Straight Talk: Local Louisiana Pharmacists, Sec. Alex Azar Discuss Urgent Issues Facing Patients and Their Pharmacies
One day after President Trump declared in his State of the Union address the need for prescription drug pricing reforms, Health and Human Services Secretary Alex Azar paid a visit to patients and pharmacists at Chateau Drug and Gifts in Metarie, LA to continue the conversation. Chateau Drug owners Kerry and Diane Milano, both pharmacists, hosted Sec. Azar and a small contingent of patients and pharmacists for an in-depth discussion of issues facing small business pharmacies and their patients.
Sec. Azar addressed several “hot button” issues: high drug prices, lack of choice, secret mark ups and exorbitant DIR fees charged by PBMs that ultimately undercut pharmacies and are passed on to patients as higher drug costs and insurance premiums. During his visit, Sec. Azar observed Chateau Drug pharmacists in action filling prescriptions and counseling patients, noting the degree to which independent pharmacies are the patient’s most accessible healthcare providers.
The visit, which was coordinated by the Louisiana Independent Pharmacies Association (LIPA) and NCPA, came as a result of Sec. Azar’s interest in some of the state’s proactive laws, which provide a level of patient and pharmacy protections against price gouging and retroactive fees. In 2016 Louisiana passed a law prohibiting PBMs from directly or indirectly charging or holding a pharmacist or pharmacy responsible for any claim-related fees that were not disclosed upfront or after submitted for reimbursement. According to a recent PUTT survey, most independent pharmacies pay an average of $107,302 per store in retroactive DIR fees.
Just last week AP news reported that Sec. Azar had asked Congress to pass the administration’s new prescription drug discount plan and provide it to all patients, not just those covered by government services plans like Medicare. The plan would channel the now hidden rebates on prescription drugs directly to patients, removing that money from the current grasp of the PBMs. In a separate story released on February 5th by CNBC, President Trump was quoted on the issue as saying, “It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, unfair, and together we will stop it.”
Dear Judge Leon,
My name is Teresa Dickinson, and I am an independent pharmacy owner in Phoenix, AZ. I am also the president of Pharmacists United for Truth and Transparency (PUTT), a coalition of more than 1,200 independent and community pharmacies across the U.S. I am writing on behalf of my organization and small business pharmacy owners everywhere to express our full opposition to the CVS-Aetna merger. We are greatly encouraged to know you are carefully considering the merger of these two excessively large corporations that together control a disproportionate share of the healthcare marketplace.
Sir, you mentioned feeling as though you are “in the dark” with regard to the merger. We promise you are, as are most Americans about the true nature of the pharmacy benefit manager (PBM) industry. CVS, along with Express Scripts and OptumRx, control nearly 80% of all prescriptions filled in the U.S. All 3 are either owned, or poised to be owned, by extremely large health insurance companies who also seek to control and serve as the gatekeeper between patients and pharmacy, medical providers and other sectors of the healthcare system.
Here are some things you may not know about CVS:
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:
With this week's news that the U.S. Department of Justice has given Cigna and Express Scripts the go-ahead to merge, it's worth revisiting - and re-stating - the obvious: PUTT opposes the CVS-Aetna merger.
PUTT also opposes Cigna-Express Scripts and any other "mega mergers" that result in one less choice for consumers; one more layer of bureaucracy for patients who find themselves "lost" or treated like a number in corporate healthcare; and one more headache for pharmacies trying to care for patients AND keep the doors open for business.
PUTT issued the following statement on December 7, 2017 just after CVS announced its intent to buy Aetna:
Why Would Community Pharmacists Travel 1,522 Miles to Ask "Less Government" Legislators for MORE Government?
When New Orleans hosted the American Legislative Exchange Council conference last week, community pharmacists traveled distances greater than 1,500 miles to ask the “limited government, free markets and federalism”-favoring legislators for MORE regulation over pharmacy benefit managers (PBMs).
Pharmacies are excluded from the “free market” system by unregulated, middlemen PBMs who have been allowed to take over the pharmacy industry, co-opting the role of physicians by deciding patients’ drug options and coverage; gagging pharmacists from informing patients when it’s cheaper to pay out of pocket than use insurance; and keeping manufacturer rebates instead of giving them to the patient. And that’s only a few of the tactics PBMs use to control the supply chain from drug manufacturer to pharmacy counter to patient.
PBMs rig the system by designing benefits plans to appoint themselves -- mere claims administrators -- as the final authority on plan formularies, pharmacy reimbursements and plan premiums and copays. Their system is “proprietary” - but that’s just code for “arbitrary and capricious” because no one knows how they actually determine plan prices and reimbursements. They are not required by law to divulge this information - even to taxpayers, whose hard-earned dollars fund Medicaid and Medicare.
Despite the White House’s promise of aggressive action to end skyrocketing drug prices and the enactment of a new state law that is supposed to cap the state’s prescription spending under Medicaid and Medicare, local consumers and patients likely won’t see relief at the pharmacy counter any time soon.
Ohio Medicaid Audit Only Proves that Transparency is Critical to Reforming a Broken System that Benefits Shareholders Before Patients
The release last week of the HealthPlan Data Solutions report allegedly “vindicating” CVS Caremark and other large pharmacy benefit managers accused of overbilling Ohio Medicaid and reimbursing Ohio pharmacies at or below the cost for Medicaid prescriptions only proves what everyone already knows: numbers can be arranged favorable to just about any outcome.
More than eyebrows should be raised at the news that Illinois Health and Family Services (HFS) Director Felicia Norwood has resigned to take a position with Anthem, a for-profit subsidiary of health insurer Blue Cross Blue Shield. The resignation of Ms. Norwood, a government “insider” who will head up the company’s division tasked with landing government contracts, should raise questions about the propriety of the move, and if it violates Illinois’ Revolving Door Act