Washington State Sen. Linda Evans Parlette is a pharmacist. "When I talk to people, I always say I'm wearing five different hatshealth care consumer, health care provider, business owner, legislator and taxpayer," she says.
At least 36 others across the country join Parlette as pharmacist-legislators, the American Pharmaceutical Association reports. There's also a pharmacist-governor, Illinois Republican George Ryan. It's a profession that's in the spotlight these days because of the politics surrounding prescription drug costs.
Pharmacists are popular as lawmakers because average people relate to them, says John Davis, director of State Legislative and Regulatory Affairs at the National Community Pharmacists Association . "Independent drug store owners, who are often pharmacists, and small business owners are very popular with the public at large. People understand they represent Main Street, not Wall Street," he says.
Pharmacists have an expert perspective in the drug debate in statehouses, and in some cases have been vocal in shaping legislation. Some pharmacists also own or run drug stores, so they're familiar with the business side of the pharmaceutical industry.
Parlette, a Republican, is regarded by national groups as one of the most active pharmacist-legislators in the country on prescription drugs. It's a title she doesn't dispute, though she says she's surprised national officials are aware of her work.
"I am very involved in the issue, but I'm cautious. States have done a variety of things (to create prescription drug subsidy programs)... but because of our state budget, I feel now is not the time to experiment," she says.
Washington legislators debated several pharmaceutical bills last session. It was widely reported that manufacturers helped defeat one of the more sweeping bills that would have required the state's okay before a drug was prescribed for Medicaid patients, a move that could have affected industry profits. Parlette, who voted against the bill, says the industry is not the villain it's often portrayed as being.
"I want to preserve the private sector, and I'm trying to build working relationships (with the industry and Democratic colleagues). You can't do that if you're punching people in the face," Parlette says.
Parlette's counterparts across the country don't necessarily agree with her take on the industry.
"Drug prices are too high. I've thought that for 30 years in state government. The public has been totally ripped off with drug prices, when you can go across the border to Canada or Mexico" and buy medicines at half the cost, says Georgia Rep. Bobby Parham, a retired pharmacist and Democrat.
Parham says the current debate over rising prescription drug costs reminds him of conversations that took place nearly 20 years ago. "(Back then), the drug companies promised politicians drug costs would only increase about the same as the cost of living, so Congress backed off on passing legislation. It was a big charade," he says.
Maine House Minority leader Joseph Bruno, a Republican who runs a chain of 13 drug stores, agrees the industry has not been completely upfront with the public.
"A study came out recently that showed 80 percent of the drugs produced between 1995 to 2000 were me-too drugs (which are modified or identical versions of existing medicines). That's unfortunate, when manufacturers say, Look at all the good things we've done,'" Bruno says.
States looking to cut back on drug costs shouldn't go after pharmacists either, says Bruno. "A lot of people think manufacturers are making a lot of money, but pharmacists (certainly) aren't. It's a shame that states are looking to cut back on pharmacy dispensing fees, and are forcing mail order in an attempt to save money. People have to realize the economic impact of actions like that," he says.
Illinois Sen. Frank Watson, also a Republican, agrees mail order will hurt his business, which goes by the unassuming name Watson's Drug Store. He says pharmaceutical manufacturers put too much into marketingdriving up the cost of drugsand that drug prices in the U.S. are out of whack with what people in other countries are paying.
"What's not right is you go somewhere else like Canada and drugs are 20 to 30 percent less (than they are here). I don't think people in this country and retail pharmacists are being treated fairly," Watson says.
State lawmakers are split on solutions to this very-public problem. Several touted existing state programs that seem to be working well.
Maine's Bruno says he's pleased with the state's efforts in crafting programs like Healthy Maine Prescriptions, which saves people on average 25 percent off retail drug prices. But he also has concerns about letting more people into the program in future years. "While Maine has done a good job (in cost containment)... the next fiscal year our drug budget will be around $250 million. That's a pretty big increase to absorb," Bruno says.
Illinois' Watson says the Legislature may try to increase the use of lower-cost generic medications or craft a preferred drug list similar to one being used in Michigan, while Washington State's Parlette says the federal government needs to revisit a 12-year-old federal budget law that set up what she sees as an unfair pricing system for pharmaceuticals. "People are getting cheaper drugs (at places like) community health centers, and that's hurting the private sector," she says.
And Georgia's Parham, who's served in the Legislature for nearly 30 years, says he's not quite sure what he'll do next year. "My head is so bloody from running up against the issue, I don't know (what measures I'll introduce), but I'm gonna try something. As long as I'm still knowledgeable about the issue, I'll fight the battle," he says.