In this episode we will discuss the importance of advocacy, standing up and having your voice heard, as a pharmacist and healthcare provider taking care of the patients in your community.
“BE THE CHANGE”Gandhi
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What You Will Learn:
- Why YOUR voice matters
- What’s happening this minute in California with Medi-Cal Fee for service reimbursement cuts and clawbacks
- What Pharmacists and the California Pharmacists Association are doing about it
- Why EVERY pharmacist should support your state pharmacy association as well as the American Pharmacists Association
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This week the episode is called the time to stand up and deliver is now as opposed president of the Orange County Pharmacist Association in interacting with pharmacists, especially independent pharmacists and pharmacy owners. Over the years, I’ve come to recognize a glaring theme over this time. The theme is that independent pharmacists or foe pharmacy owners who feel like they are stranded on a desert island and are all alone in something is wrong with policies, pharmacy laws, third party payers and other mandates. Many of the pharmacists, so the same thing. I’m only one voice. My voice doesn’t matter, nobody listens and many think there’s nothing that can be done. Well, you’re all dead wrong. Every single voice matters and counts a profession our patients demand it today. We have to stand up and deliver and I don’t have to make it clear to any of you out there who are listening today.
Those conscious pharmacist, out there those conscious pharmacy owners. We are facing a tsunami of epic proportions of legislation, cutbacks, all kinds of things that are threatening not only our pharmacies in our livelihood, but our patients’ lives, their lives matter. I’m going to be talking a lot about, um, things going on in California in this episode today. Um, things they can make a difference. Why not more pharmacists, pharmacy owners joining your local associations like Cphi and organization like Cphi, the California Pharmacists Association goes to bet for us as pharmacists and pharmacy owners every single day. I’m going to recap a couple of bills that have happened in the last about seven, eight years that have changed the face of pharmacy in California in 20. Um, SB 1195 was passed, which was an audit bill that really put the Kabash on these PBMs and insurance companies in the predatory audit practices and laid out guidelines of parameters they have to follow when they come and audit pharmacies.
The big great bill that was passed was in 2013 was SB before 93 which was the pharmacist provider bill, which expanded the scope of pharmacy practice and actually recognize pharmacist as healthcare providers. This was extraordinary and it’s really changing the way we practice pharmacy in California and hopefully in the not too distant future in the nation as a whole. In 2014 ab one one one four was passed. This authorized the department of healthcare services to establish a system for pharmacists to bill for services provided to medical patients. So for those of you who don’t know, medical is the Medicaid program in the state of California. So this was huge. This is a mechanism where we as pharmacists can now get paid for some of these expanded services that we can provide. I keep telling clients, I keep telling pharmacists our role is as a healthcare provider, it’s not as prescription filler.
The days of licking, sticking and filling or over for us as pharmacists. In 2015 ab six 27 was passed as well by the California legislature and this was the Mech transparency bill to allow for transparency in the Mac and the very opaque pricing it goes on with these PBMs. The, the law that’s currently going through the legislature right now is a very important one and talked about it on previous podcasts as well. That is SB159 , that’s the prep and pep bill. We pharmacist in California, we’ll be able to provide prep and pip. This bill is currently moving through the legislature and last week the entire California Senate voted 34 to 1, um, to, to pass this bill. So the next step for this is to go to the California assembly. So there’s still a lot of work to be done. We need to target our assembly members in the state of California because this is a very, very important bill as well.
The biggest end doozy of the mall that the California Pharmacists Association working that is working with right now and is critically important and again is a pharmacist. And if you’re in California you need to stand up and deliver. And this is the Natech pricing that’s due to go into effect what the pricing’s gone into effect. But the clawback back to April, 2017 is due to start on May 31st and that will be catastrophic not only for pharmacies in California, but for over 3 million medical recipients with chronic conditions that will lose access to lifesaving medicines. So just for those of you who just need a brush up NADAC is what is NADAC? So this is a drug pricing mechanism that came, that came up, which is the national average drug acquisition cost with the Centers for Medicare and Medicaid services. CMS randomly surveys pharmacies to determine Natick. So NADAC estimates the national average drug invoice price paid by independent and retail chain pharmacies.
It excludes specialty in mail order pharmacies and does not reflect rebates, prices, concessions and offer invoice discounts. So they randomly surveyed these pharmacies. So out of approximately 67,000 years pharmacies, they select 2,500 pharmacies per month and approximately 450 to 600 pharmacies voluntarily respond with actual drug price data. So already this is starts to be an issue when they approach these pharmacies and they have to provide all the invoices every month. It’s a voluntary basis. And I don’t know about you and for any of these legislatures out there who might be listening, I don’t know if you’ve ever actually stepped foot in a pharmacy and see, see what goes on. But the pharmacist, the people in the pharmacy don’t have time to do this. But anyway, they’re looking at 450 to 600 pharmacies responding with this, this national average of the pricing. So what kind of opportunities are they with NADAC transparency.
I mean, will they be drug transparency, um, looking at market segments such as the Medicaid programs and volume, the native pricing because of the changes in the way they’re looking at this and reimbursement to pharmacies. The pharmacies with the high volume might benefit from this because the more prescriptions that they feel, the more money they can make. So we’re looking at pharmacies is fulfillment centers and back to the licking, sticking and filling instead of the patient care, actually providing care to patients and looking at outcomes. So some of the limitations, some of them are voluntary reporting. So actually the amount of invoices and things that they receiving across the country have very minimal competitive. So 450 to 600 pharmacies out of 67,000 really skews the data as to what the national average drug cost is. As far as reported drugs. It does not include all drugs and there are that are being reported.
So how do they determine the NADAC pricing on this? And then the reference basing NADAC may not be equal to the actual acquisition costs given to a pharmacy. And there is key when our pharmacy is purchasing a drug at a cost, the least we can expect is to get a reimbursement that is adequate and that does not constitute a negative margin from some cockamamie formula that somebody somewhere has concocted and not looked at. Reality. Our pharmacies need to repay reimbursed in a positive manner according to the actual acquisition cost that that pharmacy paid for the drug. I mean it only makes sense who’s making up all these things? Who’s coming up with these cockamamie things? I did an analysis, um, on, on some of um, HIV drug reimbursement, um, with regards to this NADAC pricing. And I was really, it was mortifying actually. So in California, it’s come back to this and what’s going on with medical medical hired the firm Mercer to do an analysis of this drug pricing and drug costs and their analysis turned out to be very skewed and inaccurate because one of the things they did was throughout all the specialty drugs, drugs like HIV drugs, uh, and they skewed the data in effect that pharmacies that provide mental health, drugs and HIV medications to their patients are really going to be hit in a very negative impact.
When I did my analysis and I just picked it up, five HIV medications and looked at NADAC reimbursement, the reimbursement that the pharmacy would get from Medicare is way below the cost that the pharmacy paid for the drug. Now that’s unacceptable when authorities and agencies are coming up with drug pricing models, they should really interact with the pharmacist, the pharmacist, the pharmacy owners who are actually providing care to patient. Because when we look at HIV patients, the provision of the drug is one, one thing, one key, one part of it, but the actual care that is provided to these patients is extraordinary. The work involved. Pharmacists should be getting paid to provide this care to patients, not penalized with negative margins on the drugs that they’re they been reimbursed. So a group of individuals in California together with the California Pharmacists Association came up with um, a group called Californians for access to life saving medicine.
So community pharmacists throughout California have United to form this group, the Californians for access to life saving medicine. It’s a coalition of community pharmacy, um, advocacy group. And the purpose of this group, the Community Pharmacy Advocacy group is to help save the community pharmacy and preserved patients rights to come to our practices. Community pharmacies have already experienced this NADAC Bang in reductions to the reimbursement, but the clawback will be catastrophic. About 3 million medically fragile beneficiary stand to lose the excess to the essential life saving medicines, especially people with HIV, mental illness, cancer and those in long term facilities. The new state rules or bankrupt many community pharmacies effectively eliminating this important healthcare safety net for California’s most vulnerable populations. The State can and must do better. The state of California’s practice to discriminate against patients and pharmacies is why community pharmacists statewide are fighting back and against the state and standing up for medical patients and the right to life saving medicines and for all community pharmacies.
In addition, the CPAG group is taking on PBMs who continuously negative to negatively impact, uh, independent community pharmacies. So the plane is, the first priority is to stop the department of Healthcare services from implementing these claw backs on May 31st that the next thing, once we can stop this claw backs, is to challenge the flawed methodology that led to the department of Healthcare services to adopt these PR, this proposal in the first place, especially for specialty medicines. We need to protect, uh, patients with mental health issues are patients with cancer are patients with HIV. And we have to stand up and deliver. Let’s get conscious people. Let’s be conscious about what’s going on around us. We have to stand up. We have to deliver today. Yell, scream, and protect our pharmacies and protect our patient’s rights in our patients. Access to two medications. You can go on the CPH A, it’s cpha.com/rx-fairness and look at their website.
These are great public relations video there. All this information is also in the notes of this podcast as well. CPHA and I’m the President of the California Pharmacists Association, Doctor Ken Thai is have been going around the state doing these um, community, um, open forums. And there is going to be one here in Orange County on Thursday, June 6th at Chapman University, Rinker campus health sciences campus between six and 8:00 PM. So you can go onto the website and signup and Rsvp to come to this, this community forum to hear more about this in what you can do as pharmacists and pharmacy owners to be involved. Of course they have a campaign, um, two and a call to action to raise money so that we can fight legally against it. Uh, the goal is to raise one point $5 million and to date they have or have raised $766,000.242. So I urge you, stand up, deliver, be conscious, and yes, join your associations. Join your local associations. Your voice matters. Be conscious you patients’ lives depend on it. I look forward to you tuning into next time and remember be the change.