patient steering

What “Big Insurance” Doesn’t Want You to Know About Community Pharmacies Patients and pharmacists share a special relationship, often stretching back generations. Even the frightening spike in drug costs can’t erode the feeling of trust and care we feel when walking into our neighborhood pharmacy. But “neighborhood pharmacies” as we know them are rapidly disappearing, victims of large corporate pharmacy benefit manager (PBM) “middlemen” that now dominate the drug industry. If you’ve never heard of PBMs, you’re not alone. The largest PBMs own or are owned by, well-known health insurers (UnitedHealth; CVS Health, CIGNA) — and all own or have affiliate relationships with their own pharmacies. If you’re a die-hard CVS or Walgreens shopper, you may not be familiar with the neighborhood (or community) pharmacy — but you should be. Community pharmacies are independently-owned pharmacies that provide the same services as national retail pharmacies but cost the same, if not less, than the “big” pharmacies. Think of independent pharmacies like …

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Why are neighborhood pharmacies disappearing? Ask the Noriega Family.

Lissette Campos – July 15, 2020 I arrived at Bill’s Prescription Center in Brandon an hour early, half expecting to find a quiet operation with the owner prepping for our television interview. After all, how busy can they be? I’m here because neighborhood pharmacies like this one, close to 100 in the Tampa Bay area alone, are in danger of closing. Common sense would have you believe the disappearing act is caused by a lack of customers. Three minutes in, I realized there’s nothing common sense about this situation. A steady stream of customers didn’t just walk in for their medicines, they arrived for, what felt like, a family reunion! “Hi Basil? How are you?” asked one woman, smiling under her face mask. “How’s your Dad?” asked a gentleman. “I love this place!” another customer whispered my way. “…been my pharmacy for years.” – the microphone in my hand inspiring …

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Shane Abbott: Rural communities most affected by predatory PBM middlemen

Florida Politics, March 8, 2020 Over the past year, I’ve made the drive from my small pharmacy in DeFuniak Springs to Tallahassee dozens of times to advocate for one priority: PBM reform. Unless significant reforms are made to Florida’s broken PBM system, patients will be put at risk due to lack of access to prescription drugs — especially those who live in smaller, more rural communities like mine. Local pharmacies have been under attack for some time by predatory middlemen called pharmacy benefit managers or PBMs. The three largest PBMs control 85% of the prescription drug market and, together, these operators are driving neighborhood pharmacies out of business. This is not a situation like Blockbuster and Netflix where local pharmacists simply aren’t adapting to the new market and changing times. Our prices are competitive and the services we offer to patients are oftentimes more desirable than our competitors. We’re closing …

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Brittany Jackson: Broken PBM system puts patient access at risk

Florida Politics,  January 16, 2020 Four years after I was diagnosed with heart failure in 2013, I had a heart attack. My heart was failing, and my only option was a heart transplant. I was fortunate when a donor heart became available, and I have lived with my new heart since July 2018. Having a healthy organ is a true gift, and I view it as such. I am diligent about doing whatever I need to in order to take care of this gift that saved my life, including spending the rest of my life taking transplant medications so my body doesn’t reject this gift. I am certainly grateful that this medication exists, but I’m not happy about what I have to do in order to receive it. This could be so much easier, if not for the intervention of middlemen known as pharmacy benefits managers, or PBMs. They have …

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House and Senate in sync on PBM reform

Florida Politics, January 13, 2020 Will this be the year that Floridians at long last receive some financial relief from prescription drug costs? Physicians, pharmacists, and patients certainly hope so. One of the major issues heading into the 2020 Legislative Session is the role Pharmacy Benefit Managers (PBMs) play in setting prescription drug prices. PBM detractors often cast them as middlemen behind the rise of prescription prices. To that end, lawmakers have passed legislation eroding their profession in recent years. According to the Pharmaceutical Care Management Association (PCMA), a PBM trade association, their role is a little more nuanced. In their estimation, pharmacists deserve a share of the blame for rising prescription prices. At the core of the 2020 battle is a bill by Rep. Jackie Toledo and co-sponsor Rep. Randy Fine (HB 961) that would further limit PBMs’ ability to negotiate prices and rebates. The lawmakers held a news conference at a Tampa pharmacy last year pitching …

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Florida lawmaker’s bill to reduce prescription costs gains national support

Fox 13 News December 17, 2019 A Florida lawmaker is pushing to make your next trip to the pharmacy easier and less expensive under a proposed bill to cut price gouging for drugs and give you more choice on where to get prescriptions filled. Loretta Boesing will never forget the day something went wrong with her son’s medication. “My son, Wesley had a liver transplant at the age of 2. And after they shipped his medications in only a bag on a 102-degree day, he ended up going into liver transplant rejection,” said Boesing. The medicine was not at the right temperature, which could destroy its effectiveness, she said. Eight years later, Boesing’s family is still forced to use mail-order pharmacies. Known as PBMs, pharmacy benefit managers act as the middlemen between drugmakers and corporate-owned pharmacies. The challenges presented by PBMs are felt nationwide.  Continue Reading

Florida Pharmacists Sounding the Alarm, Accuse PBMs of ‘Hijacking’ Health Care Spending

Florida Daily October 30, 2019 With Americans continuing to be impacted by the spiraling costs of health care, some neighborhood pharmacists across Florida have an idea to do something about the growing problem. Pharmacists across Florida have banded together to push for reforms to add more transparency to Pharmacy Benefit Managers (PBMs) which, the pharmacists insist, are driving up costs. PBMs originally came into existence to be a helpful “middle man” between pharmaceutical companies, insurers and local pharmacies. They were initially designed to control costs and negotiate savings which would allow pharmacists to spend more time advising customers, making deliveries when needed and working out payment arrangements for struggling patients. But in recent years, the PBM process has grown into a full-blown, multi-billion-dollar industry. As certain PBMs got bigger, they began gobbling up the smaller ones. Currently, a handful of PBMs control the overwhelming majority of the market nationwide. Many of these …

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