iTunes | Stitcher | Google Play | Spotify


What you will learn

  • What is SB524 
  • Patient Steering is Bad for Patient Health and Pharmacy Access
  • Patient Steering destroys Independent Pharmacies
  • Patient Steering creates pharmacy deserts

Links & Resources

Subscribe & Review on iTunes

Are you subscribed to our podcast yet? Want to get bonus episodes? Be sure to subscribe so you get notified of any new episode that comes out.
Click here to subscribe on iTunes.


This is Michelle Sherman. President of Michelle promises, the culture services podcast, and the show for pharmacists providers who have answered the call to practice conscious pharmacist. Now here’s your host internationally [inaudible] speaker. Well today’s episode, episode three services, every conscious pharmacists and needs action from all of you. The title of today’s episode is schooled stuffed patients. Here. We can stop it now, and we need to support

California Senate bill five to four, introduced into the California legislature by rep representative Senator Skinner. This is a very important bill because it’s going to stop the absolutely egregious business practice of these mega behemoths like CVS, Walgreens, these behemoths, that own PBMs, that own pharmacies, that own speciality pharmacies and even own health systems like Aetna from forcing patients to utilize their pharmacies and steering them away from the pharmacies that the patient knows likes and trusts or taking care of their health. The California pharmacists association is you know, a sponsor of this bill assembly member. Evan low is chair of the assembly committee on business professions. And next week on July 6th, the committee’s meeting to review this bill. As you can imagine, the lobbying from these behemoths and healthcare PBMs against the spill is, is enormous. So we need each and every single one of you, if you’re a pharmacist, a patient or a citizen of the state of California, you owe it to yourself, you owe it to your family and you owe it to your community.

And if your pharmacist, you owe it to your employees, you owe it to yourself. And most of all, you owe it to your patients to contact your assembly member. There’s a link in the resources here of where you can click on there to contact your assembly member and contact Evan low as well to let them know how important this bill is and for it to pass an amended through the committee meeting on July 6th. Before I read the letter from CPHI to assembly member Lowe there’s some, you know, information on this steering bill, that’s also in the resources that’s CPHI provided, you know, for what is this bill and why is it important? So patients steering is a practice employed by pharmacy benefit managers or health plan insurer owned pharmacies that channels prescriptions to their own wholly owned retail mail order or specialty pharmacies in this practice.

Patients are often given a 30 to 90 day notice that if they do not switch to the PBMs or plan insurance pharmacy, they will either be required to pay higher out of pocket share of cost, or that the prescription will not be filled unless the patient fills the prescription at one of their pharmacies or mail order programs. This type of disruption in care is anti-consumer and has negative consequences for patients as it requires them to break existing relationships, to continue to receive life-saving medication. Pharmacists are trusted members of a patient’s care team. Patient steering serves no legitimate healthcare purpose and only serves to increase PBM and health plan insurer pro profits. The intent of this legislation is that it would prohibit patient steering and would allow California patients to choose their own pharmacies to ensure they receive quality care and are not steer to increase profit margins for PBMs.

While the initial purpose of PBMs was to negotiate contracts on behalf of their health plan clients, these enterprises have evolved into ones in which there is an inherent conflict of interest. And, and I’m sorry, where there is an inherent conflict of interest and lack of transparency in how they operate PBMs or squarely in the middle of negotiating prices, demanding rebates and driving formulators formulary decisions with all respect to prescribe to a prescription drug program. This inherent self-dealing is further emphasized when PBM steer their patients to their company owned mail order community and specialty pharmacies, all of which calls to question their ability to fairly represent the employers, providers, and patients. They serve 2017 Senate business proficients and economic development committee background paper on PBMs. They’ve noted. There are significantly significant potentials for conflicts in the PBM ecosystem because of the asymmetry of pricing information and each of PBMs business and PBMs often operate their own mail order, retail and specialty pharmacies establishing a climate, right for self-dealing and unfair advantages, California prohibits the potential for these types of conflicts of interest in practice of medicine.

But unfortunately those consumer protections do not apply to the practice of pharmacy, which in my opinion is completely catastrophic. When we look at overall health and everything, and we see the value as pharmacists and as healthcare providers that we bring, this type of practice is absolutely catastrophic and myself and every single one of you on this call today, see that happening every day to your patients in your pharmacies and in the communities in where you live a federal appeals court has received a proposed class action by HIV patients alleging their PBMs like CVS Caremark discriminated against them. So for those of you who’ve been following me for, for a long time, know that I’m a huge advocate of NTP BM practices. And consumer watchdog has been successful in several attempts to accuse these behemoths, CVS Caremark, Anthem blue cross Cigna for discriminating against people living with HIV V by forcing them away from the HIV pharmacies, the local pharmacists that know them, that the patients know like and trust and forcing them to go to mail order pharmacies are owned by the insurance company.

Consumer watchdog was successful in, in suing all these companies. And this also includes United healthcare and Optum RX from discriminating against people living with HIV. Why would we need to individually Sue every single one of these PBMs legislation like SP 5, 2, 4, or get rid of this egregious practice. I see that in the LGBTQ community, people trying to access the HIV meds, being forced to specialty pharmacies and not getting the care that a, they used to be, that they deserve and see that every Californian should be able to get and choose exactly which pharmacy and pharmacists they want to take care of them. It is huge another area within the LGBTQ community that I see this egregious thing happening every single day is in the provision of prep. So many of my patients that I see and prescribe prep for, or forced to go to mail order pharmacies that are owned by the PBM or forced to go to CVS pharmacy, or sometimes I can’t even get it at a local CVS pharmacy. They have to get it through CVS Caremark through some mail order convolution, which I don’t have to tell anybody, listening to this podcast today that that invariably has catastrophic consequences. So for the LGBTQ community, this patient steering is absolutely catastrophic.

The other thing patients steering does is that it creates pharmacy deserts. If we, if we look at rural areas throughout California, independent pharmacies cannot compete with what this patient steering and these behemoths mandate. They forcing their patients to go to a CVS or Walgreens or no big box store. And pharmacies are closing one after the other, after the other, creating pharmacy deserts in our rural areas that negatively not only impact the community and the business community in those areas, but negatively impact patient care and patient access to medications. So people who love their local pharmacy come in, have a relationship with the pharmacist and are getting exceptional care from the pharmacy are now forced to go either to mail order or to some big box store where they are sent into the abreast of non care. The third thing that is catastrophic about patient steering is so many of these Medicare part D plans pick preferred pharmacies, which all of these behemoths of course, pharmacies like CVS, who are the PBMs for a lot of these health plans that force patients to go to their big box stores.

It just needs to stop patient steering and allow patients to utilize whatever pharmacy they want. And to tell you the truth, these PBMs they’re opaque and transparent methods have got to be brought to a complete halt and patients need to have choice of where they want to go to and pharmacies that they want to use to take care of their their care. So in the resources of this, this of this show today, or the letter to, to assembly member Lowe the bill and text the letter that I’ll read that CPHI wrote to assembly member Lowe, and then a list of some of the podcasts that we’ve done on the conscious pharmacist podcast, like uncovering the PBM veil of deceit, a conversation with a reporter Lucas Sullivan, 21st highway robbery, essentially highway robbery. How much is that drug?

A great interview that I had with an extraordinary patient advocate, mom, Loretta boosting the temperatures rising, be brave and stop PBMs, and then PBMs unprepared for prep or total in the resources. And you can have access to that too. I urge you all, if you’re a pharmacist or a citizen of the state, you know, the state of California to contact your assembly members and your senators and local senators and have them vote yes. On, on is B 54. This, this bill needs to get to governor Newsome’s desk, the way it’s written. It’s a very short bill, not complicated, and this needs to be implemented right away. I will read you know the letter from CPHI to you now, before we end the show, just to give you an idea of everything and some more reinforcement of what a, this is very time sensitive and how critical this in is it so it’s to the honorable Evan, low chair assembly committee on business and professions, the legislative office building room 3 79 Sacramento, California.

The subject is SB 54 Skinner PBMs, patient steering, position support and sponsor. Dear assembly member Lowe. The California Pharmacists Association is pleased to sponsor SB five, four, and respect respectfully requests. Your a vote when it’s heard in the committee on April 5th, well, it’s actually going to be hurting the committee, this coming Tuesday, July 6th, but this bill is intended to limit the practise known as patient steering, which is used by some health plans insurers, and they contracted pharmacy benefit managers to steer patients from the established in network pharmacy to pharmacy there’s owned by an insurer or PBM is B 54 intends to limit this practice only for established clinical or logistical reasons rather than financial benefit to the plan insurer or the agents. The California pharmacists association was founded in 1869 is the largest state association representing pharmacists. CPHN represents pharmacists technicians and student pharmacists from all practice settings.

These practice settings include community pharmacy, both independent owners and employees working in chain, drug stores, hospitals, and health systems, and specialty practices such as compounding managed care and long-term care patients steering’s occurs when PBM moves a patient patient’s prescriptions to a different pharmacy without their consent. And the new pharmacy happens to be owned by the PBM, either a physical location or a mail order. Pharmacy patients are then given a choice of filling the covered prescriptions at the new pharmacy or pay full price out of pocket at the existing in network pharmacy. The practice of patient steering is becoming increasingly problematic for patients who are losing their right to receive pharmacy services at locations, convenient to them. And where there have been an established relationship with the pharmacist while this practice happens primarily in the independent settings, it is increasingly happening in smaller chain settings who are not owned by PBMs.

For example, CVS, one of the largest chain pharmacies in the country owns one of the largest PBMs in the country, which is Caremark. It is not an accident that Kmart CVS owned record profits in 2020, according to a recent CNBC report revenues rose 35% to $67.06 billion from $64.81 billion a year prior. It also outpaced the 66.6 billion expected by analysts. The national community pharmacists association conducted a survey, which noted that a majority of community pharmacies have lost patients in the last six months due to unfair patients steering and CVS health is most often the culprit while opponents of this bill, that patients are not forced to use specific pharmacies, recent court actions taken by patients directly Canada claim. Most notably the ninth circuit court of appeals overturned a local decision ordering holding their five. John DOE HIV patients could pursue a discrimination claim against CVS Caremark for requiring HIV patients to obtain their medications by mail order or drop shipment to a CVS store.

This decision is an important victory for HIV patients who sought to vindicate their healthcare rights and obtain their life-sustaining medications in a medically appropriate managed manner. So Jerry Flanagan of consumer watchdog, it is important to note that the opponents argue that this bill is an overreach and is preempted by federal law that violates the objective of achieving national uniformity in self-insured benefit design. They fail to acknowledge that the us Supreme court’s recent unanimous decision clears the way for state regulation of pharmacy benefit managers and everybody listening is aware of the Rutledge versus the PCMs in brief, in brief submitted by Emmy curiae. They noticed in addition to extracting revenue from pharmacies plans and PBMs have started leveraging the market power to capture the share of the retail pharmacy market PBMs have accomplished this by prohibiting their network pharmacies from distributing specialty drugs, which are typically higher cost drugs that require special handling, but simultaneously expanding the designation of specialty drugs to include non specialty medications that have been on the market for a long time.

Pbms didn’t require patients to use the mail order. Pharmacies owned by PBMs. CMS has expressed concern that PBMs are using pharmacy contracts in a way that inappropriate limits the specialty drugs to certain pharmacies in ways that have nothing to do with patient health, CMS Medicaid program contract. That was the quote while CPHI believes there’s a role for pharmacy benefit managers. The problem lies with the inherent conflict of interest and a PBM is steering the patient to their own pharmacies is at that point that we must question where the decisions are made for the benefit of the patient, or simply to increase profit margins. For these reasons, we specifically request your eight vote on SB 1, 5, 2, 4. Should you have any questions about this bill, please contact me. And this is Michelle Reavis, executive vice president of government relations for the California pharmacists association. So as you can see, this bill is absolutely essential and the opponents of this bill literally have no leg to stand on, but we as Californians each one of our voices matter, we have to open our mouth contact assembly members.

I have put on Twitter CPN seeing the resources CPHI has a link for all your Californians to contact your assembly members. I sent mine, I tweeted it out. Our assembly member in Dana point is Lori Davis. And I sent my letter to her. I mean, when we talk about pharmacy dialysis, let’s just talk about my little city of Dana point, California, right in the metropolis of orange county. There is not one single independent pharmacy in Dana point, California, not one we have to CVS or Rite aid and a save on, which is in an Albertson store. There’s not one single independent pharmacy in Dana point, California. So just imagine this is in the metropolis of orange county, what’s going on in rural California catastrophic. So I know this, this was quite a long show today, but I urge you go on to all these resources, contact Evan, low contact with your assembly member. If you’re a California resident and let’s get [inaudible] on to Gavin Newsom’s desk re signature to stop this really criminal practice of patients steering, thank you for listening to the conscious pharmacist podcast. And remember your voice matters. You are the change.