Fines, Investigations and Fired PBMs ... in Only 8 months
If you're worried about the impact of the seemingly inevitable CVS/Aetna merger, consider the following:
On February 8, 2018, Arkansas Attorney General Leslie Rutledge opened an investigation into the CVS Caremark reimbursement rates to Arkansas pharmacies, much to the delight of her state's community pharmacies -- and the nation. Ms. Rutledge took a bold and remarkable stand against PBM abuse. Since that day:
PBMs In the News
How PBMs use audits to inflate profits and intimidate independent pharmacies
By Matt Nye
Originally published in ScriptedRx.com, 10/21/18
A PBM makes $12,470 without providing any inventory, without counseling any patients, without interfacing with any healthcare professional on behalf of the patient and without fielding a single phone call regarding the medications prescribed.
Under the auspices of combating fraud, waste and abuse (FWA), the Center for Medicare Services (CMS) allows Pharmacy Benefit Managers (PBMs) to conduct audits of pharmacies that allow the PBM to deduct future payments owed for mistakes found during the period audited. Some independent pharmacy owners say the rules governing the audits are unfair, and the audits themselves are used to punish pharmacy owners that are outspoken about industry practices and who are only trying to do right by their patients.