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InFocus with pharmacist Mark Aurit

Written by: Matt Bunk

Mark Aurit first decided to study pharmacy after a college buddy told him how important pharmacists were to rural communities. At first, though, Aurit, who grew up in Steele, thought pharmacy must have something to do with farming.

Fast forward 30 years, and Aurit was running one of the most successful independent pharmacies in North Dakota with three locations at the largest supermarkets in Bismarck-Mandan.

(Photo by Matt Bunk) Mark Aurit, owner of three Health Mart Pharmacies in Bismarck and Mandan, says pharmaceutical drugs are more affordable in North Dakota because of the state's pharmacy ownership law.

But Aurit, who was named 2010 pharmacist of the year by a national industry organization, isn’t much for bragging. In fact, he gives the credit to a great staff, his family and, most importantly, God.

“One of the things that has become clear to me over the years is that someone else is in control of my life,” he said. “I believe that completely.”

Aurit attended North Dakota State University, accepted his first job as a pharmacist in Indiana and moved to Bismarck with his wife to work at Osco Drug in the 1980s. But working for a corporate-owned pharmacy soon lost its appeal, and Aurit began looking for a way to start his own business.

One day he walked across the parking lot and asked the manager at Dan’s Supermarket (then it was called Supervalu) if it would be possible to create some space in the grocery store for a pharmacy. It took about five years to plan and organize the arrangement, and he opened his first pharmacy at the former Gateway location in 1989.

Aurit now serves as the chairman of the North Dakota Pharmacists Association, which has worked hard over the years to promote the benefits of independent pharmacies across the state. One of its biggest challenges has been to defend a state law that requires pharmacists to own at least 51 percent of each pharmacy in the state.

Aurit’s three pharmacies employ 48 people. His store at the south Dan’s just won a national award for overall excellence. And he continues to look for new, innovative ways to serve his customers.

“The pharmacy ownership law was brought about because the people of North Dakota wanted the decisions on behalf of patients to be made by pharmacists instead of a corporate board room in Chicago or Massachusetts,” Aurit said. “They wanted the decisions to be made by pharmacists who were in touch with those customers.”

How did you get interested in pharmacy?

I went to college and had an interest in math and science. One morning between classes my roommate invited me over to meet his friend, who was going into pharmacy. And like anybody in college, I was trying to figure out what I wanted to do in life. And in my hometown we used to call pharmacists druggists. So when this friend told me he was going into pharmacy, I wondered how that was related to farming. That’s about what I knew about pharmacy.

Anyway, the point is that after that half-hour visit I walked across campus to change my major – before my next class – because that’s how impressed I was. That visit changed my life.

Why do you think the pharmacy ownership law is important?

In our situation, we came over knowing full well that being friendly, cordial and accessible to customers was how we were going to be successful. Being there when they needed you. We started with basic services, mail outs and deliveries. The chains have those too. But we got to know our customers. We helped them.

And we then decided we had to offer some other things to draw some people, so we got into cholesterol checks, disease-management screenings, blood pressure testing, glucose testing, bone-density screening – not all pharmacies do these things, but we had to do something.

They say you make friends before you make money. We had to win them over to get them to become our customers. There is a lot of trust between someone and their pharmacist, just like your doctor, like it should be.

Getting back to the ownership law, that’s what’s different about North Dakota. There are differences from one store to another. It’s up to the customers to find those out. It’s not all driven by the price. And that’s what opponents are making it out to be. But that’s not what it’s all about.

So, are the prices more affordable at the chain stores?

A national report that was put out in 2010 by the chain drug stores shows that in North Dakota we pay 16.7 percent less for pharmaceutical drugs and services than the national average. So our prices are lower by that much, according to the chains’ own study.

There is more competition in North Dakota because of the ownership law. We have more competition now than there ever would be if we didn’t have the ownership law. And that benefits the customers in North Dakota. The services we provide might be different than another pharmacy across the street. And that’s the kind of competition that is created by the ownership law.

I had a hope and desire – and so do the people we’ve hired – to be more in pharmacy than just counters and pourers. We wanted to provide some services and be involved in the needs of the community. We have gotten into immunizations, specialty compounding and helping people understand their Medicare Part D plans. There is a lot of confusion among senior citizens about their plans, and we help clarify their options.

I’ve noticed a lot of people working behind the counter at pharmacies in Bismarck. I’m used to the chain pharmacies out of state that have maybe two or three people working at any given time, and there’s always a long wait to get someone to help you.

The chain drug stores have good people working for them. They are good companies. But the issue for us was the two reasons I got away from them.

We never had enough help at the chain drug store. We were busier than ever, but there wasn’t anyone there to help you because they didn’t have another pharmacist or another technician.

They watched their payroll so much, and they had to show a profit for their investors.

For us, I made the commitment that when we had the business, we’d have the employees. As we’ve added services, we’ve added employees. To do what we do, we need to have the personnel.

Efforts to repeal the pharmacy ownership law have been defeated several times in the Legislature. But it keeps coming back up. So do you think the battle over the ownership law ever going to end?

It’s been a challenge from day one. It was taken to the United States Supreme Court, and they sent it back and said this is a good law, it’s justifiable. We sometimes go through streaks where it gets brought up every two years in the Legislature, and that’s what’s been happening lately.

I believe pharmacy needs to continually grow and benefit the customers of North Dakota. And when we get sidetracked with defending a law like this, I get to the point where I feel like we’re spending a lot of resources justifying our own existence.

I believe the people should have a say. A lot of my colleagues say “It’s about time. Instead of this coming up in front of the Legislature all the time, let’s turn it over to the people.” And a lot of the legislators say that too.

The challenge is that how do you explain such a complex issue to customers in only a couple of minutes and have them understand what’s going on and the benefits that they could be giving up down the road.

It’s tough. I wish it would go away. But the big chains are after it, and they will continue to be after it.

Your opponents tried again this year to get enough signatures on a petition to put the ownership law on the November ballot. They failed to rally enough support, even though they have the backing of some really large companies. Why do you think that is?

The executive director of our association has been told, “You don’t have enough money and you know in time eventually this is going to happen, so why don’t you just give up?” And he replied, “But these chains don’t know the people of North Dakota. That’s why.”

In 2009, the pharmacists in North Dakota collected over 22,000 signatures in support of the pharmacy ownership law in only six weeks. In 2011, we collected over 14,000 signatures in only 19 days supporting this law. And that’s when the pressure was on. We could get more.

There are a number of people who support our side in North Dakota. They know the pharmacists are honest and trustworthy.

What would happen if the ownership law was repealed?

The pharmacies in Bismarck and urban areas might not be affected, but in the rural areas if they lost a portion of their business to chain pharmacies it could devastate them and force some of them to close. So accessibility in those rural areas will be affected.

A lot of those places are doing extra things. They may be the post office for the community, they may be the café for the community. They’re doing other things to make enough money to stay open already, so to lose a little bit on the prescription end of it they might have to close.

There is no chain drug store that will go into Linton or Steele. They might go into Watford City or Beulah or Bottineau. But the issue is that they will draw from those rural areas.

As I understand it, it’s not all about the direct competition that would be the problem. But many of these chain pharmacies can get favorable contracts with the middlemen, so to speak, between drug manufacturers and retail pharmacies.

A lot of the chain drug stores are the pharmacy benefit managers (PBMs) of the world. It’s like CVS/Caremark – CVS is the pharmacy and Caremark is the PBM.

So it isn’t the business that the chains would take from independent pharmacies – it’s the contracts that they write. The independents will get squeezed and reimbursements will get squeezed. And if the independents lose the margins in the contracts that are being made, that’s the problem.

Chain drug stores are able to go in and get a very good contract because, sometimes, they own the PBM already. With the independents, the PBM comes in and says “Here’s the contract, here’s the rate. Take it or leave it.” And there’s nothing we can do about it.

So there’s more to this discussion than just these $4 prescriptions. That’s just a piece of the puzzle. There are $4 prescriptions at Gateway Pharmacy. There are $4 prescriptions at other independent pharmacies. But that’s all you hear from the side that wants to get rid of the pharmacy ownership law.

As the chain drug stores come in, they will force out some of the independents. And then there goes the competition that is keeping prices low in North Dakota.

So, maybe I should be asking Walmart or somebody else this question, but what’s the problem with owning 49 percent of a pharmacy? What’s so bad about allowing a pharmacist to have 51 percent ownership and the chain owning the other 49 percent, like the law requires?

I tell people that it’s not the pharmacy ownership law that’s keeping Walmart from owning pharmacies in North Dakota. It’s about control. They want total control.

The reason the pharmacy ownership law came about is that they believed the pharmacists treating and taking care of the customers would make decisions, as we have, to provide services that would benefit the customers.

The chain drug stores do it too. They offer some services. But I’ve been there. The services we offered at Osco Drug back in those days were nothing compared to what we offered when Gateway Pharmacy first opened. And the services we offered when we opened are nothing compared to the services that we offer today.

Gateway Pharmacy just won a national award. What’s that all about?

Our south location was named 2012 Pharmacy of the Year by McKessen, the largest pharmaceutical supplier in the United States. They did an evaluation of pharmacies across the nation that were growing to find out what they were doing to cause that growth. It’s a result of the services that we provide to our customers, the purchasing that we do from McKessen, the installation of new technology into our operation, and a number of different things.

So we were nominated – we’ve been nominated the last three years – and our south location got the award this year.

This is an award for one of your stores, but you’ve personally been recognized with a national award, too, right?

This award is a direct result of the outstanding work of the employees we have. Without our employees, Gateway Pharmacy wouldn’t be what it is today. It isn’t Mark who won this award – it’s totally employee-driven.

What was the award you won personally a few years ago?

In 2010, Pharmacy Times, a national pharmacy magazine, got together with a few other technology-driven companies to award a number of pharmacists in the United States for what they’ve done in their communities.

I was nominated in the Entrepreneur of the Year category. There were 10 different categories.

And they also give an overall award to one of the pharmacists who won in those categories – Pharmacist of the Year.

And that was you.

That was me.

The North Dakota Pharmacists Association has done a lot of work to stop the problem of pharmaceutical drug abuse. It has created programs to monitor the use of prescription drugs and to collect unused drugs to keep them out of the wrong hands. But the problem seems to be getting worse. So are you working on anything else to stop that problem?

Those programs have been immensely successful in helping to control the problem – we call it drug-seeking behavior.

But, as Attorney General Wayne Stenehjem has said, the challenge has been on the providers’ end of it – some doctors are doing a fantastic job, but we need to do more to increase participation in the drug monitoring program. The providers need to embrace it more.

Will we need a new law to make that happen?

I’m not going to get into the medical-needs argument or step on anybody’s toes. But what we’re able to do as pharmacists is up to a point. We can refuse to fill a prescription, but they can go across the street or go to another state to get it filled.

And that’s one of the problems. We’re working on taking this statewide program and making it national, so a person can’t just go to Moorhead to get a prescription filled.

-Matt Bunk is publisher of the Great Plains Examiner.

 

 

 

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Comments

  1. Prescriptions are NOT more affordable in North Dakota, at least when comparing Bismarck versus Minneapolis. My mom moved back last year and her 4 scripts combined cost almost $200 more here than they did out there. She’s called around to other pharmacies and they were all comparable with each other locally. A good way to compare is to call and compare cash prices at CVS here versus CVS out there. Same company but much higher here.

  2. I too have shopped prescription costs around ND and other states for various family members. From what I can tell, it has more to do with “regional pricing” than it has to do with a pharmacy ownership law. First, comparing Bismarck to Minneapolis isn’t an apples to apples comparison. For starters, CVS has multiple regions around the country and they all vary. It is kind of like going to the Wal-Mart South store in Bismarck and then up to the North store…the prices at the South store are typically higher than the north store. Why the hell is that…because the North and South stores have different pricing based on the market place it serves. Comparing apples to apples and “cash prices” ND seems to come out on top this is even based on the National Association of Chain Drug stores annual report which they publish! ND cash prices are roughly 17% lower than the national average.

    • Groups can find studies that support either side of any argument, what I can say is from experience… drugs are higher here than Minneapolis. My mom called numerous pharmacies in Bismarck after moving back and all were around the same price of each other – all HIGHER than she was paying.

  3. I guess I was speaking from experience as well hence my first sentence. Some drugs are more expensive and some are cheaper regardless where you are located. My grandpa got racked over the coals in Sioux Falls, SD. Cost him almost $300 more at Wal-Mart. Got him in the door for a $4 script even though his Medicare copay is only $2 n then took him for a ride on his other drugs. You will have a tough time changing my mind that ND’s pharmacy ownership law is a horrible law. We haven’t even talked about other aspects of the law just price, which is a mute point as there are examples that benefit both sides when it comes to price.

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