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Prescription for Transparency

California Business Journal – August 25, 2020 Pharmacy Benefit Managers (PBMs) were created to be the middleman and negotiate drug prices. Working with the health care providers, pharmacies and the pharmaceutical companies determine reimbursements and what they’d charge the pharmacies. The problem is that without regulation, the PBMs have bad business practices. The fix is on the way. Magnified by the economic and health care impacts of the novel coronavirus, the Florida legislature is honing in on regulations for a long-veiled middleman in the chain of rising prescription drug pricing. Intended to serve as a beneficial consumer go-between for pharmacies and health insurance companies to provide cost analysis, Pharmacy Benefit Managers (PBMs) have instead transformed into a profit-driven model favoring, among other things, large pharmacy chains over payer and patient pocketbooks. The classic Big Guy vs. Little Guy yarn was threatening to spin out-of-cost-control until organized advocacy groups and legislative …

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Pharmacy Deserts Are on the Horizon if PBMs Continue to Underpay Medicaid Reimbursements

Grit Daily – August 17, 2020 Independent pharmacies are being forced into bankruptcy due to underpayment for Medicaid reimbursements, which are managed by Pharmacy Benefit Managers (PBMs.) These small pharmacies are deciding to either turn away Medicaid patients or to close their practices, creating pharmacy deserts in poor neighborhoods. A survey of 123 independent pharmacies in Florida found that over 60% “may be forced to discontinue taking Medicaid patients if changes are not made to the program that currently requires neighborhood pharmacies to sell most prescription drugs at a loss.” 93% declared having to turn away at least one Medicaid patient per month because dispensing to them would cause the pharmacy to lose money. There are ripple effects to having pharmacies take repeated financial losses in order to provide patients with necessary medications. Many of the customers who were refused Medicaid drug fulfillment ended up having an adverse health effect. This puts a …

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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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Pharmacy Benefit Managers Are the Real Reason Behind Skyrocketing Drug Prices

Grit Daily – April 30, 2020 Why are drug costs so high in America? If you ask Bernie Sanders, he will tell you that it’s due to the greed of the pharmaceutical industry. If you remember when “pharma bro” Martin Shkreli, former CEO of Turing Pharmaceuticals, made the price of the life saving drug Daraprim 5,000% higher overnight, you may agree with this assessment. But, there is more to the story, and it has to do with Pharmacy Benefit Managers (PBM’s). Within the healthcare industry, there are pharmaceutical manufacturers, pharmacists, insurance companies, and Managed Care Organizations (MCO) for Medicaid, but there is one more player that few outside of the industry discuss—the pharmacy benefit manager, or PBM. A PBM’s original role was to negotiate lower drug costs between drug manufacturers and insurance companies, with the goal of passing those savings on to the consumer. Instead, the rise of PBMs, who have amassed great …

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Neighborhood pharmacies struggle to stay open due to PBM restrictions

Tampa Bay News 10, July 9, 2020 So far, at least 8 independent Tampa Bay pharmacies have shut down because of challenges with Pharmacy Benefit Managers (PBM). As COVID-19 cases skyrocket in Florida, we’ve talked a lot about what doctors’ offices are doing, but what about pharmacies? Whether you realize it or not, your pharmacy options are becoming more limited but not because of COVID, but from something called Pharmacy Benefit Managers, or PBMs. It’s a big enough problem that one Tampa lawmaker is working to pass a bill to protect independent pharmacies and demand transparency. “Our motto here at Bill’s Prescription is to treat people like family,” pharmacist and owner of Bill’s Prescription John Basil Noriega said. Noriega’s family opened their own pharmacy back in 1956 in Brandon, at a time when the city population was just 2,000 people. “We have a lot of life long customers. We consider …

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Opinion: Your local pharmacy is at risk of going away

83 Degrees, July 14, 2020 Tampa summers are typically the “slow season” for local pharmacies. But during COVID-19, nothing is typical nor should be taken for granted. The coronavirus pandemic coined the term “essential workers” and your local pharmacy is obviously essential, right? Pharmacies are always open, even in a public health crisis. Of course, they’re open, why wouldn’t they be open? Pharmacies are always there when people need them. But what happens if your local pharmacy can’t be there for you? Opinion column by Pharmacist Alex HerwigA recent survey among Florida independent pharmacies shed light on a little-known, but critical issue. Intended to examine the viability of Florida’s Medicaid managed care model on local pharmacies, the survey instead uncovered disturbing statistics: 61 percent of community pharmacies are being forced to reconsider participating in the Medicaid system. Another 41 percent are considering whether to close their business altogether. The problem …

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Okeechobee pharmacist demands ‘special session on drug pricing reform’

NBC WPTV 5, February 13, 2020 A popular pharmacist is calling for prescription drug pricing reform in Florida after a newly released report shows small pharmacies are having a difficult time competing with corporate giants and some in our region fear they will have to close their doors. For decades JoAnne White has chosen Okeechobee Discount Drugs for the savings and the people. “The prescriptions are just ridiculous,” said White. “If [this drugstore] goes out of business and I have to go to one of these others – I don’t know what I’ll have to do.” On Thursday, White and other customers stood in the drugstore – not for prescriptions – but to draw attention to the need for reform. “It is imperative that we demand a special session on drug pricing reform,” said Steven Nelson, a registered pharmacist, and Okeechobee Discount Drugs owner. “Lawmakers in Tallahassee continue to walk …

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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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Pharmacy benefit managers are making decisions that harm my Tallahassee patients | Opinion

Tallahassee Democrat, January 11, 2020 There are people with no medical training and no obligation to patients who have the power to override medical decisions made by patients and their physicians. These people are pharmacy benefit managers — called PBMs. These pharmaceutical middlemen claim their role is to negotiate savings on prescriptions for patients. But their scope extends dangerously beyond business negotiations. They can decide whether patients can receive the treatments recommended by their physicians. These are businessmen, not medical professionals — and they are altering the care patients receive. Many of my patients in Tallahassee have had their health jeopardized by these dangerous practices. Delays from PBMs recently left one of my patients without oral chemotherapy medication for six weeks. Those delays have real consequences and, due to this interruption, my patient must now drive from Chattahoochee to my office three times a week for a more intensive IV treatment. Continue Reading on the Tallahassee Democrat

How pharmacy benefit managers dictate care | Column

Tampa Bay Times by: Dr. Michael Diaz December 26, 2019 When patients are battling a life-threatening disease like cancer, they want a skilled and qualified physician advising them about treatment plans and the best way to beat this insidious disease. But that’s not always what they get. Sometimes, predatory middlemen called pharmacy benefit managers insert themselves into the decision-making process between the doctor and patient. As just one example, our team was working with a patient who had metastatic kidney cancer. Both the medical oncologist and urologic surgeon determined that the patient was not a candidate for surgery because of the patient’s other health conditions and the extremely low probability of a cure or any benefit. His doctors instead recommended a specific standard medication approved by the Food and Drug Administration for this condition. However, when the prescription was submitted, the PBM – who is not a physician – denied …

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