In this episode, we will recap some major events that affect pharmacy coming out of Washington DC and beyond.
“BE THE CHANGE”Gandhi
What You Will Learn:
- Update on CMS Rule
- CMS Drug Pricing Transparency
- Protected classes
- 340B Hospitals
- HIV Drug pricing
- Oklahoma Patient Right To Pharmacy Choice Bill
About MichRx Pharmacist Consulting Services:
MichRx Pharmacist Consulting Services is a healthcare and training company providing state of the art Medication Therapy Management (MTM) , Chronic Care Management (CCM) and telehealth consulting with a focus on HIV Care, resulting in improved patient outcomes and increased profits for our clients.
We create these results by focusing on the role of the pharmacist as a key healthcare provider, saving patients lives, improving outcomes and enhancing patient quality of life. The care provided is across all stakeholders such as pharmacists, physicians, third party payors, PBM’s, drug manufacturers, AIDS Service Organizations and NGO’s and clinics.
For more information about MichRx Pharmacist Consulting Services, Inc. visit MichRxConsulting.com
About Ubuntu Pharmacist Care Program:
The Ubuntu Pharmacist Care Program is a unique advanced practice MTM (Medication Therapy Management) CCM (Chronic Care Management)and DSM (Disease State Management) pharmacist consultation program of MichRx Pharmacist Consulting Services,Inc.
Problems are identified by the HIV Pharmacist specialist and a customized proprietary care plan is developed and communicated to the patient as well as physicians, family members, case managers and other entities necessary for improved patient care and optimal outcomes
About Ubuntu Care Academy: The Ubuntu Care Academy is our online training portal designed to provide online training and education for you and your TEAM.
Resources & Links
- Patient Protection and Affordable Care Act 2020
- Fact Sheet-Final HHS Notice of Benefit and Payment Parameters for 2020
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Today’s episode, which is called The Washington update. What happened on the way to the Rodeo? We’ve had several things coming out of Washington, DC, and CMS over the past few weeks. So I thought I’d do just a quick recap on today’s episode.
What have we seen lately? Well, one of the big things, in the last few weeks was that CMS released the final rule for 2024 for Medicare part d. And just as a quick note, at the bottom of the transcript of this episode or links to resources of the final rule, the Medicare later, if you want to go more in depth and read everything.
So one of the biggest bugaboos out of this final rule was the fact that CMS did not address the DIR fees. That is the thorn in the side, the bugaboo, the greatest pain source for many, many pharmacies, especially those pharmacies that provides specialty type medications to their patients, HIV patients, cancer patients across the board.
These pharmacies are getting dinged by these PBMs for these DIR fees that in my opinion are a modern day form of complete highway robbery. You remember way back in the day in the wild west when the stage coach who is, you know, going across the cross the desert with all the money and all the people in it and these highway main came riding up with the horses, guns drawn Bandanas across the faces, robbing the people. Well these PBMs are modern day form of that. Instead of writing up on the stage coach, they go just literally don’t pay the pharmacies for these reasons, for Dir fees that are completely untransparent, completely opaque that nobody knows why.
In my opinion, the specialty pharmacies, people providing care to HIV patients provide care that is extraordinary. We provide direct patient care that impacts patient outcomes every single day so that these rules and reasons for these clawbacks and these DIR fees are completely unknown and have no place in the specialty arena or quite frankly any place at all. These are fees that have risen 45000% yeah, I know you’re all conscious and you’re listening and that is right. 45000% and the money just goes back into the coffers of the PBM’s. It is a disgrace. It is the biggest travesty in our system right now. And CMS did not address that. There’s still hope because all the associations and, agencies or are going to Congress to get them to put a stop to this. But it is absolutely catastrophic that CMS did not address this DIR fee rule.
They had over 4,000 comments regarding the administration’s proposal to move pharmacy price concessions and including Dir to the point of sale and they did not do anything. So hopefully that will change. The CMS rule requires prescription drug pricing transparency in direct to consumer advertising. So CMS finalized the rule requiring direct to consumer prescription drug TV Ads to include the wholesale or list cost of the products directly or indirectly paper, either Medicare or Medicaid. This is a joke really when you’re going to put prices on TV.
First of all my opinion, my personal opinion in my conscious pharmacist view of what’s been going on is why do we have direct to consumer advertising of drugs on TV? The relationship between the patient and the physician and maybe even the pharmacist in looking at their medical condition and what drug is best to treat their condition is a sacred thing and shouldn’t be advertised on TV.
What patient ever has gone to the pharmacy, to the doctor and saying, I saw this amazing aired on TV for this new chemotherapy drug I wanted like really?
So, first of all, that’s a topic for another episode. This whole thing about TV advertising and wasting money advertising drugs on TV, but now putting the pricing on, my question is like what price? The price of wood. When patients ask me, what is the price of my drug? My answer is always, it depends on who you ask.
The price, the pharmacy paid for it, the price they’re getting reimbursed, the price, the PBM, the whole. And you all know the whole structure of drug pricing is like a joke. So what drug, what price are they really going to put on TV? It’s just a ruse to show patients because it’s nothing that they ever going to do.
And plus its talks about any drug cost over $35 for a 30 day supply. What drug out day doesn’t cost more than that in the arena that I work in, in HIV, it’s a joke. The price of the drugs. The other thing that came out of this was, you know, the 340 B pricing and 340 B hospitals and entities really got a reprieve from the district court in DC who struck down the administrations rule cutting back on three 340 B pricing.
The president directed, Alex Azar or to work on a Florida drug import plane to come up with a plan to import drugs from Canada and they’re like, well when I looked at this overall, we already have imported drugs. When we look at where all our generics are produced, a lot of them overseas in India in actually in facilities that are not regulated on a regular basis by the FDA.
It is horrifying. So why wouldn’t we import drugs from Mexico and Canada? This, this ruse that, oh, they’re not safe is a joke because our own FDA is allowing generics to be manufactured in other countries that aren’t with facilities that aren’t even being regulated. Cms did crack down on spread pricing and issued regulatory guidance to support state efforts to monitor and audit Medicaid and children’s health insurance program. The chip program managed care planes to identify spread pricing practices by pharmacy benefit managers.
SOther things that happened in Congress was the house oversight and reform committee examined HIV drug prices and they had the CEO of Gilead on the hot seat. By holding this hearing to examine the growth of HIV drug prices and the emphasis, the impact on patient access was huge. Why are these drug prices going so high? We need to ask ourselves that. We need to be conscious, we need to be conscious as to what is going on the Congress, CMS, all these agencies need to be conscious and asked the people who are providing the k what is going on and how do we stop it? Stop listening to the lobby groups, the PBMS, the health insurance companies. Go to the source, go to the pharmacist, go to the pharmacies, go to the patients. And then the energy and Commerce subcommittee held a hearing on the supply chain.
It was a hearing on deconstructing the drug supply chain, the two-panel hearing. So testimony from pharmaceutical manufacturers, PBMs, insurers, and other industry representatives and familiar debates occurred with pharmaceutical representatives, siding, PBM actions and rebate structures for high drug prices.
Listen, people, let’s get conscious. The too many cooks, you know that adage. Too many cooks spoil the broth. Will they? Too many cooks in too many middlemen in this whole drug pricing thing. We need doctors to prescribe drugs. We need patients to have access to two drugs. We need insurance cover companies to cover those drugs.
These PBMs in these middlemen need to go away and stop raping and pillaging the f the pharmacies, the patients and everybody in between and making money hand over fists on the lives of other of our patients. One quick point at the point that I wanted to mention, which was a great one, was what happened in Oklahoma.
In the last couple of weeks though, go Oklahoma in Oklahoma, the governor signed HB 26 32 which is the patient’s right to pharmacy choice act. That is huge. Our patients are getting strangled and not having the ability to go and choose the pharmacy that they want to go to. Every willing pharmacy should be able to participate in any claim that they choose without penalty and the patient should go and have the choice of the pharmacy that they want to go to.
The patient’s right to pharmacy choice to act establishes minim and uniform access to a provider in standards and prohibitions on restrictions of a patient’s right to choose a pharmacy provider. And PBMs are not allowed to use the mail-order pharmacies to comply with the accessibility standards. So what that means is patients in Oklahoma can choose any pharmacy, the trusted independent community pharmacy that they may have been dealing with for many, many years to be able to go and get their prescriptions filled.
Makes total sense to me. So this is our red pup on the Washington update and what happened on the way to the Rodeo. Remember, be conscious, you can do it and be the change.