The Highs, the Lows, & the WTHs: PUTT's 2021 Year in Review
PUTT Blog / PUTTRx Medium
If you thought 2021, aka the follow-up to When Satan met 2020, seemed like a mixed bag of forward momentum and frustrating setbacks in the move to reform PBMs, you’re in good company. As we look over the year that was 2021, we’re encouraged by many of the high points (Louisiana Independent Pharmacies Association v. Express Scripts; Comer Forum on Drug Pricing) and positively puzzled over the rest (UnitedHealth Acquiring Change Healthcare?). You be the judge as we recall this year’s highlights:
January was a time of hope and relief as the first COVID vaccines became available to high-risk members of the public. Not surprisingly, Walgreens and CVS locked up contracts with the federal government to vaccinate residents in nursing homes and long-term care facilities, only to fumble nearly every step of the way. West Virginia made national news when its independent pharmacies quickly and efficiently vaccinated its most vulnerable populations; proving once again who the true healthcare heroes are. The fledgling Arizona Independent Pharmacy Coalition (founded and supported by PUTT members) introduced their first anti-PBM transaction fees legislation, while Florida Small Business Pharmacies Aligned for Reform (SPAR) introduced aggressive Medicaid managed care reform legislation. Overall, 43 states introduced 111 pieces of legislation intended to rein in PBM abuses and overreach. Continue Reading
ACROSS THE NATION
Biden Administration Poised to Give Pharmacies a Major Lobbying Win
January 7, 2022
The Biden administration wants to rein in fees charged in Medicare by controversial middlemen that play a crucial behind-the-scenes role in the pharmaceutical pricing system.
It would be a huge win for pharmacies, which have been lobbying in Washington for the change for years. The proposal would also lower out-of-pocket costs for some Medicare patients, but not all, as plans would likely raise premiums to compensate. The Centers for Medicare and Medicaid Services said the agency expects “more than half” of traditional Medicare patients would see lower total costs.
Pharmacies, particularly independent ones, have complained for years that retroactive fees lack transparency and sometimes result in Medicare plans reimbursing them less than what they pay for drugs.
“After many years and multiple administrations, this is as close as we’ve ever come” to reforming the fees, said Douglas Hoey, chief executive officer of the National Community Pharmacists Association.
The pharmacy fees have been growing at a significant pace in recent years, according to John Leppard of Washington Analysis, which tracks the impact policy has on the pharmaceutical industry for investors. He calculated the fees increased to $9.5 billion in 2020 from $2.1 billion in 2016, a 35% jump.