"Many Canadian Prescriptions aren't Canadian at All"
published April 1, 2019 by FloridaPolitics.com
On Thursday, the Florida House Health & Human Services Committee approved a bill to allow prescription drug imports from Canada. It now heads to House floor for a full vote.
As a practicing pharmacist in Tampa, I understand the motivation behind this legislation.
Every day, I see the negative impact of high prescription drug prices. I’ve often seen customers walk away from the pharmacy counter because they can’t afford their prescriptions.
Many patients have told me they’ve experimented with purchasing Canadian drugs online in order to save money.
A nationwide survey by Kaiser Health found that 8 percent of Americans said they or family members had imported prescription drugs.
I sympathize, yet I always caution against this move. The monetary rewards of Canadian prescriptions are just not worth their safety risks.
I urge Florida legislators to listen to health care experts on this issue rather than the understandable populist appeals and vote no on this dangerous legislation — and then get back to working on more productive ways to lower drug prices for Floridians.
Thousands of Americans have been injured or killed by imported prescription drugs.
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DR. BENJAMIN ALLI, OPINION CONTRIBUTOR published on 04/15/19
A new Trump administration rule is forcing drug middlemen known as Pharmacy Benefit Managers (PBMs) to direct some of the rebates they receive back to the consumers they're supposed to be representing has sparked a major lobbying brawl in the health-care industry.
The specific Trump proposal is relatively narrow: it requires PBM drug copays to be based on what they pay wholesale for a drug, instead of its list price, thereby guaranteeing that consumers realize the gains instead of the middlemen.
But the policy is one of the first significant blows against the increasingly powerful PBMs.
PBMs are supposed to use their market power to negotiate better drug plans for the insurance plan enrollees they represent, but in the past several years, evidence is mounting that something is very wrong in their corner of the health-care universe.
Here are five signs this industry is desperately in need of reform:
Copay costs more than the drug? Wait, what?
Most people think they pay hefty insurance premiums so that when they do need care, the insurance companies pay most of the cost. By and large, that's true. But now an increasing number of patients are having the bewildering experience of finding out their prescription drug is cheaper to buy out-of-pocket. Sometimes much cheaper.
Last summer, PBS published a groundbreaking expose on the practice, highlighting an academic study which estimated copays are above the rates reimbursed to pharmacies an astonishing 25 percent of the time, resulting in a $135 million in annual revenue.
The story also includes one of the most remarkable "liar, liar, pants on fire" interactions ever between Express Scripts, one of the three big PBMs and PBS. Asked for comment, Express Scripts stuck to its increasingly untenable denials, even when confronted by the testimony of numerous pharmacists, internal company documents and an on-the-record admission from their insurance plan partner.
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CBS Boston - April 16, 2019
PROVIDENCE, R.I. (AP) — Drugstore chain CVS Health has agreed to pay $535,000 to resolve federal allegations that it filled dozens of Percocet prescriptions its pharmacists should have known were forged.
The U.S. attorney for Rhode Island and the head of the Drug Enforcement Administration’s New England office announced the penalty Tuesday.
Percocet is a brand-name painkiller that contains acetaminophen and the opioid oxycodone. Federal officials say the forged prescriptions were filled at several Rhode Island locations between September 2015 and June 2017, in violation of the federal Controlled Substances Act. The statute places a “corresponding responsibility” on pharmacists to ensure the prescriptions they’re filling are valid and legal.
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One of the newest episodes of this season's Patriot Act focuses on the U.S. drug pricing crisis. Comedian Hasan Minhaj presents a funny and irreverent, yet well thought out and documented take on the rising cost of prescription drugs. Hasan breaks down how America’s complicated healthcare industry has lead to these price hikes over the past few decades, and looks specifically at how increases in insulin prices have impacted the millions of Americans that need it to survive. An informative take worth watching that approaches the situation with hysterical comedic timing and insights.
Released by Pharmacists Society for the State of New York
NEW YORK – January 24, 2019 – Prescription drug middlemen may have pocketed more than $300 million from taxpayers in New York State between April 1, 2017 and March 31, 2018, based on a study conducted by 3 Axis Advisors. The study found a 24 percent difference between the cost of generic drugs reported by the state and the payment for generic drugs to community pharmacies, a controversial practice known as “spread pricing.” The report, which was released today is the most comprehensive ever conducted of the state’s prescription drug spending.
In 2017, New York spent an estimated $1.3 billion on generic drugs within its Medicaid managed care program – more than any other state. Within the period analyzed, middlemen known as pharmacy benefits managers (PBMs) overcharged New York by as much as 39 percent on generic drugs – $5.62 per prescription on average. Generics accounted for an estimated 89 percent of the state’s Medicaid managed care prescription drug claims overall.
By Todd Brown, Executive Director
Massachusetts Independent Pharmacy Association
Originally Published in CommonWealth Magazine, 12/13/18
A RECENT FEDERAL LAW allows pharmacists to inform patients when the price of their medication is less than the copayment they would pay using their insurance. This is helpful to some patients using certain low-cost medication. But there are much bigger savings to be realized by limiting payments to pharmacy benefit managers (PBMs) who have gone unregulated and taken advantage of that fact.
Unfortunately, the current system lacks transparency and accountability, allowing for a conflict of interest that results in PBMs reaping excess profits at the expense of all of us – employers, those covered by insurance plans in the private market, and taxpayers for publicly funded insurance programs.
By Steve Twedt
Originally published in Pittsburgh Post-Gazette, 12/11/18
Pennsylvania Auditor General Eugene DePasquale on Tuesday called on legislators to demand more transparency and accountability from pharmacy benefit managers, the middle-man companies that Medicaid contracts with to administer prescription drug plans that cover about 2.9 million Pennsylvania residents.
In an 18-page report released Tuesday, Mr. DePasquale said Pennsylvania paid PBMs $2.86 billion in 2017 for Medicaid beneficiaries’ prescriptions — an amount that one pharmacy benefit manager immediately disputed.
By comparison, the report said the state paid PBMs $1.41 billion in 2013.
The payments include both the pharmacy benefit managers’ cost of doing business and some profit, the report says, “but because PBMs’ business practices are shielded from public or government scrutiny, there’s no way to verify how much was profit.”
As a result, the auditor general concluded that Pennsylvania taxpayers “might be paying too much for medications, and PBMs might be pocketing that money."
by Katie Wedell
Originally Published in Dayton Daily News, 11/21/18
Ohio Attorney General Mike DeWine joined 32 other attorneys general in filing an amicus brief in the United States Supreme Court on Wednesday, supporting states’ rights to regulate pharmacy benefit managers and address the rising cost of prescription drugs.
Pharmacy benefit managers, or PBMs, act as middlemen between pharmacies, drug manufacturers, health insurance plans, and consumers for access to prescription drugs. The brief argues that regulation of PBMs is a matter for state authority in protecting the access to and affordability of prescription drugs.
by Matt Nye, originally published in ScriptedRx 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.
In one example recently recounted to ScriptRXed, an independent pharmacy was subjected to an audit that focused on expensive insulin products and other name brand medications. Upon completion of the audit, no fraud was found, but the PBM cited clerical errors – like failing to properly document the substitution of Humalog for Novalog on an insulin prescription – as violations (the substitution was confirmed with the doctor, it just wasn’t documented to the PBMs standards).
Patients would be steered away from their physicians, Association of American Physicians and Surgeons said in letter to AG Jeff Sessions.
By Susan Morse
Published in Healthcare Finance, 9/25/18
The Association of American Physicians and Surgeons has added its voice to that of the American Medical Association in opposing the proposed merger between CVS Health and Aetna.
The deal would steer patients to insurance plans and site of care, and away from their physicians, according to AAPS President-elect Marilyn Singleton, MD, wrote in a letter to U.S. Attorney General Jeff Sessions and to Makan Delrahim, the assistant attorney for the General Antitrust Division of the Department of Justice.
WHY IT MATTERS
The Department of Justice is currently considering the proposed $69 billion deal for CVS to buy Aetna, with the industry expecting approval by the end of the year.