MO Chambers of Commerce – Pharmacies Not a Priority?
Attended Missouri House Health & Mental Health Committee Hearings last week, and experienced a few unexpected scenarios. This video is clips from the opposition testimony representing Missouri Chambers of Commerce. As many of the representatives voiced, pharmacies are often active members of local chambers of commerce. The primary concerns voiced included how does Missouri Chambers […]
Rotten Fruit Basket
After listening to the Pharmaceutical Care Management Association (PCMA)’s testimony last week at the Missouri House Health & Mental Health Committee Hearing for House Bills 1850 & 1975, we found a few discrepancies. First off, what are they supposed to be managing? Pharmaceutical care was originally defined as “the responsible provision of drug therapy for […]
1. Paying Pharmacies Below Their Cost to Buy Medications: This is not competition — it is market destruction.
There are dozens of examples daily at most every community retail pharmacy. These are some examples to showcase the commonality of items, with specific exact dollar values and what these medications are for. EVERY insurance plan is doing this to one or more medication, to most every pharmacy, on a regular basis. No other industry sells product […]
2. Self-Dealing Through PBM-Owned Mail-Order and Specialty Pharmacies: This is preferential treatment, not a free market.
*Patient fills and picks up 8 medications regularly through retail community pharmacy. After 2 fills of Humalog, is told now must use mail-order facility or pay 100% out-of-pocket for medication. Patient cannot get an override or authorization to keep refrigerated insulin therapy at local community pharmacy, is required to use Express Scripts mail order for […]
3. Non-Negotiable, Take-It-or-Leave-It Contracts: This imbalance of power removes real competition and violates fair dealing principles.
*Most pharmacies today exist with a relationship into what is known as a Pharmacy Services Administrative Organization, or PSAO, that helps “negotiate” contract terms with PBM’s. Most “negotiations” today exist as a review of what is given to the PSAO, and whether the PSAO feels members can financially sustain such a contract. Then, contracts are […]
4. Lack of Transparency and Data Access: Markets cannot function when pricing and rules are hidden.
*PBM’s are one of the few organizations that can be asked for information and tell such requestor to “take a hike” on a regular basis. *Rules continue to change with the PBM’s, continuing to add to the confusion and complexity in reviewing these plans and policies, as well as typically only benefiting the bottom-line of […]
5. Steering, Clawbacks, and Retroactive Fees: This creates financial instability by design.
*One large employer group underwrote a health insurance policy with prescription coverage for their 300+ employees. The employees found upon attempts to use the policy that the CareMark policy required them to either pay out-of-pocket or utilize a CVS/CareMark pharmacy (mail order, or nearly 100-mile average for employees to the nearest physical store). *PBM’s hold […]
Winner, Winner – PBM Dinner?
Sorry for the delay since the last post, but it has been VERY BUSY around here lately, with continued games from the insurances. We had a patient just call to complain about a prescription being sent to another pharmacy, who hadn’t filled it for her despite texting to come pick it up. They were ordering the […]
New Year, New Tricks
Numerous legislation and regulations have been implemented across a variety of states, creating an entirely new field of options that have yet to be discovered. Historically, this means a new funding method, audit recoupment policies, “updated” procedures, or entirely new practices that had not been seen or interpreted prior… There are a variety of factors […]
Rural Health Statistics
Everybody continues to hear about the dwindling access to healthcare opportunities, but aren’t aware of them unless it directly effects them as individuals… Today, we wish to help put into visual text what has been said, and give a more direct approach to the information people are seeking… Rural and Critical Access Hospitals This sector […]