pbms

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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Independent Pharmacists Stress Personal Touch In An Industry Dominated By Chains

The Town Crier, February 28, 2020 On Wednesday, Feb. 19, the advocacy group Small Business Pharmacies Aligned for Reform (SPAR) hosted a press conference at My Community Pharmacy in Wellington regarding pharmacy benefit managers (PBMs) and their effect on pharmaceutical pricing. Speakers at the event outlined what they called “shady” practices in the PBM industry that aims to put independent pharmacies, such as My Community Pharmacy, out of business. The pharmacy is located at 2615 S. State Road 7 near Whole Food Market in Wellington, owned by Johnny Meier, one of the speakers at the event. In attendance with Meier were other local, independent pharmacists, customers and Wellington Mayor Anne Gerwig. Several speakers addressed the problems involving pharmacy benefit managers — middlemen who are supposed to negotiate savings for customers — and complained that they do not, in practice, benefit either the pharmacists or their customers. The pharmacists addressed several bills …

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Data Proves PBM Industry Maximized Profit At Patient Expense

Cision Newswire, June 15, 2020 Physicians and Patient Advocates Call for More State Disclosures The Alliance for Transparent and Affordable Prescriptions (ATAP) reacted today to a report issued by the Texas Department of Insurance (TDI) showing the financial activity of the pharmacy benefit manager (PBM) industry in the Lone Star State. Texas law requires that PBMs annually report to the Insurance Commissioner aggregate data on rebates. “The Texas rebate report is unambiguous. The PBM industry has been generating significant profits while patients struggle to afford the cost of prescription drugs,” stated ATAP’s President Dr. Robert Levin. “Since 2016, through a complex rebate and price concession, the PBM industry in Texas pocketed more than $350 million in revenue, while passing a mere $16 million in savings to enrollees.” The data as reported by the PBM industry and compiled by the TDI may be found here:  https://www.tdi.texas.gov/reports/documents/drug-price-transparency-PBMs.pdf “PBMs owe it to patients to pass along savings to them,” Dr. Levin continued. “Now that Texas is …

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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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Alex Andrade tackles Rx drug legislation, but does it go far enough?

The Floridian, February 21, 2020 Florida state Rep. Alex Andrade (R) is advocating for a bill that would create more transparency around the prescription drugs that Floridians buy. But some groups are questioning whether it goes far enough. This week, Rep. Andrade presented his bill about prescription drugs to the House Health and Human Services Committee. The bill, HB 7045, addresses a number of different aspects including creating advanced notice requirements for drug price increases and requiring new reporting standards for certain entities in the prescription drug market. However, critics point out that the bill does not fix one issue that many consider is the biggest issue facing prescription drug supply chains, which is pharmacy benefit managers or PBMs. In a recent study by a group called 3 Axis Advisors, it was reported that PBMs – which are middlemen that set the prices of many prescription drugs – are using a process called …

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Local pharmacists complain drug middlemen hurt patient prices and business

Citrus County Chronicle February 12, 2020 In the competitive pharmaceutical industry where drug manufacturers vie for huge market shares, middlemen work billion dollar deals, and pharmacy goliaths dominate the prescription landscape, it’s hard to be small, and, in many cases, unfair. That’s the take by Jesse Brashear, of Brashear’s Pharmacy in Lecanto and Inverness, and who is hoping proposed legislation that requires more transparency about drug prices. Brashear’s focus during a local press conference Wednesday was predominately on pharmacy benefit managers and House Bill 961. Brashear said pharmacy benefit manager middlemen who work out drug prices between pharmacies and insurance payers often favor large chain pharmacies or pharmacies they own, leaving small, local pharmacies to wither pacing far lower reimbursement rates. “Local pharmacies are being preyed upon by the predatory practices of PBMs,” Brashear said. “Independent pharmacies like ours aren’t asking to be paid more than another pharmacy under Florida’s …

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