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For Immediate Release
New law by first woman legislator to take on PBM abuse would help make prescriptions more affordable at point of purchase; prohibit secret practices that drive up drug prices and force closure of community pharmacies TAMPA, FL (December 17, 2019) --- Pharmacists United for Truth and Transparency (PUTT) applauds Florida state representative Jackie Toledo, who today unveiled new draft legislation aimed at reducing prescription drug costs for patients at the pharmacy counter by outlawing certain secret practices of pharmacy benefit managers (PBMs) - the “middlemen” who act as intermediaries between a patient’s health plan and their pharmacy. Rep. Toledo’s bill, entitled the “Prescription Drug Cost Reduction Act” would provide immediate relief for patients, health plan sponsors/payers, pharmacy providers and Florida taxpayers by:
Bad practices have resulted in the closure of hundreds of Florida community pharmacies, which have left some of the state’s most vulnerable populations and those living in rural areas with fewer options for filling their prescriptions, a problem Ms. Toledo’s bill would ultimately fix. # # #
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FOR IMMEDIATE RELEASE
WINSTON-SALEM, NC (October 10, 2019) -- Pharmacists United for Truth and Transparency (PUTT) is calling on the Wisconsin General Assembly and State Senate to put aside their political differences and turn their collective attention back to patients who need access to medicine from their local pharmacies. SB 100 by Sen. Jon Erpenbach and AB 114 by Rep. Michael Schraa introduce legislation that would put the state’s patients and taxpayers ahead of crass profiteering in state-sponsored healthcare by pharmacy benefit managers (PBMs). “By now most states have learned that PBM middlemen have invented ways to generate outsized profits for themselves well above what could be considered reasonable and fair to patients and taxpayers,” said Scott Newman, PUTT president. “The fact that Wisconsin legislators had the foresight to begin drafting strong regulation that would keep state taxpayers from paying too much for Medicaid prescriptions is a testament to the commitment Wisconsin lawmakers have to their constituents. But we are greatly disappointed that bills introduced in February are still waiting for a vote because of political infighting. Wisconsin patients and taxpayers deserve better from their leaders.” SB 100 / AB 114 would disallow the kinds of tactics PBMs have used to develop revenue streams in the hundreds of millions from state Medicaid programs. If passed, SB 100 / AB 114 would:
PBMs have come under intense scrutiny over the last 12 months as states discover their Medicaid programs have been charged in excess of $200 to $300 million between what pharmacies were reimbursed and what PBMs charged state Medicaid for prescriptions filled. The spread pricing crisis first caught the public’s attention in 2018 when the State of Ohio discovered it had been charged more than $225 million above the cost of Medicaid prescriptions dispensed. A similar study in New York estimated taxpayers had been billed more than $300 million, while studies in Illinois and Michigan revealed similar findings. “Pharmacies cannot bear the burden of subsidizing their state’s Medicaid plan by being forced to accept below-cost reimbursements for prescriptions,” Dr. Newman said. “No business can sustain while being forced to lose money, and patients depend on their pharmacies for access to medications. As this trend continues we see more and more pharmacies in small and rural communities closing their doors and leaving patients with fewer options to obtain medication. This doesn’t have to happen in Wisconsin. We urge the state legislature to take action immediately and stop PBMs from absconding with millions in tax dollars that could be reinvested back in the state.” Pharmacists United for Truth and Transparency (PUTT) monitors PBM and other industry practices in the interest of improving the quality, safety and cost of patient care. To learn more about PUTT, visit TruthRx.org. “Foreign drug importation, while it may provide some superficial cost savings, will not provide the choice or value patients need .. and will not fix the problem of high drug prices.”
TALLAHASSEE, FL (April 19. 2019) - The non-profit advocacy group, Pharmacists United for Truth & Transparency (PUTT), has issued a formal warning for legislators and consumers against the legalization of prescription drug importation, which is currently being considered in Florida and other states in response to the high prescription drug price crisis. PUTT noted that “As pharmacists, our first concern is for patient safety. But we also know (a little too well) how drug prices force some patients into rationing medicine or not filling a prescription, and that legislators are responding to constituents’ concerns for drug cost. Still, foreign drug importation, while it may provide some superficial cost savings, will not provide the kind of choice or value patients need.” PUTT recently reviewed the public records for the CanaRx Program in Flagler County, FL and determined that even in a foreign drug importation program there are loopholes and opportunities for middlemen to profit. “There’s a reason why the PBM industry fights so hard to maintain opacity, why they resist the elimination of rebates and the inclusion of the true drug experts to help plan sponsors and patients save money with prescriptions in America. This is why PUTT stands for transparency in the prescription drug supply chain.” Some of the major points that PUTT noted in Flagler County’s CanaRx program: Transparency works. Under Florida’s “sunshine laws” we can see the 2018 quarterly cost reports for prescriptions available under CanaRx. On the report, the green highlighted items are prescriptions ALREADY available as generic in the U.S. True costs are never disclosed, even in a drug importation program. Flagler County’s plan incentivizes beneficiaries to use CanaRx by offering no copay on prescriptions through that plan. It sounds like a good deal, but what most plan sponsors don’t realize is the true cost of the drug - at least as it was paid to the pharmacy -- is never disclosed in the interest of keeping a “proprietary information” secret. This makes even a Canadian drug importation plan payer subject to spread pricing, and spread pricing drives up drug costs. Plan sponsors do not get access to their true claims data, at least not without threat of legal action, and even legal action is no guarantee if the State of Ohio’s case is any indication.For plan sponsors - even under CanaRx - It would be like paying your credit card each month without an itemized bill but under assurance from the credit card company you were getting “discounts” on your purchases. Canadian prescription imports as the solution to high drug prices is a fallacy. The assumption of lots of drugs available for cheap prices from Canada, just isn’t so. On the Flagler County prescription list, putting aside the green-highlighted U.S.-available generics, the remaining prescriptions narrow to less than 100 drugs in various dosing forms, strengths and combinations. Of this remaining list, there are some that have OTC substitutes or something VERY similar and already available in the U.S. as a generic for that class. Imported drugs are still subject to PBM rebates: Remarkably, the vast majority of the remaining prescriptions are the ones the PBM middlemen extract the most amount in rebates for inclusion - or as we learned in last week’s Congressional hearings - exclusive placement on plan formularies. So even the CanaRx list is subject to PBM rebates in the U.S. These drugs include inhalers, newer blood thinners and type 2 diabetes drugs. This rebate scheme can account for 50% or more of the medication’s cost. Where is the true savings if that game were eliminated as being discussed by the Federal government now? Benefits brokers contribute to high costs. Benefits brokers help steer health plan sponsors to the PBM who can best meet the plan payer’s needs. The CanaRx program was set up with the help of a broker. What most people don’t realize is that brokers aren’t just paid a fee for this service, many receive a commission on every prescription sold through the plan every month. PUTT has heard reports of commissions ranging from $10 to $20 or more per prescription per month, and brokers making in excess of 6-figures some of which comes from the pass- through income on these prescriptions, which is more than likely not disclosed to the plan sponsor. Pharmacists are in the BEST position to work with plan sponsors Pharmacists work with all types of medications on a daily basis and can speak to the cost- and outcomes-efficacy of the benefits plan. Pharmacists, unlike PBMs and brokers, do not have a financial stake in the benefits plan design because pharmacies do not set the price patients and plan sponsors pay. PBMs know this, and go to extreme lengths to prevent pharmacists from talking to end payers, including threat of legal action or removal from the PBM pharmacy network. PUTT’s recommendation to the problem of high prescription drug prices? “Transparency and the removal of the “safe harbor” exemption of kickbacks - not foreign drug importation - is what will make prescription drugs affordable again for Americans.” Florida Lawmakers Should Focus on the Real Issue: PBM “Middlemen” Profiting at Every Stage of the Prescription Drug Supply Chain
TALLAHASSEE, FL (March 29, 2019) – Following approval of the House Appropriations Committee for a bill that would allow the State of Florida and possibly individual citizens to import foreign drugs as an alternative to trying to afford the sky-high price of some prescription medications, Pharmacists United for Truth and Transparency is calling on lawmakers to reconsider this dangerous and risky proposition. HB 19 would allow the state to establish the Canadian Drug Importation Program with the intention of enabling the purchasing of prescription drugs at a discount price. The idea has been hailed by some as a way to stimulate competition in hopes of bringing U.S. drug prices down. “You know what else the U.S, drug market has that Canada doesn’t have other than unaffordable prescription drugs, Pharmacy Benefit Manager middlemen”, said PUTT President Scott Newman. “Florida lawmakers are choosing to ignore the well-documented affect PBM middlemen have on prescription drug pricing. Importing foreign drugs sends a bizarre and dangerously tone-deaf message to the state’s patients and consumers. Florida is the only state with no PBM regulation bills on the docket this year. This legislation is playing Russian Roulette with people’s lives.” These bad actors within the prescription drug supply chain, if addressed, would provide the people of Florida and the U.S. a clear view of how our drugs are priced and what percentage of the price consumers pay actually goes to pharmacy benefit middlemen positioned between the drugmaker, the patient and the pharmacy, Newman said. But the complexities of prescription drug pricing aside, there are several other reasons PUTT opposes “Canadian” and other foreign drug importation: ● Patient and product safety and liability are not guaranteed. Several studies point to the danger and fallacy of importing drugs from “Canada”. The reality of so-called “Canadian” drug sites is that most are not Canadian, nor do they sell Health Canada-reviewed or approved medications. A 2017 review by the National Board of Pharmacies showed many of these sites do not require a valid prescription - a troublesome prospect in light of the nation’s opioid crisis. Worse, several were found to sell counterfeit medications. 1. (Can we take out this bullet? I know it makes the safety statement) ... Here - let’s try this: Its not wise to expect another country to oversee and ensure the safety of medications as American consumers have come to expect with the FDA. (or something like that?) and then put in the sendense about patient importing. ● Canada does not support this idea. One previous Canadian lawmaker told another house committee that it is ILLEGAL for licensed Canadian wholesalers to export prescriptions priced for consumption by Canaidan citizens. Operating outside of their license brings not only stiff penalties by also possibly jail time. Depending on Canada under these circumstances will create a demand that cannot be supported and will ultimately disrupt their drug supply chain. It will lead to a “grey market” that only further calls into question the safety of these imported medications. We must remember that Canada’s population is only slightly larger than Florida’s -- and Florida, like Oregon and 14 other states, is seeking to implement a Canadian importation system. ● Importing drugs does not guarantee health plan savings. Pharmacy benefit managers (PBMs) have already limited the number of American wholesalers that pharmacies can use to purchase products for billing insurance plans. Even if safety could be guaranteed - which it can’t - opening the floodgates to importation, only to realize that PBMs have blocked use of Canadian wholesale medications for American insurance plans, is one more threat that will frustrate and break the hearts of Floridian patients. ● Temperature changes have been associated with reduced potency and diminished integrity of pharmaceutical products. There is no evidence to suggest importing from Canada to Florida will reduce the likelihood of medications damaged from extreme cold or heat. ● The savings that would be realized are not enough, even if the pharmacy were the “importer” of the drugs. While importing from another country could potentially reduce drug costs by 50 percent, for many patients, the discounted medication is still too high. What good is a $300 drug marked down to $150 if the patient has difficulty affording a $50 insurance copay? It is the extremely high price of medications, even generic, at the heart of the nation’s drug pricing crisis. ● The opaque system that favors the middleman would still exist. The fact remains that much of the activity conducted by PBM middlemen takes place behind closed doors, with no regulation requiring transparency or accountability. Some 85% of Americans are enrolled in pharmacy benefits plans designed and administered by only three PBMs, each of which is a part of larger healthcare or health insurance companies, and each one still operating without licensure (they are “registered” in Florida) and with very minimal if any regulatory oversight. ● Canada does not support this idea. It is illegal for licensed wholesalers in Canada to export medications and will lead to the loss of licensure for any Canadian pharmacists who export medication. Depending on Canada under these circumstances will create a demand that cannot be supported and will ultimately disrupt their drug supply chain. It will lead to a “grey market” that only further calls into question the safety of these imported medications. We must remember that Canada’s population is only slightly larger than Florida’s -- and Florida, like Oregon and 14 other states, is seeking to implement a Canadian importation system. “Pharmacies and patients have a sacred relationship,” said Monique Whitney, PUTT Executive Director. “If something goes wrong in the foreign drug importation process, patients will turn to their pharmacies for help. It makes better sense to avoid the risk all together by focusing on the real driver of high prescription drug medications - the PBMs.” “We believe the simplest solution is the best solution. Importing medications is not simple - it is risky and adds one more layer of complexity. The simplest solution is to require transparency of prescription drug benefits programs and the PBMs who design and manage them,” said Ms. Whitney. “Throwing back the veil of secrecy allows everyone to know and understand how drugs are priced, including where and how price markups are determined, and what can be done to bring high prices back down to affordable levels.” “On behalf of Florida’s pharmacies, we are asking the State of Florida to do the right thing, to take the potentially more difficult path, and work with healthcare providers and healthcare business leaders to resolve the problem for Floridians and to hold the health insurers and their contracted benefits managers accountable for their significant role in the unnecessarily high cost of American prescription drugs,” said Newman. Originally intended to process prescription claims, PBMs portray themselves as helping reduce costs. However, PBMs are nothing more than the “middlemen” in the pharmacy industry. The largest PBMs have been widely documented and fined for antitrust activities including questionable pricing, unfair practices and passing on costs that make it difficult for all, including the largest pharmacy chains, to do business. The result is an unlevel playing field that has forced hundreds of independent pharmacies, often serving small and/or rural communities, out of business. 1. Rhode Island Medical Society, “Is Importation of Drugs from Canada the Answer?” Oct. 2018 https://bit.ly/2V5MU5g Pharmacists United for Truth and Transparency (PUTT) exists to unify, promote and preserve independent pharmacies through education and access; to monitor PBM and other industry practices which, when identified as abusive, are exposed in various manners in the interest of improving the quality, safety and cost of patient care. For more information about the negative impact of Pharmacy Benefits Management company practices on the cost and accessibility of medications, or to learn more about PUTT, visit TruthRx.org or contact Monique Whitney, (505) 480-4150.  “DIR” Fees Meant to Lower the Cost of Prescription Drug Coverage for Seniors May Be Going to Pharmacy Benefit Managers Instead WINSTON-SALEM, NC (February 14, 2018) -- On the day traditionally reserved for honoring matters of the heart, Pharmacists United for Truth and Transparency (PUTT) released the heartbreaking results of a survey measuring fees PBM middlemen charged independent and community pharmacies for filling prescriptions under Medicare Part D in 2017 and 2018. The fees, called direct and indirect remuneration, or DIR, are supposed to reward patients and pharmacies for achieving certain therapeutic and health-related outcomes by reducing plan plan premiums and out of pocket expenses but appear to instead have become a secondary revenue generation stream for pharmacy benefit managers (PBMs). In a survey of nearly 600 independent pharmacies, PUTT found PBMs had charged average per-store DIR fees of $74,711 in 2017 and average per-store DIR fees of $129,614. The $54,903 difference represents a 74 percent increase in a single year. If all of the approximately 22,000 community pharmacies paid the 2018 average, PUTT estimates PBMs would have returned some $2.85 billion back to CMS and Medicare patients. “At a time when the Health and Human Services Department is reporting a decline in Medicare Part D for 2018 and a projected decline in Part D premiums for 2019 (1) , we are deeply concerned to see the burden of DIR fees have not only NOT decreased, they have increased nearly 50 percent in one year,” said PUTT president and independent pharmacy owner Scott Newman. “The purpose and intention of claiming these fees at the pharmacy level was to encourage adherence and foster an environment in which patients and providers could partner to achieve the patient’s healthcare goals. Instead, pharmacies are carrying the financial burden of the DIR fees, patients are being cut off from their pharmacies and PBMs are raking in billions in profit they may or may not be sharing with CMS.” PUTT conducted the survey in response to the Centers for Medicaid and Medicare (CMS) proposed rule “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Out of Pocket Expenses”. The new rule provides patients and their providers with greater transparency of information related to expense and availability of prescription medication options. Such transparency will also allow pharmacies to know upfront the amount in DIR fees they will pay per Medicare-covered prescription. However, for most independent pharmacies, DIR fees have become a costly and unsustainable expense they must shoulder if they want to help patients with Medicare fill their prescriptions. Under the DIR program, pharmacies are supposed to be able to recoup fees if their patients meet certain preset healthcare outcomes. Additionally, pharmacies are rated under the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuiPP), a standardized quality measure that provides unbiased benchmarked performance data to health plans and community pharmacy organizations. The average EQuiPP rating among pharmacies participating in PUTT’s survey was 4.6. Pharmacists United for Truth and Transparency (PUTT) monitors PBM and other industry practices in the interest of improving the quality, safety and cost of patient care. To learn more about PUTT, visit TruthRx.org. # # # 1. https://www.cms.gov/blog/proposed-changes-lower-drug-prices-medicare-advantage-and-part-d The offer the chance to get the money back if you meet certain goals. You could have 100% compliance with therapeutic goals and outcomes and still not get that money back. WINSTON-SALEM, NC (January 16, 2019) -- Pharmacists United for Truth and Transparency
(PUTT) is calling out the Florida State Board of Pharmacy for non-compliance with Florida law requiring at least two members to be pharmacists “practicing in a community setting” and for allowing the participation of two appointees currently serving in executive positions at CVS Health and Walgreens while their employers are engaged in a lawsuit brought by Florida Attorney General Pam Biondi alleging exploitative practices that contributed to the nation’s opioid crisis. “The Board of Pharmacy is responsible for pharmacy compliance, ensuring the safe practice of pharmacy and care of patients but is not itself compliant according the rules of the State of Florida,” said PUTT President Scott Newman. “No state can afford to have its pharmacy board operate in a condition of non-compliance. We’re asking Governor-elect Ron DeSantis to review the current roster of Florida’s Board of Pharmacy and to restore order and compliance with new appointments.” Florida law requires the nine-member Board of Pharmacy be composed of 7 pharmacists licensed in the State of Florida with at least four years’ active engagement in the practice of pharmacy in Florida. Of the seven, two must be actively practicing pharmacy in a community setting, two must be actively practicing in a Class II institutional pharmacy (e.g. hospital pharmacy) and the remaining three must be practicing pharmacists regardless of practice setting. Currently only one member of the Florida Board of Pharmacy, David Wright, is a practicing community pharmacist while two other members work in executive positions at CVS Health and Walgreens. Because both CVS and Walgreens have been named in Attorney General Biondi’s sweeping lawsuit against opioid makers and distributors for racketeering and engineering an “endless campaign” to supply Floridians with opioids, PUTT is calling on Governor DeSantis to replace Board members Jeenu Phillip and Jeffrey Mesaros with appointees whose organizations are free from questions of ethical violations and possible public harm. WINSTON-SALEM, NC (December 14, 2018) -- Today Pharmacists United for Truth and Transparency (PUTT) and the Pharmacists Society of the State of New York (PSSNY) jointly filed a motion asking U.S. District Court Richard Leon to stop CVS and Aetna from further integration while the Court determines the merger’s potentially harmful effect on consumers and smaller competitors.
“We strongly believe the Department of Justice’s decision is shortsighted,” said PUTT President Teresa Dickinson. “History has shown that when CVS acquires rivals, consumers pay more and service and quality suffer. Past acquisitions have enabled CVS to restrict consumer access and force them to use more expensive drugs. That’s why the California Commissioner of Insurance, major consumer groups such as Consumers Union, the American Antitrust Institute and the American Medical Association (AMA) - the nation’s largest group of health care providers - all stated the merger should be blocked.” PUTT, PSSNY and numerous independent pharmacy associations have previously joined the AMA, consumers and patients groups in vigorously protesting CVS Health’s acquisition of Aetna Inc., pointing to the loss of one more choice for consumers and decreased access to their local providers as reasons to block the merger. Additionally, both organizations have addressed the dangers the merger of the nation’s largest pharmacy retailer and third-largest health insurer presents to smaller healthcare providers to maintain access to, and care of, their patients. Pharmacists United for Truth and Transparency expresses its thanks and appreciation to reporters Lucas Sullivan, Catherine Candisky and the editorial staff of the Columbus Dispatch
Pharmacists United for Truth and Transparency (PUTT) congratulates Florida governor Rick Scott and the Florida State Legislature for passage of HB351 — the “PBM Transparency Bill” — into law this week.
In time with a newly-released report by President Trump’s Council of Economic Advisors that calls for transparency among the largest pharmacy benefits management companies (PBMs) in order to help reduce the high cost of prescription medications,
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