the PUTTblog

“Cold comfort for change
did you exchange
a walk on part in the war
for a lead role in a cage”
--David Gilmour

Recent activity suggests the market is waking up to the need for PBM reform NOW.

Damning articles in the New York Times and the Wall Street Journal - the latter covering an explosive new 3 Axis report detailing the degree to which PBMs profit through their mail order pharmacy at the expense of employee plan sponsors - have decision makers beginning to wonder if they’ve been misled by their PBMs...

While it was difficult to watch Congress take PBM reform provisions off the table during the last round of government funding negotiations, we now have a unique opportunity to address a glaring omission from Congress’ proposed PBM reforms in Congress: ensuring federal legislation creates a fair and equitable business environment for pharmacies free from PBM greed and financial retaliation...

Independent pharmacy owners have had enough.

Guest Post | Dawn Butterfield, RPh

There’s a lot of talk lately about disrupting the traditional pharmacy model, but it’s not pharmacy that needs disrupting. If any aspect of pharmacy is ripe for disruption, it’s the prescription drug pricing model...

Guest Post | Antonio Minniti, RPh FACA

As incoming President of the New Jersey Pharmacists Association. I view this period in our profession’s history as critically important. We’ve reached an inflection point and if we are to advance the profession of pharmacy, we must rise to meet this moment with bold ideas and actions...

Dr. Stephanie Smith Cooney and the Express Scripts Leaders behind the IndependentRx Initiative:

Express Scripts announced it would seek input from independent pharmacies to improve our mutual working relationship. We respectfully submit the following recommendations, on behalf of our members. These recommendations are primarily organized around the business of pharmacy, understanding that, as a business, no pharmacy can provide quality patient care if it cannot generate sufficient revenue to conduct its daily operations...

PUTT’s Sponsor Spotlight focuses on independent-pharmacy friendly businesses and organizations who support PUTT’s mission to end systemic PBM overreach and abuse. PUTT sponsors donate financial and/or in-kind resources, including special offers for PUTT members.

Datascan Pharmacy Software | https://datascanpharmacy.com/

Every year the pharmacy benefit managers (“PBMs”) your pharmacy contracts with conducts a reconciliation of certain pharmacy claims. The PBM may send you a notice directly if you carry direct contracts or may direct your PSAO to conduct the reconciliation and subsequent recoupment. These reconciliations include network-wide effective rates for Brands (BERs), Generics (GERs) and Dispensing Fees (DFERs). The calculations are measured at the aggregate level across all member pharmacies, to determine the overall network-wide liability to allocate among all member pharmacies in the network...

A fascinating, if somewhat imperfect, move this month by Blue Shield of California is sparking interesting questions about the future of the “Big PBM” business model and where it might go from here.

Late last week Wisconsin’s Circuit Court, Branch II, joined the California Court of Appeals in finding OptumRx’s forced arbitration contract clause “unconscionable.” The judgment is a victory worthy of its own fireworks, but it surely also came as a huge relief to Wisconsin pharmacies, whose fellow pharmacies in the neighboring state of Illinois received a very different ruling from their 5th District Appellate Court.

OPINION: Do you know who else your lobbyist is working for?

Davis City Pharmacy was originally founded in 1892. Located about half an hour’s drive west of Ft. Worth in Weatherford, the founders of this Texas treasure surely never imagined a world in which 21st century robber barons would have it in for their little community pharmacy - and could possibly permanently close the doors of the 131-year-old small business...

.. How the other pharmacy came to use her NPI is still a mystery (not exactly NPI theft or spoofing, no money paid to that submitting pharmacy, no actual evidence of a crime), but even more mysterious is why CVS Caremark hasn’t reinstated Leah’s pharmacy’s access to billing after she fulfilled every request they made as a condition of reinstatement?...

Florida Governor Ron DeSantis’ January 12th announcement calling for tough new anti-PBM abuse laws was a surprise to many - but not the dozens of small business pharmacy owners who’ve spent years petitioning lawmakers and advocating for change.

PUTT member Ben Levene, who is also a board member of Florida Small Business Pharmacies Aligned for Reform (SPAR), shared some of his thoughts behind Gov. DeSantis seemingly “sudden” decision to pursue legislation that would curtail PBM profiteering...

Happy Holidays! Is it 2023 yet?

Kidding! 2022 was such a good year for PBM reform, we’ll be a bit sad to say goodbye.

We spent much of this year focused on PBM reform education, with PUTT Executive Director Monique Whitney participating on panels at the annual Community Oncology Alliance conference in March and the Partnership to Advance Cardiovascular Health (PACH) in November, in addition to talking to members of the media whenever possible.

Like many of you, we participated in the spring and summer FTC hearings, urging the commissioners to investigate PBMs over practices that disrupt patient care and drive so many pharmacy owners to the brink of - and sometimes beyond - permanently closing. And when the FTC voted unanimously to proceed with the investigative study, that sound we collectively heard in June was the implosion of PCMA’s “shift the blame” strategy (and possibly a rolling head or two).

PBM reform is a united effort, and PUTT was proud to strengthen relationships with other organizations leading the way...

Now that midterm elections are mostly complete, we’re grateful for the reprieve from political ads, debates, texts and robocalls. While midterms are generally not as flashy as their presidential counterparts, they can still have a big impact on proposed legislation.

What Happened This Year:

Redistricting created thousands of new legislative districts that produced new names on many ballots, leaving pharmacy owners across the country hoping Congress continues the push for transparency (and karma) on drug pricing and PBM reform.

Local pharmacies proved to be important touchpoints of healthcare access for patients...

A local pharmacist recently alerted us to a dramatic increase in seemingly predatory east coast area DEA inspections. These inspections appear laser-focused on administrative processes, levying hefty penalties for reasonably minor clerical missteps.

The pharmacist* noted, “Our pharmacy has never had a red flag or been cited by a regulatory agency, yet the agent seemed intent on finding any possible means to assess an exorbitant fine, no matter how irrelevant...

“You should expect a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.”  – TRICARE Beneficiary Brochure

An apt description of how most of us already feel, “Lost Care and Broken Promises” is actually how Military.com first labeled the travesty of TRICARE decisions that left thousands of active military and retired veterans without access to local medical care at nearby military bases in 2020. 

Just 2 years later, TRICARE - or should we say Express Scripts, because we all know whose job it is to ensure network adequacy - is at it again, this time cutting 15,000 pharmacies from the TRICARE network effective October 24, 2022. Predictably, Express Scripts has the Department of Defense doing its dirty work, making the announcement through official channels and citing “cost savings” as its rationale, even as Express Scripts is wasting no time steering active and retired military to ESI-owned pharmacies and charging a tidy administration fee in the process.

Dear PCMA,

We need to talk. It’s not good news.

First, we feel we should thank you. Remarkably, your clients have somehow united the U.S. in a way usually reserved for terrorist attacks and tragic natural disasters.

Also, we’re impressed at your latest PR offensive. How fascinating to watch the public’s overwhelmingly negative reaction to your recently published opinion pieces defending PBM business practices and claims of value generation.

But it’s time for some tough love. Even your recently-released white paper assessing the (economic) value of pharmacy benefits management is stretching to salvage what may soon become an unsalvageable public image. At this rate you’ll soon join the ranks of the tobacco industry and other notorious industry charlatans who profiteered at the expense of people’s health and safety. You don’t really want that to be your legacy, do you?