FLORIDA BASED PHARMACY LOSES CLOSE TO 330 MONTHLY PRESCRIPTIONS AFTER CVS CAREMARK CONTRACTS FLORIDA BASED MEDICAID HMO PLAN

CONTACT: Melissa Kiguwa
(480) 797 2281
melissa@felicewhitney.com

 

FOR IMMEDIATE RELEASE
July 20, 2016

 

FLORIDA BASED PHARMACY LOSES CLOSE TO 330 MONTHLY PRESCRIPTIONS AFTER CVS CAREMARK CONTRACTS FLORIDA BASED MEDICAID HMO PLAN

 

Patients of Discount Pharmacy in Dade City, Florida were surprised to receive cautionary network restriction letters from their Medicaid HMO Plan, Staywell. The letter warned that after March 31, 2016 only the approved pharmacists listed in the letter would be covered under Staywell’s Managed Care Plan. Patients quickly noticed Discount Pharmacy was nowhere to be found on the list.

One of the co-founders of Discount Pharmacy describes that period as a flurry of confusion, “Since the restriction was enacted in April, we’ve lost approximately 326 prescriptions per month from 51 patients, because, and rightfully so, they don’t want to change their plans.” The co-founder did note that many patients are dismayed at the change because some of the services available through Staywell are not offered by the other Medicaid managed care plans. These services include Diabetic Educators on regular home visits to work with and counsel patients, sending a nurse to provide weekly home visits, and intensive care post surgery. 10 patients opted to stay with the pharmacy because Discount Pharmacy offers bilingual staff at all times and free delivery for those who do not own cars and live in locations where public transportation is scarce.

The story of Rx Discount Pharmacy is all too common. Despite the great value independent pharmacists provide to the economy (pharmacy small businesses represent over $81 billion annually), according to the National Community Pharmacists Association approximately 1900 independent pharmacies have closed their doors over the course of the last 10 years. This is roughly a 5% reduction in the total number of small business pharmacies.There are a number of different reasons for this, but the co-founder of Discount Pharmacy speculates many of these closures are the consequence of industry reimbursement and contract abuse. “In my opinion, when CVS Caremark contracted to be the pharmacy processor for Staywell in 2015, CVS was then able to re-channel the prescriptions and business towards their own stores. This is happening even though it’s tax money that is being utilized to fund these plans. About 90% of independents are excluded from these network approved plans.”

CVS Caremark, as well as, Optum and Express Scripts are three of the largest Pharmacy Benefit Managers (PBMs) in the United States. PBMs are third party intermediaries for prescription drug programs between pharmacies and health plan enrollees (employees of private companies and government agencies as well as welfare programs). PBMS face little to no government oversight and the lack of transparency has led to substantial discrepancies in how reimbursements are both calculated and paid out. Unexplained fees are charged to pharmacists in such extremities that independent pharmacists find themselves paying manufacturing costs and being reimbursed at only 40-60% the full cost. Independent pharmacists are increasingly being forced to send prescriptions to larger pharmacies whose bottom line is not as severely impacted.

Discount Pharmacy has already seen a $20,000 reduction in its bottom line since April. The staff is currently conducting immunizations and Medication Therapy Management in an effort to generate alternative income, however they worry that this is not sustainable in the long term. Inevitably, things will not change for small businesses like Discount Pharmacy until lawmakers begin to take notice and draft regulatory legislation keeping PBMs accountable.

Pharmacists United for Truth and Transparency (PUTT) exists to unify, promote and preserve independent pharmacies through education and access; to monitor PBM and other industry practices which, when identified as abusive, are exposed in various manners in the interest of improving quality, safety and cost of patient care. For more information about the negative impact of Pharmacy Benefits Management company practices on the cost and accessibility of medications, or to learn more about Putt, visit TurthRx.org or contact Monique Whitney, (602) 359-0626

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Contact info:
Melissa Kiguwa
melissa@felicewhitney.com
(480) 797-2281

Health Subcommittee Reviews Federal Health Spending Ahead of 114th Congress

Health Subcommittee Reviews Federal Health Spending Ahead of 114th Congress

Subcommittee Members Review Options to Strengthen Federal Health Care Priorities

WASHINGTON, DC – The House Energy and Commerce Subcommittee on Health today held a hearing to review climbing federal health spending ahead of the 114th Congress. Subcommittee members discussed the unsustainable spending trajectory of Medicare, Medicaid, and the Patient Protection and Affordable Care Act. The subcommittee also explored opportunities for savings and policy options to strengthen the health care safety net and protect the most vulnerable.

Health Subcommittee Chairman Joe Pitts (R-PA) commented, “The federal government faces enormous budgetary challenges. Our biggest challenge is mandatory spending, particularly Medicare and Medicaid, which together accounted for 25% of all federal spending in FY2013. These programs need to be strengthened and modernized, not just because millions of Americans depend on them for their health care, but also because out-of-control entitlement spending is crowding out other important priorities.”

Full committee Chairman Fred Upton (R-MI) said, “Critical areas of our discretionary budget are facing increasing pressure because federal spending on mandatory health programs is so significant.”

Dr. Mark Miller, Executive Director of the Medicare Payment Advisory Commission, testified, “Health care spending and its growth over time puts pressure on employer, government, and family budgets. For the Medicare program, this pressure is particularly acute given the outlook for the federal debt and the projected increases in Medicare enrollment.”

Chris Holt, Director of Health Care Policy at the American Action Forum, added, “The expansive spending created by the Affordable Care Act (ACA) will continue to generate fiscal issues for years to come. … Decreasing ACA spending and applying some of these savings to Medicare reform is just part of the fiscal priorities conversation. Any change undertaken should lay a foundation for a more efficient health care system, and the 114th Congress should work towards that ultimate objective by focusing on achievable goals in the present.”

Marc Goldwein, Senior Policy Director at the Committee for a Responsible Federal Budget, offered, “Although policymakers should focus mainly on those policies that help to ‘bend the health care cost curve,’ those policies may not prove sufficient to put the national debt on a sustainable long-term path. And while the answer to this concern should not be indiscriminant cost-shifting, it does mean hard choices will have to be made – choices where the winners and winnings (including for future generations) roughly equal rather than greatly exceed the losers and losing. Identifying the right ‘Savers’ means thinking about how scarce federal health dollars should be allocated to do the most overall good.”

Read complete witness testimony and watch the full hearing online here.

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Patty Benjamin Joins PUTT as Senior Advisor

PSAO & PBM Operations Expert Patty Benjamin Joins PUTT as Senior Advisor to Further the Independent Pharmacy Marketplace

Washington, DC — October 6, 2014 — Pharmacists United for Truth and Transparency (PUTT) is pleased to welcome Patty Benjamin as its new senior advisor on managed care policies. Patty brings over two decades of experience developing programs around and managing PBM relationships and PSAO operations. Benjamin’s background in retail drug contracting, business development and the overall health care and pharmaceutical industry will enable PUTT to further advance its mission in the independent pharmacy marketplace.

“Independent pharmacies have a proven business model and are dedicated care providers.  Many PBMs are creating contracting obstacles for the independent pharmacies furthering the gap in reimbursement between the chains and the independent. Patty Benjamin’s expertise will help us in our work to level the playing field and create an independent pharmacy friendly environment for our businesses to thrive,” said PUTT President Jason Wallace.

“Promoting fair competition and equal access is essential for not only independent pharmacies, but to all who rely on their local pharmacy for their prescription and health care needs. I look forward to working with PUTT and its members in establishing programs and polices that allow their businesses to excel,” said Patty Benjamin, PUTT’s senior advisor on managed care policies.

Before joining PUTT as a senior advisor, Patty was Vice President Managed Care at H.D. Smith, the fourth largest wholesaler in the country. There, she led the Pharmacy Service Administration Organization (PSAO) to record growth in revenue and member count.  She created and implemented industry leading business solutions by reorganizing and refocusing her department and she created much needed efficiencies in PBM contracting protocol.  In addition to her PSAO responsibilities, Patty also oversaw the HDS employee pharmacy benefit plan design where she realigned vendor partners creating significant cost savings for the company

Her career in pharmacy, health and managed care also includes positions at RotaCare, Milliman IntelliScript, Ingenix and Long Drug Stores. Patty is a graduate of the University of Illinois, Champaign/Urbana and Golden Gate University.

PUTT, and its more than 2,000 members across the U.S., are dedicated to helping all Americans afford reasonable drug costs by exposing widespread abuse and manipulation by many of the larger pharmacy benefit management companies.

To learn more, visit www.truthrx.org.

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ABOUT PHARMACISTS UNITED FOR TRUTH AND TRANSPARENCY

Pharmacists United for Truth and Transparency (PUTT) is an independent watchdog organization dedicated to exposing the role pharmacy benefits managers (PBMs) play in driving up prescription drug costs for consumers and employers. PUTT is a growing coalition of independent pharmacists and pharmacy owners and a resource for employers, policy makers and members of the media. It is a not-for-profit organization funded by individual members, not corporations or other special interest groups. For more information visit TruthRx.org.

 

FOR IMMEDIATE RELEASE
Contact:
Elizabeth Bartolomeo
ebartolomeo@fenton.com
202-789-7753

Independent Pharmacists Condemn Express Scripts’ Move to Block Coverage for Compound Drug Ingredients

Washington, DC — July 2, 2014 — Pharmacists United for Truth and Transparency (PUTT) issued the following statement in response to Express Scripts blocking coverage to compound medication ingredients.

Notes PUTT President Jason Wallace, Pharm. D.:

“This is another case of Express Scripts doing what it does best, decrease access to important medications under the guise of savings. Compounded medications have been around since the dawn of pharmacy and play a vital role in the health of patients across the country.

“Doctors turn to compounded prescriptions when traditional modalities fail, cause unintended side-effect profiles or the patient needs a dosage form, strength or delivery method that is not commercially available. Furthermore, in many instances, the compounded medications cost much less than commercially available products.

“We condemn Express Scripts decision and will work with physicians and our patients to ensure that they continue to have access to these vitally important specialized forms of medication. PUTT hopes that employers and plan sponsors will also realize that this move by Express Scripts is yet another reason to choose your PBM wisely.”

PUTT, and its more than 2,000 members across the U.S., are dedicated to exposing widespread abuse and manipulation by pharmacy benefit managers and the ways they inflate prescription drug costs for millions of Americans.

To learn more, visit www.truthrx.org.

###

ABOUT PHARMACISTS UNITED FOR TRUTH AND TRANSPARENCY

Pharmacists United for Truth and Transparency (PUTT) is an independent watchdog organization dedicated to exposing the role pharmacy benefits managers (PBMs) play in driving up prescription drug costs for consumers and employers. PUTT is a growing coalition of independent pharmacists and pharmacy owners and a resource for employers, policy makers and members of the media. It is a not-for-profit organization funded by individual members, not corporations or other special interest groups. For more information visit TruthRx.org.

 

http://www.truthrx.org/2014/07/02/1966/