On Jan. 13, a story was published about the closing of The Rumford Drug Store owned by John Bartash. As a former owner of an independent pharmacy, I know the difficulty and anguish that John had in making his decision.

As most independent pharmacists do, John gave personalized service. He knew his patients and their families. He was available for emergency service. I am sure there were many times he gave a discount to someone who had fallen on hard times.

In 1969, there were 270 pharmacies in Maine. There were one or two CVS stores and the LaVerdiere’s chain of 50 or 60 stores. The remaining 200-plus pharmacies were owned by local pharmacists. The average prescription price was around $10. Patients paid cash for their prescriptions. Some patients had insurance and were able to submit their receipts for reimbursement. Pharmacists made a gross margin of about 40 to 45 percent above their cost of the medication. Our average net profit after expenses was a reasonable 4 or 5 percent.

Today there are approximately 250 pharmacies in Maine. About 57 are independently owned. The remaining 200 are owned by large companies.

In the past two years, 13 pharmacies have closed their doors. The retail pharmacy industry in Maine employs almost 15,000 people and pays about $118 million in state taxes every year.

In 1970, the Medicaid program became the first major insurance that pharmacists could bill directly. Under this plan, pharmacists were paid $2.70 above the cost of the medication for each prescription. The current fee paid for each prescription is now $3.35, an increase of only 24 percent in 35 years.

As the years passed, more insurance companies began paying directly for prescriptions. Most patients have insurance and pay only a co-payment for each prescription. Many patients were unaware that new medications were becoming substantially more expensive because they saw the price only as this co-payment.

Currently, insurance companies and the government set reimbursement rates. They do not negotiate these rates. They dictate them.

Independent and chain pharmacies are told to either accept the terms or do not participate in the contract.

The average gross margin has declined to 20 percent or less and the net profit has declined to about 1 percent.

Drug companies now advertise medications on television, in magazines and in other media. They claim this helps to educate patients. However, they neglect to give information comparing the medication to older, less expensive medications that may be as effective. They do not have to indicate a relative cost comparison to similar medications. It is rare for a new medication to become available at less than $1 per dose. In most cases, the cost is $2 to $3 or more per dose.

In 1970, prescriptions accounted for approximately 2 to 4 percent of each health care dollar.

They now account for upwards of 15 percent of the health care dollar.

In order to attempt to control this rising cost, insurance companies and the government continue to squeeze dollars from pharmacies. We are not to blame for the high costs. The profit makers are the drug manufacturers.

In every other industrialized country, the government negotiates the cost of prescription medications with the drug manufacturers. Only in the United States does the government allow the drug companies to charge what they want to. We had the opportunity to provide real drug-price relief with the introduction of the Medicare drug plan. The current administration chose to show its loyalty to manufacturers by not including the negotiation of price in its proposal.

One method of supposedly decreasing costs is the use of mail order plans. Many plans now make mail order mandatory or provide lower co-payments as an incentive to mail away. Among the problems with mail order is the lack of personal contact with a pharmacist to answer questions and provide information on the prescription. Mail order companies do provide toll-free telephone numbers, but patients are reluctant to call. They are often put on hold for long periods of time. Many are not happy talking with and confiding in someone they don’t know.

Some medications are sensitive to temperature changes. We are currently seeing extremely cold temperatures. Liquid medications such as insulin or eye drops can freeze and crystallize as they thaw.

Using multiple pharmacies prevents any pharmacist from being able to check for drug interactions and from knowing multiple diseases affecting a patient.

Economically, mail order sends money out of the Maine economy. Every dollar sent out of state means less tax revenue for our state. This will lead to Maine residents losing their jobs. As pharmacies lose revenue, there is less money available for them to help support their communities with contributions to local arts organizations, local schools and other local events.

To keep retail pharmacy a viable industry, drugs costs must be reduced where the most profit is being made – the drug manufacturers.

Stanley L. Tetenman, a registered pharmacist, lives in Poland. He owned Scott Pharmacy in Lewiston from 1969 to 1998 and was a member of the Board of Pharmacy for six years.