and one of the big box stores. A prescription that costs $35 at an independent drug store may cost $4 at a big box store’s pharmacy, simply because the big box chain has the buying power to purchase most meds in large quantities, that the savings can be passed on to the consumer. Every time the subject of pharmacy ownership comes up, you all start circling your wagons and screaming “The sky is falling!” If anything, a little added competition will force you to do your jobs better. If you can offer your clientele an incentive or a reason to stay with you, they’ll stay. Like we’ve said before; the small town drug stores should be just fine, because I doubt hardly anyone would want to drive an hour away just to save $10 on a particular script.

          • RandyBoBandy

            The savings are almost never passed on to the consumers. The price differences are always going to be significant in predatory insurance battles. Worst case scenario, they simply do not cover your prescriptions at, “non-approved,” retail locations.

            http://www.pbmwatch.com/how-pbms-affect-cost.html
            http://chaindrugreview.com/front-page/newsbreaks/more-states-push-pbm-audit-legislation

          • Rick Olson

            I understand that to be the case. Many insurance companies have “preferred” providers, even among the pharmacy business. It wasn’t long ago that customers of Walgreens across America that had I think it was ExpressScripts coverage had to scramble, because ExpressScripts didn’t renew its contract with Walgreens. So, the other pharmacies including Walmart were courting ExpressScripts customers. How my insurance works where I work is there’s a network of preferred providers. However, since none of them operate pharmacies in North Dakota, I’m allowed to use whichever pharmacy I choose and will get the same benefit if I were using a preferred provider. But, who knows what’s going to happen. Perhaps when Obamacare comes fully online, we’ll be forced to buy our prescriptions from a government pharmacy or something?

          • Hal801

            I hear you, Rick. Thankfully ExpressScripts and Walgreens did finally come to an agreement.

          • RandyBoBandy

            “However, since none of them operate pharmacies in North Dakota, I’m
            allowed to use whoever I choose and will get the same benefit if I were
            using a preferred provider.” That is exactly how they have been putting up and coming independent owners nationwide out of business. If you chose not to succumb to their terms, they will not allow you to process their customer’s prescription claims. It literally has nothing to do with providing a service or Walgreens/CVS being better than JohnDoeRx. If you do not agree to the PBM contracts from ExpressScripts, which now controls 1/3 of the nation’s market, you are literally screwed.These contracts include low reimbursement rates (even on dirt cheap generic drugs) and crippling audits for things as simple as misspelling Rikc Olson (despite all other identical data, thus leaving the claim unaffected). PBM drug formularies are dictated by cost and not therapeutic efficacy. Physicians and pharmacists alike can tell you absolutely absurd insurance stories that not only inconvenience patients and providers, but also possibly harm patients because there is almost zero room for clinical judgement. Even as more and more prescription drugs become generic the savings are not passed on to the consumer, but rather as extra profits. PBMs generally only cover the drugs with the best rebates from the manufacturers (usually, but not always the BEST therapeutic option). Try calling for audits on PBMs, it basically cannot be done. When 99% of all pharmacists have nothing positive to say about PBMs, there is probably a problem somewhere.

          • Rick Olson

            Trust me, I know what small business owners face. I work with small business owners all the time in my line of work. A large number of my customers are themselves small business owners, farmers, ranchers, attorneys, accountants, day care center owners, etc.

            The pharmacist/owners of the small independent drug stores in North Dakota are indeed business owners. They have to do what’s right for their customers, all the while having to deal with these same issues you raise. They have every right to make an honest living for themselves and try to make at least a small profit in the meanwhile.

            My mother was a small business owner for about six years of a ceramics and gift shop. It’s a whole different world when you’re the boss, the payroll department, the accounts receivable and payable department, the head buyer, all those hats rolled into one.

            These pharmacist owners either have to negotiate all those contracts themselves; but I understand some of those drug stores join a consortium or buy into a franchise in companies like Medicine Shoppe, ValueRite Pharmacies, and others.

      • dakotacyr

        Who do you speak for with the “our” in research?

        • Hal801

          Is dakotacryer getting jealous again?

          • dakotacyr

            would you like to clarify you question so it is understandable?

          • Hal801

            Sure. Why are you always nipping at people’s heels like an annoying dog? Get over your jealousy of people and focus on something productive and one day, you too, can be successful.

        • Rick Olson

          I believe I have been completely transparent about this. I was a member of the sponsoring committee of both of the ill-fated initiative measures; and I was an active participant with North Dakotans for Affordable Healthcare as a volunteer. The research I speak of was research that was undertaken by the campaign organization.

  • Rick Olson

    Bottom line is this. If North Dakota’s law specifically forbade corporate-owned pharmacies; then we wouldn’t be having this discussion, right? However, the door got opened a crack back in 1963 when Thrifty White and Osco Drug were allowed to continue to operate in the state, when the pharmacy ownership law was enacted. Osco of course is now CVS Pharmacy, one of the nation’s largest pharmacy chains. By virtue of their status in the current law, Thrifty White and CVS Pharmacy are allowed to operate pharmacies in this state. Yet, the other big box stores such as Costco, Kmart, Target, Walmart, etc. because of the nature of their business models are unable to comply with the ownership requirements of a pharmacy.

    It really is the consumer who suffers the most under the present scenario. Customers who don’t have insurance coverage are forced to pay artificially inflated prices just to keep a few hundred independent pharmacy owners rolling in the dough. In my opinion, folks, that’s the bottom line here.

    Hey, listen, I hail from small town North Dakota — Rugby, N.D. I get the fact that small towns face big time challenges. I get the fact that businesses oftentimes don’t get replaced as the older owners reach retirement age. I get the fact that small towns are shrinking in many cases.

    But answer me this one question: Why should one specific sector of our state’s economy, the pharmacy industry, have all of this government protection from significant competition; while virtually no other sector of the economy in this state has such a high level of protection from competition? I know North Dakota is famous for its protectionist, as Rob would say nanny statist laws.

    I’m sure Joe the Plumber would love to have this same strong level of protection that the pharmacists get, over his competitor Hal the Plumber. Other sectors of the business world do not get the same level of protection against their competitors as the pharmacy owners do.

    If the law forbade anything but family owned grocery stores, our food prices would skyrocket, am I correct? As a result, the mom and pop grocery store owners would be laughing all the way to the bank, right? Since there is open competition in the grocery store business, it’s reflected in the prices that people pay for their groceries. People can shop at any grocery store they would like to.

    Why can’t this sort of competition be allowed in the pharmacy industry?

    But really, it’s time for this law to go.

    • dakotacyr

      Yeah, well Rick check out BCBS. They have a law all to themselves. Where is your outrage?

      • Hal801

        If we had real health care reform, we would be able to purchase health plans offered in other states. I don’t think any business should be shielded from competition by the government.

      • Rick Olson

        But they are not the only health insurer that is licensed to do business in North Dakota. Anyone can obtain coverage from whomever they may choose.

    • Justin

      But the reason they say that this law is upheld is because pharmacies that are owned by pharmacies are more concerned with patient health and outcomes… Because the big box stores don’t care about customers??? Because the pharmacists that work at the big box stores aren’t allowed to give vaccines, medication therapy managment, CLIA waved health testing, counsel patients, etc?? People go to the big box stores because they have the resources to offer alot of extra services, lower prices, and convenient locations. Now thats the American way, but not the North Dakotan way I guess. Also, if you have ever worked in a big box pharmacy you would know that when you are in the pharmacy the pharmacist is in charge.

      • Rick Olson

        There must be a pharmacist in charge of the pharmacy at all times in accordance with most state laws and regulations. If there is only one pharmacist on duty and that person leaves to go to lunch, then the pharmacy counter must close until he or she returns. There is a sign which prominently points this out. In other words, while a pharmacy technician may prepare a prescription, label it and package it; the pharmacist must still sign off on every prescription that is dispensed. All due care and every precaution is always taken to make certain that a patient is getting the correct medication. Whether at a family-owned drugstore or at a big box store pharmacy.

  • Thresherman

    Rule 1# in all things; If it aint broke don’t fix it.
    In today’s world. people rely on their doctor to prescribe medicines, but too often in the impersonal medical field that has been dictated to us by cost saving measures that the government is only going to make worse with Obamacare, physicians are over and counter prescribing medications. I know of several instances where patients were complaining of side effects to their various specialists only to be told that they need to continue their medication. But when they went to their local pharmacist, he/she was horrified at what the patient was being prescribed. In one case A fiend of mine lost 40% of his heart function because of conflicting prescriptions and it wound up killing him. The last thing that we need is a further depersonalization of medical practices in order to save a few bucks at the cost of many lives!

    • ec99

      That presupposes the ability to recognize when it’s “broke”. Something North Dakotans seem incapable of doing.

  • The Truth

    This is an non-issue as we are putting in place people from the Democrat & Republican parties to further our agenda of “the land, resources, minerals” belong to the people & the people should share the profits. Healthcare is giving us the green light. Farms,mining,property taxes,hunting fees to name a few will be shared with the people. This land is our land, we will eliminate property rights. One world is easier to control than many nations – the UN has taught us that. We don’t want your guns as we have drones & FEMA camps. Personal property will in time belong to the people. We are here.

  • http://www.verticalpharmacy.net/petcare.html pet meds n more

    All they want is Money , they don’t care about the people.

    • Rick Olson

      Completely not true. For example, Walmart reinvests millions of dollars each year back into the communities it serves through in-kind donations of food, merchandise and cash. Target reinvests millions of dollars each year into the communities they serve through their program where a percentage of a customer’s purchases made on a customer’s Red Card are donated to the school of their choice. Both companies also have college scholarship programs, which high school students are invited to apply for each year; and also generous tuition reimbursement programs for their employees who are taking college classes related to a business degree.

      • http://www.verticalpharmacy.net/petcare.html pet meds n more

        They have to do it to show income tax exception, its all in the game :)

  • Rick Olson

    It could be entirely possible that when Obamacare is completely implemented, we just might not have anything left to debate. Who knows? We could very well be forced to buy all of our prescriptions directly from some government agency. I’m sure every stakeholder in this debate would sure not want to see that bridge get crossed.

  • Rick Olson

    People can argue with me all they want to. Just because I was involved as a volunteer in both ill-fated initiated measure efforts on this subject does not make me an expert. However, I don’t have a crystal ball, nor am I a magician. I am aware of no new efforts to revisit this issue; or of any group that’s planning on mounting yet another initiative on the subject of the pharmacy ownership law. One can never say never, however. I suspect if a new group does take this up, you’ll hear about it sometime this year.

  • Rick Olson

    Fast forward to May 13, 2013; and I am unaware of any efforts at revisiting this issue at this time. There were no bills introduced in the just-completeld legislative session. However, one can never say never, especially when it has to do with politics. I think another effort could be mounted as far as an initiated measure would be concerned. I still have the text of the measure that was approved for circulation in the 2011-12 timespan. Would have to check with an attorney to make sure it still meets current specifications as to the requirements for legal statutory language.

    The main thing that none of us who were involved in the campaign previously is independently wealthy and could afford to bankroll an entire campaign themselves. I’m an hourly retail worker and I definitely don’t have that kind of money at my fingertips (more like at all).

    I figure any group that would take up this cause again would need at least $50,000 as seed money, just to get the ball rolling again. Ultimately, a credible campaign utilizing radio, television, print, internet and billboard advertising could reach in excess of $5 million. Advertising rates continue to go up each year, even in North Dakota.

    It would take a firm commitment by at least one if not more of the big box companies who would stand to gain more business if they were allowed to operate pharmacies in their stores in North Dakota. Unfortunately, none of the big box store companies is anxious to get into this, out of fear of damage to their respective brand names; if they were to get out in front in support of changing the law. I would say the companies that have been in business in North Dakota for a long time would particularly feel this way.

    Companies like Costco and Walgreens, which don’t have hardly much of an investment in North Dakota (one location each in the entire state) really wouldn’t stand to lose a whole lot if they were to get out in front on this issue. The retailers themselves will need to get in front of the public and tell their customers how this would be a good thing for consumers, and convince the public that this is not simply a means for them to make more money.

    I’d be interested to know what you think. E-mail me at [email protected].

    Thanks,
    Rick Olson

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