INDEPENDENT PHARMACIES SUE MAJOR PBM OVER ILLEGAL PRICE DISCRIMINATION AND BELOW COST REIMBURSEMENTS
Jacobs Law Group - Newswire
Pharmacies Allege OptumRx Knowingly Paid Them Less Than Large Retail Chain Pharmacies
The newest litigation against a major pharmacy benefit manager comes from a most likely source: their small business victims. Unwilling to tolerate the low reimbursements which threaten to drive them out of business, more than 50 independent pharmacies have sued pharmacy benefit manager (PBM) OptumRx, a division of UnitedHealth Group, charging the company violated state laws governing pharmacy claims reimbursement.
The lawsuit alleges that OptumRx ignored state legal requirements, unlawfully paid local pharmacies substantially less than it paid large chain retail pharmacies like CVS or Walgreens and far below what the company paid its own mail order pharmacy for the same prescriptions. The lawsuit further alleges that in many cases OptumRx knowingly reimbursed local pharmacies below their wholesale cost to acquire generic prescription drugs necessary for their patients.
PBMs administer the prescription drug portion of health insurance and self-insured plans, acting as a middleman between the insurance plan and the pharmacist. Over the last 20 years these companies have accumulated immense, unregulated power - the three largest PBMs controlling up to 80% of the healthcare market - and have utilized that power to increase prescription drug costs, decrease competition and restrict patient choice.
The PBM practice of below cost reimbursements to independent pharmacies is likely one reason why OptumRx is the most profitable component of UnitedHealth Group the world’s largest health insurance company with over $225 billion in annual revenues.
Plaintiffs involved in the lawsuit allege that:
Optum built a wall of secrecy around its conduct by forcing network pharmacies into confidentiality agreements that conceal the truth about Optum’s business practices – specifically how much Optum is paid by insurance plans for prescriptions, how much Optum receives in
The survival of independent pharmacies in America’s healthcare system is seriously threatened by the unethical, predatory business practices of PBMs. The lawsuit brought forth by this group of small-business pharmacies seeks to break this wall of secrecy and hold Optum accountable.
The pharmacies are represented by Mark Cuker and Neal Jacobs of the Jacobs Law Group, which represents over 400 pharmacies in lawsuits pending in Federal Court in Pennsylvania. For more information about the lawsuit, contact Mark Cuker at (215) 531-8512.
1,230 rural pharmacies have closed since 2003, including 45 in Colorado. Some blame benefit management companies that reimburse for medications at less than they cost to buy.
The Weatherford Democrat
Just as Parker County first responders have worked together to ensure the safety and well being of local residents during the COVID-19 pandemic, two longtime fixtures of Weatherford, Davis City Pharmacy and Jamak recently teamed up to provide hand sanitizer in an effort to look after those on the front lines.
Following a temporary FDA policy issued back in March allowing for the manufacturing of hand sanitizer by pharmacies and other industrial businesses, Davis City Pharmacy, which has been serving local residents for decades, began supplying first responders with their own in-house made supply.
Soon after Jamak, which has been in Weatherford since 1974 and manufactures and distributes silicone components used in defense, public safety, food, transportation, healthcare and medical devices caught wind of the effort and reached out to the pharmacy’s manager, Brandi Chane to offer assistance, an offer she warmly welcomed.
“Jamak saw the story in the Democrat and then asked me if there was anything they could do to help with our efforts,” Chane said.
“At that point it was getting really hard to get ahold of ingredients, and so they asked me for the formula, and have since been able to donate. They just dropped off 10 gallons to us [Wednesday].”
The joint venture has already supplied Parker County first responders and frontline workers with roughly 20-25 gallons of donated hand sanitizer, Chane said, while financial donations by local businesses and private citizens alike have further helped fuel Davis City Pharmacy and Jamak’s efforts.
“We’ve been doing that since the beginning of March,” Chane said.
“We were also selling it to the general public and basically, every one that was purchased by a customer, another was donated to a first responder, frontline worker or essential business. We’ve had sizable donations, it just helps us continue to be able to make the purchases we’ve needed to and we turn right around and donate it as first responders need it.”
In terms of getting these needed supplies to first responders, Chane said she is in constant communication with Parker County Emergency Management Coordinator Sean Hughes, who relays what is needed at any given time.
Even more, those conversations have expanded to include the prospect of antibody testing, a service Chane said is in the works.
“Sean Hughes asked me about antibody testing, I did some research and once FDA-approved, reliable antibody tests are available, we’ll be doing that here as well as four other pharmacies that I’ve coordinated with so that we can spread those services throughout the county,” Chane said.
Helping the local community through such efforts is an undertaking the Davis City Pharmacy manager said is close to her heart.
“I think it’s really important,” Chane said.
“We’ve all been really happy that we’ve been able to do just this one small thing. I have a brother who’s an officer with the county, and I’ve been in healthcare for the last 20 years and I always want to volunteer, help out, donate wherever I can. This pharmacy has been here for decades and it’s always been extremely important to us that we make sure our community is taken care of. Jim and Myrlan Coleman who own the pharmacy, whenever I spoke with them about it, they jumped right onboard.
“Everyone is willing, able and ready, and so we’re gonna do whatever we need to take care of our community.”
President of Jamak Dan Thompson echoed Chane’s commitment to serving first responders and frontline workers.
“Jamak’s been located here in Weatherford for many years, and we love the people in Weatherford and Parker County who make up our team,” Thompson said.
“We’re honored to be able to work with Davis City Pharmacy to help provide hand sanitizer in a difficult time for our first responders and emergency professionals who take care of us. We’re just delighted to be able to do that for the community and certainly feel fortunate to have the resources to do it.
“It’s certainly not the only thing we’re going to be doing with the community, but we’re just happy that we could do this at this time.”
Drug Store News
Lawmakers are seeking to eliminate DIR fees as the coronavirus pandemic continues straining small business, independent community pharmacies.
One hundred fifteen members of the U.S. House of Representatives are supporting a bipartisan push to include language permanently prohibiting pharmacy DIR clawbacks by pharmacy benefit managers in future coronavirus relief packages.
A letter, led by Reps. Buddy Carter (R-Ga.), Peter Welch (D-Vt.), Doug Collins, (R-Ga.), Raja Krishnamoorthi (D-Ill.) and Vicente Gonzalez (D-Texas), was sent to House Speaker Nancy Pelosi, Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer and House Minority Leader Kevin McCarthy.
The letter stated, "We must keep pharmacies open during this crisis. Pharmacy DIR reform has strong bipartisan support in both the House and Senate. We ask for these reforms to be enacted now and hope that Members of Congress will not overlook the critical need to ensure the sustainability of pharmacies during this public health emergency."
A National Community Pharmacists Association analysis released last week found that 66% of independent pharmacies are experiencing such negative cash flow issues as DIR fees, decreasing reimbursement and coronavirus-related expenses. That means pharmacies are paying more for inventory and clawback fees, which makes it difficult to stay in business, NCPA said.
“Independent pharmacies are stepping up to help their communities through the coronavirus crisis," NCPA CEO Doug Hoey said. "They are expanding home delivery zones, putting their own health and safety on the line, continuing to provide a paycheck to thousands of workers — quite literally, they are doing more with less as PBMs claw back funds and reimburse prescriptions below the pharmacy’s cost."
NCPA noted that half of pharmacy owners reported paying more than $10,000 in pharmacy DIR fees since March 1. If this pace continues, the average independent pharmacy will be on track to have over $100,000 clawed back in the next 12 months.
"The majority of neighborhood pharmacies are already experiencing negative cash flow issues and, for their efforts to help through this pandemic, will get a big bill months from now as PBMs come calling for DIR fees," Hoey said. "Eliminating these fees and reining in PBMs has never been more vital if pharmacies are to continue operating now and when this emergency passes. Our continued thanks to those policymakers who understand this and are fighting for PBM reform.”
Small pharmacies are under financial pressure just when they’re needed most: ‘The math doesn’t work’
The Philadelphia Inquirer
Richard Ost has run Philadelphia Pharmacy in the city’s Kensington neighborhood since 1983. It’s the one you can’t miss for the bright blue mural that washes over the building. In response to the coronavirus pandemic, he made some changes: He engaged more drivers to deliver prescriptions, bought masks for his employees, and hired another person to keep watch over the entryway and provide masks to customers without them.
People still need their prescriptions, and Ost is delivering them, for free, at a clip of 150 customers a day, up from 20 to 30 deliveries before. But when he looked at the books last month, amid lower drug reimbursements and fees that kicked in before the crisis, Ost and his wife wondered whether it was time to retire.
Then Ost resigned himself to the 2020 reality: His business will lose money this year.
“I’m looking at it like the next six months are a charity operation,” Ost said. "Let’s give back to the community that has provided to us over the years.”
Pharmacies are high on the list of essential business that have remained open during the pandemic. But independent pharmacists in the Philadelphia area say that, at a time when they are doing more to meet demand, they are struggling with low reimbursements and professional services fees, particularly from Pennsylvania’s Medicaid managed-care program.
Most of Ost’s customers are low-income Medicaid beneficiaries. After new contracts took effect at the start of the year, “I was, for lack of better words, beside myself," Ost said. “Because I really questioned whether we could stay open with the reimbursements.”
The bulk of the state Medicaid program is contracted out to health plans, known as managed care organizations, or MCOs. Four such companies serve Medicaid patients in Southeastern Pennsylvania, and they hire pharmacy benefit managers, or PBMs, to run their pharmacy networks.
PBMs say they help keep health-care costs down by negotiating drug prices with pharmaceutical companies and payments to pharmacies. But their closely guarded business agreements have also raised questions about pricing transparency in some states, including Pennsylvania. And independent pharmacies say they often have no choice but to accept a PBM’s terms or risk losing a health plan’s customers.
“Our stores are offering curbside pickup, or 10 times the normal deliveries,” said Mel Brodsky, the head of a trade group that represents about 200 community pharmacies in Philadelphia. “As our expenses have increased because of COVID-19, our reimbursements are decreasing.”
Brodsky knows of at least a half-dozen independent pharmacies that are "in the process of trying to sell or being sold because they can’t support their stores anymore,” he said.
While CVS is perhaps best known to consumers for its pharmacies, the company’s PBM division, Caremark, serves two of the region’s Medicaid health plans. CVS is also the corporate parent of Aetna Better Health, one of the managed care organizations that contracts with the state.
Brodsky’s group eyes CVS warily. “They want to get rid of the competition,” he said.
“CVS Caremark continues to work to provide drug costs savings to our Managed Medicaid clients and the state of Pennsylvania," CVS said in a statement. “Ensuring Pennsylvanians can access their medications has remained a top priority for CVS Caremark throughout the COVID outbreak.”
Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a trade group for PBMs, said that “PBMs are working with the entire prescription-drug supply chain, including pharmacists, to help patients access needed medications during this public health emergency. That should be the focus of all stakeholders — putting patients first, not profit margins.”
The Medicaid program, Lopes said, "services the commonwealth’s vulnerable population, and should not be, especially during a pandemic, used by independent pharmacies as a place to increase revenue.”
Coronavirus struck at a sensitive time for discussions about pharmacy reimbursements in Harrisburg. A suite of measures to clamp down on benefit managers passed unanimously out of the state House last November. The legislation has support from Pennsylvania Auditor General Eugene DePasquale — who conducted his own examinations of PBM practices — and the bills had moved onto the state Senate for consideration.
For now, however, activity on the legislation appears to be paused. "Right now we’re kind of on hold, with a hope that we’ll be able to see some opening up in May or June,” said Patricia Epple, CEO of the Pennsylvania Pharmacists Association, which represents independent pharmacies. In the meantime, she said, her members are “on the front line” and being paid less — while some are closing their doors for good.
Pharmacists are also frustrated that new requirements in the state’s contract with the managed care organizations have taken months to iron out. The MCOs are supposed to get state approval of their pharmacy payment policies, to make sure that the payments reflect the cost to acquire a drug, and a pharmacist’s professional services.
On Tuesday, the Pennsylvania Department of Human Services (DHS) said it has approved the pharmacy payment policies for three MCOs so far, all of them serving the Philadelphia region: UnitedHealthcare Community Plan, Aetna, and Keystone First. DHS continues to seek “clarification” from the other health plans. “While there is not a hard deadline, the department expects the review process should be completed in the near term,” spokesperson Erin James said. Once payment policies are approved, they will be retroactive to Jan. 1.
Keystone First said the company does not comment on its payment policies. “We continue to work with DHS and our pharmacy network to help our members access the medications they need during the COVID-19 emergency situation,” a Keystone First spokesperson said.
A UnitedHealthcare spokesperson confirmed that its pricing methodology was approved by the state.
A fourth MCO that serves Medicaid patients in Southeastern Pennsylvania — Health Partners Plans — did not respond to a request for comment.
Human Services “has received no complaints" from Medicaid patients about being able to access pharmacy services, James said.
But if community pharmacies end up closing because they can’t cover their costs, Brodsky said, "sooner or later, access will be hurt.”
Robert Frankil sold his Sellersville pharmacy in 2018 to buyers who wanted to continue to run it as an independent store, not a chain. Frankil still considers himself a strong advocate for the community pharmacy, but says the business model is tough these days.
“I saw the writing on the wall that this is not going in the right direction very quickly,” Frankil said, adding: ”PBMs have control over everything: Price, what drug is covered, what pharmacies are in the network."
Under a smaller component of state Medicaid — the “fee-for-service” program — pharmacists are paid a $10 dispensing fee on prescriptions. That program is run directly by the state, not contracted out to health plans, and serves fewer patients.
By comparison, Ost says he receives about 30 cents, on average — $1 at most, and often just 10 cents or 15 cents — as a dispensing fee to fill a prescription.
A pill vial alone costs him about 20 cents. A label costs 4 cents. Transmitting a prescription electronically costs 16 cents. Labor costs to fill one prescription run $4.50.
And out of the drug reimbursements and dispensing fees, he also must pay his employees.
As Ost put it: “The math just doesn’t work.”
You may not think of a pharmacist as an essential healthcare worker because you don’t necessarily see them running around the emergency room at your local hospital, but these health care providers are more essential than you might think.
Pharmacists across the country are working on the front lines to ensure patient safety while putting themselves at risk every single day. In our current situation with the COVID-19 pandemic, pharmacists and pharmacy technicians are pumping out much more volume with much less support, including proper PPE. Anyone can walk up to a pharmacy counter, making the pharmacist the most accessible health care worker to patients across the country, but also putting the pharmacist at the highest risk for contracting the virus.
Yet, for some reason, pharmacists are not being recognized as essential.
The legislation, Helping Emergency Responders Overcome Emergency Situations (HEROES) Act of 2020, initially did not include pharmacists as beneficiaries and it wasn’t until the American Pharmacist Association (APhA) fought to include them, were they even considered and later added to the Act. Additionally, places like Starbucks, are offering free coffee to “essential” front line workers which includes police officers, firefighters, paramedics, doctors, nurses, hospital staff and researchers, but pharmacists were not mentioned and this holds true for other retail companies as well. With all the restrictions put in place, pharmacies remain open and yet the pharmacist is the last one to be recognized as essential, if at all.
In addition to the community, pharmacists are also in hospitals, distributing medications to patients on every floor. They are rounding with the infectious disease teams to ensure your loved one’s antibiotic doses are safe and appropriate while also serving in the intensive care units to keep patients alive.
Pharmacists are seeing patients in clinics to manage their chronic conditions to prevent an unnecessary ride to the ER. Pharmacists assist in areas where primary care physicians are scarce and serve as a reliable resource for drug information. Pharmacists are also found in laboratories and academic institutions, partnering with medical facilities to produce the latest and greatest research studies while also educating future pharmacists and preparing them for the front lines of our ever-evolving world.
The profession of pharmacy has transformed dramatically over the past 50 years, advancing from a Bachelor’s of Science degree to a Doctorate and shifting from primarily a dispensing role to functioning as a clinical provider integrated into the healthcare team. With these changes, pharmacists can go directly into the community, or they can complete post-graduate training and become specialized in a variety of areas including but not limited to oncology, infectious disease, pediatrics, emergency medicine, and ambulatory care. Pharmacists can also choose to become researchers, developing clinical trials to study patient outcomes or formulating the next life-saving medication. The profession of pharmacy is limitless when it comes to choosing a career, but one thing that is consistent with all of these opportunities; pharmacists are an essential part of the team.
The laws for pharmacist activities are governed by individual states and most now recognize pharmacists as providers, but it hasn’t always been that way. Alabama was the last state in the country to recognize pharmacists as providers in 2017; it was the 49th state to sign a bill to implement collaborative practice agreements between pharmacists and physicians. The next steps would be for the state to allow pharmacists to utilize and expand their “provider status” role, similarly to many other states in the country, and for the Board of Pharmacy and Board of Medical Examiners to fully implement the Collaborative Practice Act and enhance those partnerships within our communities.
Pharmacists are essential healthcare workers. Pharmacists are providers. To all my fellow pharmacists who are unseen, unheard, and unnoticed…I see you, I hear you, and I appreciate you.
By Nicole Slater, Pharm.D., BCACP, Assistant Clinical Professor at the Harrison School of Pharmacy’s Mobile campus
The Capitol Forum
Walgreens (WBA) and CVS Health (CVS), the Nos. 1 and 2 drugstore chains in the U.S., are accelerating efforts during the coronavirus outbreak to buy out rival independent pharmacies upended by the economic turmoil the pandemic has caused, the pharmacists said.
Independent pharmacists in West Virginia, Wyoming, Minnesota, Illinois and Georgia told The Capitol Forum that Walgreens has been especially aggressive with their solicitations, referencing the pandemic’s harsh economic impact in emails sent over the past 30 days.
“I know the market is really tough and hectic right now due to COVID-19 and [wanted to] see if you are looking to sell,” John Michael Vecchietti, a Walgreens senior analyst in retail mergers and acquisitions, writes to an Illinois pharmacist.
The persistent offers rankle the pharmacists, who accused Walgreens and CVS of using the global health crisis to grow their market shares. The pharmacists said their suspicions about CVS’s motivations, in particular, were compounded by pharmacy benefit managers (PBM), including market leader CVS Caremark, slashing the druggists’ prescription reimbursements recently.
“They are bullying us into selling,” said a West Virginia pharmacist who spoke on the condition of anonymity, fearing retaliation from Walgreens and CVS.
Two years ago, independent pharmacists accused CVS of taking advantage of its vertical integration to conduct a “squeeze and buy,” cutting prescription reimbursements through CVS Caremark and then offering to purchase financially weakened rivals.
Prescriptions are vital to these small businesses, constituting 93% of the $75.8 billion in revenue independent pharmacists generated in 2018, according to a report last year from the National Community Pharmacists Association (NCPA), an industry trade group.
The druggists have expressed their most recent concerns to lawmakers, including Representative Buddy Carter (R-GA), the only pharmacist serving in Congress.
“PBMs bring no value to the system, and now they are exploiting a global pandemic,” said Carter, a longtime critic of PBMs and co-chair of the Community Pharmacy Caucus. “This is absolutely unacceptable.”
Independent pharmacists have struggled for years to compete against chain stores’ scale and deep pockets, and to receive consistent reimbursements from PBMs, which are hired by companies and government agencies to keep their employees’ prescription costs as low as possible.
The pandemic has put many independent pharmacists in an even more financially precarious situation. Government stay-at-home orders and other social-distancing restrictions have reduced foot traffic in their stores.
The pharmacies have tried to encourage prescription home deliveries but said they’ve been thwarted by PBM policies diverting customers to the PBMs’ own mail-order services.
The pandemic’s impact on Walgreens and CVS is more mixed. CVS last month warned that the outbreak has increased operating expenses and reduced efficiency. Walgreens Boots Alliance, the international chain that operates Walgreens, reported last week that same-store sales rose 26% in the first 21 days of March. But sales then fell off in the last week of the month, a time when governments were urging people to stay home.
Walgreens Booth said that before the virus, it was on track to meet its annual guidance of flat growth. But “many rapidly changing variables related to the pandemic” have made it difficult to determine if the forecast now is accurate, according to the company.
Still, both companies have said they’re going to hire tens of thousands of new workers to handle higher customer demand.
A Walgreens spokesperson didn’t respond to multiple requests for comment about the pharmacists’ accusations. CVS spokesperson Mike DeAngelis said, “These are ridiculous claims that do not warrant a response.”
PBMs are supporting pharmacists during the outbreak, encouraging them to deliver prescriptions to customers’ homes, said JC Scott, president and CEO of the Pharmaceutical Care Management Association, an industry trade group.
“PBMs are working with the entire prescription drug supply chain, including pharmacists, to help patients access needed medications during this public health emergency,” he said. Scott’s full statement is here.
Express Scripts, the second-largest U.S. PBM, isn’t cutting reimbursements, said Jennifer Luddy, a company spokesperson.
“These assertions are false. Express Scripts has not made any changes to the way it reimburses network pharmacies,” she said. “We continue to reimburse them fairly and in a timely manner.”
A spokesperson for OptumRx, the No. 3 U.S. PBM, didn’t respond to a request for comment.
“Extraordinary time.” Pharmacists are adamant, though, that their reimbursements are shrinking while CVS’s and Walgreens’ solicitations are increasing.
Daniel Hay, a Walgreens senior analyst for retail mergers & acquisitions, begins one such email with a pandemic reference. “This is an extraordinary time in healthcare and in our world,” he says. “With this rapidly evolving situation, our industry is on the front lines of helping people worldwide.”
Then Hay makes his pitch to the pharmacist: “If there is anything Walgreens can do to help, either in the present or in the near future, please contact me directly.”
Walgreens representatives sent similar messages to drugstores in Illinois, Minnesota and Georgia, according to emails reviewed by The Capitol Forum.
CVS’s recent emails to pharmacists have been more direct. In one email, Yolanda Baez, a CVS regional director of pharmacy acquisitions, writes, “I wanted to reach out to you to find out if you would be interested in receiving an offer (with no obligation on your part) from us for your pharmacy.”
Pharmacists complain about reimbursement cuts. As the emails fill inboxes, PBMs’ decreasing reimbursements on some drugs have left some pharmacies cash-strapped, said Monique Whitney, executive director of Pharmacists United for Truth and Transparency, an advocacy group for independent drugstores.
CVS Caremark’s reimbursements for simvastatin, a drug used to treat high cholesterol and triglyceride levels, fell to $2.20 on Tuesday from $9.21 on December 31, a 76% drop, according to data obtained by The Capitol Forum.
The PBM’s reimbursement for hydrocodone, a popular painkiller, decreased to $22.67 on March 31 from $27.69 on March 2, an 18% reduction.
Patricia Epple, CEO of the Pennsylvania Pharmacists Association, complained in an op-ed Thursday that PBMs during the outbreak have cut reimbursements to antidepressant aripiprazole, heartburn medication omeprazole and some blood pressure treatments.
In Illinois, PBMs steadily decreased reimbursements last month, said David Falk, owner of SavMor Pharmacies, which has eight locations in the state.
“They are trying to push us over the edge,” he said.
In some cases, PBMs have put off paying reimbursements. Last month, OptumRx told Pharmacy First, a network of 2,300 independent pharmacies, that the payments were delayed due to changes related to the pandemic.
When the reimbursements arrive, they sometimes don’t cover the cost of buying and filling the prescriptions, said a Georgia pharmacist who requested anonymity out of fear of PBM retaliation.
With lower reimbursements, the pharmacists have less cash to pay for drugs, Whitney said.
Mail-order referrals. As more mayors and governors restrict people’s movements to slow the virus’ spread, independent pharmacists are trying to increase their mail-order and delivery business. About 76% of them make deliveries to home and work, according to the NCPA report.
But PBMs are hampering those efforts by diverting patients to their own mail-order services, the pharmacists and their supporters said.
Patient advocate Loretta Boesing, whose son needs medication every 12 hours to stay alive, said she’s pushing for PBMs to be more supportive of independent pharmacies.
Boesing is founder of Unite for Safe Medications, which advocates for alternatives to mail-order delivery.
“Independent pharmacies are vital to me and my child and the entire community,” she said.
Boesing, who lives in Park Hills, Missouri, a town of 8,600 people that’s 68 miles south of St. Louis, said she relies on a local pharmacy to fill prescriptions for her son, who underwent a liver transplant several years ago.
Because of PBM restrictions, many in Park Hills can only get a 30-day supply of medication from the pharmacy, she said. But PBMs allow customers to buy a 90-day supply through their own mailorder services, Boesing said.
She said recently her PBM, CVS Caremark, agreed to allow the pharmacy to sell her a 90-day supply of her son’s medication.
Health insurance plans and employers determine how much medication a person can buy at a drugstore, Express Scripts’ Luddy said. Express Scripts supports 90-day supplies purchased in a pharmacy or through mail order because people tend to take their medication more faithfully when they buy in such amounts, she said.
Drugstores urge government action. The delivery issue united independent and chain drugstores to press for provisions in the recent $2 trillion coronavirus aid package.
In a March 20 memo, organizations that represent both types of drugstores urged Congress to “instruct PBMs to allow 90-day prescription refills for patients by home delivery from any pharmacy of their choice or mail to include commensurate reimbursement.” The groups also asked for expedited reimbursements.
None of the PBM-related recommendations, though, ended up in the bill.
The NCPA now is pleading with the Centers for Medicare & Medicaid Services to issue guidance on reimbursements, and audit and delivery issues with PBMs, said Ronna Hauser, the group’s vice president of policy and government affairs operations.
Separately, the group is asking Walgreens and CVS to reconsider attempting to buy out their smaller competitors during the pandemic, she said.
“It is disheartening to see these type of letters at the time of the national emergency,” Hauser said.
For a PDF of this article click here
The coronavirus disease 2019 (COVID-19) pandemic is affecting the work of health care providers across the nation, and pharmacy technicians are no exception. However, in the midst of rapid industry changes and new demands, pharmacy technicians are meeting the challenge of these evolving roles and responsibilities head-on.
Recently, 12 pharmacy organizations in the United States jointly released a cohesive set of recommendations for policymakers to address the COVID-19 pandemic, including expanding pharmacists’ role in combatting the virus. As the role of the pharmacist is expanded to meet the greater needs of the public, so too will the role of the pharmacy technician within the pharmacy.
Jeremy Sasser, pharmacy content strategist at the National HealthCareer Association (NHA), told Pharmacy Times® that as quicker testing methods for COVID-19 become available, some states that allow pharmacists to administer point of care testing for chronic conditions, such as diabetes and hypercholesterolemia, and acute illnesses, such as strep throat and influenza, may allow pharmacists to administer these tests for the coronavirus.1
Pharmacies that provide such services must obtain a Clinical Laboratory Improvement Amendment (CLIA) waiver to do so since they are not a traditional lab. Pharmacy technicians can handle the paperwork required to obtain this waiver, according to Sasser.1
“As antivirals become available, it would be the hope that after a pharmacist administers such a test, with a positive result, then be able to prescribe treatment according to established guidelines. In order for pharmacists to do any of that, requires technicians to take up the slack in other duties in the pharmacy, such as possibly taking new verbal orders over the phone, or performing technician product verification,” Sasser told Pharmacy Times®.1
Amari Hopkins, a pharmacy technician based in Decatur, Illinois, is among technicians who have been shouldering more responsibility with hectic daily work operations. Hopkins told InStyle that her pharmacy’s scripts jumped from 300 to 600 a day in the past week.2 “We have way more customers, and way more people coming in. We have like a ‘will call’ wall with the filled prescriptions, and it’s usually pretty full, but now it’s empty because everyone’s coming to get their prescriptions.”
Much of the frenzy surrounding patients and their prescriptions follow new suggestions from organizations such as AARP, who have told patients to stock up a 3-month supply of prescriptions during the COVID-19 pandemic in case of a complete lockdown, Hopkins said.2-3
Sasser told Pharmacy Times® that unfortunately, even in the midst of a pandemic, chronic diseases don’t take a vacation.
“Medications to treat metabolic diseases such as hypertension, diabetes, and dyslipidemia must continue to be filled and available for patients who need them, [and] pharmacy technicians are well-poised to continue those services,” Sasser said.1
Currently, states such as Pennsylvania are allowing certain out-of-state pharmacies to ship goods into the state and will permit remote supervision of pharmacies by telephone or computer. This temporary ability for remote supervision allows pharmacy technicians and interns to additionally dispense medications with a supervising pharmacist on the premises. Additionally, it improves social distancing, practices which is currently recommended in pharmacies.4
In addition to their daily activities, pharmacy technicians can perform point of care testing in states that allow it. Sasser said numerous studies have shown outcomes that strongly favor the ability of pharmacy technicians to perform these tests, such as swabbing the nasal passage, throat, or performing a sterile finger stick.
“Bottom line is that, as pharmacies continue to provide more front-line direct patient care services, technicians will need to support all of the other operational duties that pharmacies will need to continue to provide,” Sasser said.1
However, the changes brought about by the COVID-19 pandemic present new challenges as well. Pharmacy technicians are put under immense stress in their pharmacy due to growing patient needs. Additionally, pharmacy technicians put themselves into harm’s way while working in a high-risk environment for infection. According to Sasser, health care workers should understand the risks involved with their daily work and undergo proper training, such as bloodborne pathogen training, taking effective hygiene measures, and wearing personal protective equipment (PPE) required to mitigate the transmission of disease.1-2
According to Sasser, following CDC guidelines and Occupational Safety and Health Administration precautions surrounding safe working conditions is vital to protect the staff from spreading the virus. As patients increasingly seek to obtain 3-month medication supplies, pharmacy technicians should look toward the use of drive-thru(s) or coordinating delivery of medications.1
“Understanding and informing patients about what [pharmacy benefit managers] are allowing given the circumstances, such as temporarily allowing early refills on chronic medications, can help ensure patients are stocked up on critical medications so as to limit the need for trips to the pharmacy,” Sasser said.1
Like most Americans, I’ve closely followed press briefings by the White House on the national response to COVID-19, looking for hints of public health expertise. What caught my attention most were comments from Ambassador-at-Large, Deborah L. Birx, coordinator of the U.S. Government Activities to Combat HIV/AIDS, and now a leading voice on the White House COVID-19 taskforce.
Rightly so, Ambassador Birx has earned a leadership role during this critical time, given her extensive leadership role in our global HIV prevention and treatment strategy. Her most astute comment, I believe, highlighted how “communities are at the center of this,” and that the virus should be stopped “at the community level.”
Providing COVID-19 screening access to the American people across all geographic and socioeconomic areas is critical, particularly given our collective and shared knowledge that exposure to COVID-19, like the flu, does not discriminate. Hospitals and urgent care clinics are apparent sites for screening.
In Westchester County, N.Y., drive-up screening for residents greatly improved access to screening and now similar drive-ups are being implemented in other states. But in places like Harlem, where I live, and neighborhoods like South Bronx and East New York-Brooklyn, as well as the vast non-urban areas across New York State and the nation, going to the hospital for a test may not be the most viable strategy.
They definitely should not be emphasized as our only community-reaching frontline effort. While drive-up screening aligns with the concept of social distancing, it is not accessible or practical for Americans living in densely populated urban centers, regardless of social, economic level, due to the high likelihood of gridlock.
As we conceptualize a comprehensive community COVID-19 strategy that gives all Americans access to screening services, I believe we must prioritize attention on increasing the number and types of screening access points. Simple math would tell us that with more access points and greater geographic distribution, the higher the ability for social distancing.
What has not been mentioned and exists in plain sight is the expanded public health role for pharmacies, which includes independent small business and minority-owned pharmacies. Many of us are familiar with pharmacies extending their practice beyond filling prescriptions to include blood pressure screening, flu vaccinations, and even co-located primary care clinicians.
A successful pharmacy practice innovation that arose out of the HIV epidemic and included a large proportion of independent, small minority-owned pharmacy businesses, were on-site HIV screening services in high risk, lower-income communities. The research revealed strong evidence of such practical and feasible screening services being able to reach those systematically disconnected from traditional healthcare access points.
Pharmacies are frequented by all segments of the population and typically located within 5 miles for 95 percent of all Americans. They usually have flexible hours and capacity to properly store and dispense all forms of pharmaceuticals, provide medication counseling and medical advice, and are known for their strong ties in their communities, particularly independently-owned pharmacies.
Taking this idea a step further, the rationale for pharmacy-based COVID-19 screening also supports the capacity for pharmacists to create linkage to treatments readily available and forthcoming, which are likely to arrive much sooner than a vaccine. Currently available COVID-19 treatment includes fever reducers, supplemental oxygen, and respirators – all of which are safely stored in pharmacies and could easily be scaled up.
While “big box” corporate chain pharmacies are being considered for a frontline role as suggested, it is critical to place more (or at least equal) attention on supporting the part of the independent, small business-owned pharmacies, who are frankly being overlooked. Independent pharmacies represent 36 percent of all U.S. retail pharmacies, with over 22,000 locations. These pharmacies are typically located in geographic areas where large chains are absent, including rural and lower-income urban areas across the U.S.
At a time when the administration is taking unprecedented actions to remove bureaucratic barriers and support small businesses in general, legislation should prioritize economic support for independently-owned pharmacies to purchase pharmaceuticals and supplies related to administering COVID-19 screening services. The White House should also prioritize policy that gives small pharmacy business owners access to high-cost medications that are exclusive to large corporate conglomerates.
Falling short in our public health response will not only extend the mounting fear, and disruption of American life, but will essentially weaken the positive impact of critical public health efforts employed thus far such as travel restrictions, school, and college closings, bars and restaurant closings, bans on crowded events, and social distancing.
We must think innovatively about COVID-19 screening access at the community level. The more viable and practical screening and treatment access points we put in place, the higher the likelihood of minimized chaos, crowded waiting lines, and an expedited return the social freedoms that we all took for granted will become possible again.
Crystal Fuller Lewis Ph.D. is an infectious disease epidemiology from Johns Hopkins Bloomberg School of Public Health and is currently an associate professor at NYU School of Medicine, Department of Psychiatry. Lewis has spent two decades conducting NIH funded research to expand access to HIV prevention and related social and medical services to high-risk communities.
Legislation to cut out the role of pharmacy benefit managers in handling Medicaid prescription drug claims won final passage in the Kentucky legislature Wednesday.
The Senate voted 30-1 to send the measure to Gov. Andy Beshear after it accepted changes made by the House. The bill would require the state's Medicaid program to pay pharmacies directly for prescription drugs, bypassing pharmacy benefit managers.
Lawmakers took action on stacks of bills amid uncertainty about how much longer this year's session will last because of the coronavirus outbreak. Wednesday was day 48 in the 60-day session scheduled to end in mid-April.
Senate President Robert Stivers said Tuesday that the goal is for lawmakers to finish their business “as quickly and expeditiously as possible, and then go home.” The biggest job for the Republican-led legislature is to finish work on a new two-year state budget.
The bill dealing with pharmacy benefit managers is among proposals being considered to shake up some inner workings of Kentucky's Medicaid program.
Republican Sen. Max Wise, the bill's lead sponsor, has said the current system funnels hundreds of millions in taxpayer money to companies to handle prescription claims.
Drugstores, especially in rural areas, have been hurt by the pricing and reimbursement practices of pharmacy benefit managers, or PBMs, he has said.
The bill's opponents include CVS Health, a national player in pharmacy benefit management. It says the measure is based on a “flawed analysis” and would be a “costly step backwards" for Kentucky.
In other action Wednesday, the House passed a bill to allow Kentucky consumers to have spirits, wine or beer shipped directly to their homes. The measure passed 52-33 and now goes to the Senate.
The bill would apply to producers only. It would also allow Kentucky bourbon distillers to ship their products directly to consumers outside Kentucky, if their states allow such shipments. The same would apply to the state's beer and wine producers.
The bill's supporters include the Kentucky Distillers' Association, which represents many of the state's bourbon producers. Kentucky produces about 95% of the world's bourbon.
“This important measure creates a model framework for the responsible shipping of alcohol that will allow our signature bourbon industry to market their products globally, creating more jobs, investment and local revenue for communities all across Kentucky,” KDA President Eric Gregory said in a statement.
Under the measure, consumers receiving direct shipments would pay the same taxes and fees that retailers face in their state. It also would put monthly limits on amounts of direct shipments — 10 cases of wine, 10 cases of beer and 10 liters of distilled spirits.
The bill is the product of lengthy discussions among alcohol producers, wholesalers and retailers.