I’m tired of PBM abuse!
My name is Teresa Stickler. I’m an independent pharmacy owner and the new president of PUTT (Pharmacists United for Truth and Transparency). I chose to become involved with PUTT because of the abuse and unfair practices that PBM’s, (Pharmacy Benefit Managers), pile on independent pharmacies. The ONLY reason PUTT came into existence is because of PBM greed and their egregious practices against employers and providers.
When I went to pharmacy school, I was excited to become a pharmacist and help patients. I only envisioned myself working at a chain, helping patients, going home at night, and repeat the next day. Then I worked at a chain, and realized this wasn’t what I signed up for. Getting yelled that through the drive-through because someone’s insurance didn’t pay for the medication was not my idea of helping patients. I was frustrated with the level of care I was able to provide to my patient, so I set off to open up my own pharmacy.
I wanted to be “the neighborhood pharmacist”, to know my patients by name and be a part of their lives. I wanted to be there for them and help them make decisions to live a healthy life and was excited to open up my own pharmacy. I poured sweat and tears into it; I charged my credit cards to $90,000 for the buildout and mortgaged my house for the rest. I spent countless hours day and night working on the business, while sacrificing time away from my husband.
In the beginning, it was very exciting and invigorating. Hearing appreciative words from my patients kept me going. Then it all started to happen. Each year was something new. It started with the PBM’s forcing my patients to use their own mail order facilities. My patients weren’t given an option. I was losing patients who didn’t want to leave our pharmacy and there was nothing I could do. Then CVS bought Caremark and put their logo on my patient’s insurance cards, implying that they had to go to CVS for their prescriptions. Then CVS forced my patients go to CVS or else they wouldn’t pay for their prescriptions. I remember my patients getting letters comparing copays at my pharmacy vs CVS and offering a financial incentive on their Copays if the patient uses CVS. In the meantime Caremark controls how much I am paid, how much CVS is paid and how much the insurer or employer is charged.
Each year the abuse from the PBM’s got worse. I learned about spread pricing, where the PBM pays the pharmacy one price while they charge the employer a much higher price and keeps the difference. I learned about rebates, where the PBM agrees to use certain medications on their preferred formularies, getting money back based on usage, and not giving the rebates back to the employers. I learned about repackaging, where the PBM plays a shell game by creating their own new NDC and billing the employer for a much higher price in their mail order facilities. No wonder they were pushing mail order!
While PBM’s claim that they negotiate contracts, many times the choice is to “take it or leave it.” Experience has shown with these contracts that there are many instances where pharmacies are forced to choose between serving our patient and accepting reimbursement for less than the drug costs us or sending the patient to another pharmacy who may not realize they are losing money on the Rx. This is especially true with generic drugs where PBM’s develop their own proprietary “Maximum Allowable Cost” list, (MAC), based on prices they feel MIGHT be available from wholesalers. Many times their prices are months if not years old and despite complaints from providers, the PBM’s refuse to alter provider reimbursement.
I have also had the direct pleasure of Arizona’s own state Medicaid program, (now under control of a PBM), kicking independent pharmacies out of the network with no notice and no option to accept the same reimbursement as pharmacies permitted to stay in the network. As a resident of Arizona I pay significant taxes to the State and am locked out of this program, yet out of state corporations who pay little to no state taxes are permitted in the program. How does this happen?
Recently the PBM’s switched their profiteering practices against consumers through a tactic called “clawbacks”. A “clawback” occurs when a PBM instructs a pharmacy to charge a patient $20 for a prescription and tells the pharmacy that they must pay the PBM $16.50 because the contractual rate for that Rx is only $4.50. Wait a minute; aren’t PBM’s claiming they are saving consumers money and lowering drug costs? If a pharmacy inflated a patient copay and profited in this manner we would be charged with fraud! Do employees and employers know this is happening?
What’s next? When does the abuse stop?
It feels like the PBM’s control Washington D.C. with their lobby. Pharmacy’s call for reform and regulation of PBM practices falls on deaf ears while independents go out of business every day. Most pharmacy owners and pharmacists got into this business because we want to help our patients. Is it too much to ask for a reimbursement that allows us to at minimum pay rent, labor, insurance, electric, heat?
It’s time to disclose how the large PBM’s are increasing the cost of healthcare. It’s time to show how much money PBM’s are costing consumers, employers and taxpayers. It’s time to expose the abusive practices PBM’s bring to the pharmacy industry.
It’s time for Pharmacists to become United in bringing Truth and Transparency to the pharmacy benefit industry. I urge everyone reading this to join and support PUTT. As individuals we are not feared. The biggest fear the PBM’s have is unification of independent pharmacy and the sunlight we bring to their practices. Please join us in the fight for your survival.