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