In this episode, ee’ll give you latest updates on the PBM and pharmacy reimbursement.





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What You Will Learn:

  • The latest in California on Medi-Cal reimbursements and clawbacks
  • Latest on Community Pharmacy Advocacy Group
  • Updates and Unconsciousness and goings-on on the Federal level
  • PBM mayhem in Ohio and elsewhere

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Michelle Sherman, president of MichRX pharmacist consulting services, and your host for the conscious pharmacist podcast. The podcast this week is called now what the circus rolls on. We’ll give you latest updates on the PBM and pharmacy reimbursement. Crazy. So where do we begin this week? There’s been a lot of things going on. Um, let’s start with California. Some updates on, um, the, the coalition group, the Community Pharmacy Advocacy group is the Californians for access to life saving medicine. What’s going on with the coalition? Um, there was a call for coalition members with the law firm law firm who parent Lundy and Bookman to discuss, um, the latest legal strategy for the um, court case where they have sued the department of Healthcare Services for the medical NADACreimbursement, the formula and the egregious clawbacks. Um, that, thank goodness on hold now until the court case. Um, on August 30th. So that was, um, very interesting.

Um, the California Pharmacists Association has signed on, um, two the dir letter, um, that has gone to senator chuck grossly. Um, you can get a copy of the letter, um, at the end of this podcast, um, on, on the website. Um, but it’s the, the letter that has been signed by multiple stakeholders across the country to senator grossly and ranking member Wyden, um, asking them for Congress to take steps to eliminate Dir fees since the administration and CMS refused to do so. Even though they well aware that Dir fee skyrocketed by 45000%, that just wasn’t enough for them to act. So this letter has been sent to um, Senator Grassley and hopefully, um, the finance committee can get the ball rolling to once and for all just eliminate these dir fees. They’re all literally killing and strangling pharmacies all over the place. I’m also in California as a result.

AB 315, which is the bill I’m trying to put oversight on these PBMs that the department of managed care has created a joint task force on PBM reporting. And he said to begin to work on Wednesday, July 31st in Sacramento, the task force will be meeting once a month until the end of the year. And we’ll be discussing what information, if any, is related to pharmaceutical healthcare service plans or the contracted pharmacy benefit managers should report to the Department of managed care. Some of the things that they’ll be looking for that are related to pharmaceutical costs or wholesale acquisition costs for pharmaceuticals, rebates obtained by the healthcare service plan or the pharmacy benefit manager from pharmaceutical manufacturers payments to network pharmacies, exclusivity arrangements between health case service plans or contract pharmacy benefit managers within with pharmaceutical manufacturers. And then inflammation already reported by health plans related to the cost of covered prescription drugs as required by Senate bill 17, um, from 2017.

So I think the task force has got it to work cut out for them. Um, for all of us, we know what’s going on. So hopefully the department of managed health care and the insurance commissioner can like look at these and come up with solutions for um, pharmacies in California that could then be replicated across the country. The, the California Insurance Commissioner, you know, the, the National Association of Insurance Commissioners is very interested in PBM issue issues and has formed a subcommittee to specifically address PBM issues. All these things that I’m going over in this, in this podcast today, oh, all that kind of obvious, but let’s face it, this circus has been running for too long and they are too many cooks. And we know this broth has been spoiled way, way long ago. It has reached the stage of critical point way. It’s literally this broth is poisoning everybody, poisoning every pharmacy, every pharmacist, and ultimately poisoning every patient, not only in California, but across the country.

It’s really high time that we stopped having all these fractionated committees and task forces and everything. It’s pretty clear what the problem is and it shouldn’t be such a difficult fix. Come on people. Let’s get conscious. We need to be conscious. We need to fix this nonsense. So the insurance commissioners are looking at, at PBMs pharmacies, there’s a provided PBM complaint hotline in California. I’m sure that hotline will blow up, um, that, that hotline is one eight, seven, seven, five, two five, one, two, nine, five. Uh, these are things that you can do. Every pharmacy is so busy and so wrapped up in the egregious reimbursement dealing with all these things and submitting forms to show how egregious this is instead of being able to take care of our patients, which is why we there. So we need to get rid of this. So let’s move out of California and to look at like federal updates on what’s happening in Washington.

So, um, the president has announced, um, an effort trying to tie to mystic drug prices to international drug prices. Um, to me, none of that even makes any sense at all. Like what drugs are gonna make the same prices they are in India, where we have an HIV drug that costs the pharmacy $3,500. Are you going to suddenly make it like $3? Because that’s the pricing. Africa. India doesn’t make any sense, but more to come on that. Um, the, the Trump administration’s final rule on direct to consumer drug price trends, um, parents, he was deemed unconstitutional by the US District Court on July 8th. Um, so that thing is pretty much dead in the water. Um, again, that doesn’t surprise me. Um, what are drug companies going to put for the price of the drug? I mean, whatever price pops up on the TV screen is who, who’s that price for?

After the PBM has received rebates, the pharmacies paid thousands of dollars for the drug, good negative reimbursements, the patient pays what they paid, what price is going to actually be on this direct to consumer drug price transparency thing. The whole thing seems completely ridiculous. Um, the administration or also pull the rebate reform regulation. That is, everybody knows it was, um, advice that we get rid of drug rebates, but I guess the, the lobby in Washington is way too great. Um, these PBMs are a force to be reckoned with when, when all these PBMs or on the ticket type of Wall Street we all have as pharmacists and all our patients were just commodities on the ticket type of Wall Street where they’re making billions and billions of dollars of profit. Suddenly the rebate reform regulation just boom went away. Some other, um, updates from con Congress, um, law makers are seeking information regarding the FDA ability to regulate the drug support supply.

Especially since many of our drugs are manufactured in plants out of the country in India, lots of generics and in other parts of the world and there isn’t, as we’ve talked about in previous episodes, there’s no oversight on these. Um, these drug facilities. Um, there has committee on energy and Commerce has advanced 10 bills related to healthcare. The most pertinent to, um, pharmacy and drug pricing is HR two, two, nine six, which is the Fair Drug Pricing Act of 2019. Um, let’s see, with this goes, it’s a bipartisan bill. But as we all know, with what’s going on in Congress, nothing ever gets done again. It’s act come on. People, let’s get conscious when people are looking to fix healthcare. Maybe it’s high time, they asked like actual healthcare providers, physicians, pharmacists, how do we fix the system? In my opinion, it’s not complicated. It’s not hard to fix.

We need to get rid of all these money grabbing middlemen, PBMs and everything in the middle so we can fix healthcare and make it fair for everybody. And most of all make patients be able to get access to the, um, their drugs. Another big thing this week was, um, the article that came out in the Columbus dispatch again at the end of this, um, podcast on the website is a link to, to the entire article. It was titled Metal Man poised to grow back money. They’ve already paid to Ohio pharmacists. This is again Optum and CVS Caremark doing these massive clawbacks to pharmacists and pharmacies, um, throughout the state of Ohio. No big deal. Right? So before we end this podcast, I just want to end on the note of, um, you know, these PBMs implementing these egregious fees. We’ve talked a lot about dir fees, but what about all these other rubbish nonsense, any audit fees and clawbacks that they about to implement and pull back from pharmacies, things like B e our fees, these brained, um, effective rates. Like what rubbish is that? Um, and the dfe ores, the dispensing fee fees, I mean, and GE or fees on generics, they are making up such rubbish. That is so untransparent that the goal literally is to drive every pharmacy across the country, out of business and patients will die. So this is Michelle Sherman signing off. Until next time, remember, be conscious we can make a difference. We cannot stop advocating right now and remember be the change.