To illustrate his point, he holds up a receipt. Filling a prescription of indomethacin, a generic anti-inflammatory drug, cost him $118.88. But the reimbursement from the patient's pharmacy benefit manager, or PBM, was 54 cents below that.
Unlike big chain stores, he said, University Pharmacy - and other small pharmacies like it - lack the negotiating power to get better contracts with the PBMs.
"Because they say this is how much we're going to pay, that's it. There's nothing we can do," Rasmuson said.
And, unlike the big chain stores, they're less able to make up for that lost money somewhere else.
Under antitrust laws, it's illegal for pharmacies to band together and negotiate their contracts. But having the ability to do so "would allow us as a group to say, 'All right, PBM, you've got to stop doing this,' " Rasmuson said.
It's a fight independent pharmacies are taking to Congress. The Community Pharmacy Fairness Act of 2007, they say, would level the playing field, giving them the same leverage large chains enjoy when negotiating Medicare Part D and other contracts with insurers.
But the Pharmaceutical Care Management Association, a PBM professional group, claims the sweeping antitrust legislation is a bad deal for consumers.
"What this legislation would do is grant independent pharmacies a license to collude, raising drug prices without adding value for consumers or payers," said association spokesman Charles Cote.
Some studies have shown that pharmacists are adjusting well to market conditions and are successfully sustaining their businesses, he said, which "goes against any need for collective-bargaining legislation."
The same pharmacists also have market tools available to them, such as smaller joint-purchasing groups, which can help them grow their market share, lower their costs and compete more effectively, he said.
Retooling the federal antitrust laws could also be expensive, Cote added.
The Congressional Budget Office, in its analysis of the legislation, found that exemptions for pharmacists could increase federal costs by $640 million over the next 10 years and that increased drug costs to health plans, employers and consumers could result in higher deductibles and co-payments.
The Federal Trade Commission agrees. Pharmacists, however, say the only thing the legislation would increase is competition - and the likelihood they will be able to stay in business.
Dean Jolley, a pharmacist and owner of Jolley's Compounding Pharmacy, said he is losing money on everything he's filling.
"The Medicare contract says, 'You accept this price or else,' " he said. "I could refuse the contract, but because I've got a little bit of a soft heart, I want to help the elderly Medicare patients."
But Reid Barker, executive director of the Utah Pharmacists Association, wonders, "How long can he stay in business trying to make it up somewhere else?"
lrosetta@sltrib.com
