Even During COVID, We're Still Fighting PBM Abuse

Between the pandemic and the vaccine race, the last 12 months have felt like an endless episode of Nightmare on Sesame Street brought to us by the letters C-O-V-I and D. And while “COVID fatigue” may or may not be an entirely too-polite term for the exhaustion and disappointment many of us feel over bungled roll outs and vaccine mongering by certain very large pharmacy chains, there is some good news. 

The war against PBM abuse continues, and PUTT is fixed on the front lines. We’ve seen promising forward movement in states that have either traditionally been PBM holdouts (Florida, where CVS’ now former CEO Larry Merlo resides) or strongholds like Arizona, home to the largest PBM mail order pharmacies and corporate home of CVS Caremark. 

Still, we’re realistic. We feel the frustration of having to start over again with a new administration. While President Biden has stayed the Trump Rebate Rule, a win for PBMs and literally no one else, we’re undeterred and will continue pushing for rebate kickbacks to end. 

DIR fees remain the #1 threat to independent pharmacies, and we’d be remiss if we didn’t take a moment to address the thrust of NCPA’s lawsuit, which seeks to move DIRs to the point of sale. While we appreciate the gesture, we strongly believe the push to increase transparency of DIR fees does little to alleviate the exorbitant financial burdens DIRs place on pharmacies. We’re exploring options, and will report back to members with our findings.

It’s often the small victories that matter most. States that included their community pharmacies in the vaccine rollout saw demonstrably better results than those who did not - and the gap was widely reported in the national news, raising the profile of independent pharmacies across the U.S.

Texas, New Mexico, Minnesota, Michigan, Wisconsin and now Arizona are taking their next steps toward meaningful PBM regulation, seeking to create or tighten laws that protect patients, payers and pharmacies. New Mexico, in particular, passed a comprehensive law in 2020 that greatly limits PBM overreach. Earlier this month, PUTT testified at the state’s House HHS committee on measures to help further strengthen the new law.

More states are passing laws to limit non-DIR transaction fees. PUTT is assisting independent pharmacy organizations to pass bills modeled after Texas’ successful 2015 transaction fee bill. Arizona’s bill recently passed the Senate and moves to the House next. We’re building a cache of evidence-based rebuttals against the opposition’s frequently -made points. Please contact us for more information about our evidence files. 

Keeping our members informed and empowered is a priority.  Please join us for the upcoming webinar “Big Insurance’s Money Machine: The Secret and Not so Secret Ways PBMs Make Money”, hosted by PUTT board member and webinar series organizer Nathan Mair. Space is limited, so be sure to register soon!

Also be sure to check out PUTT board member Dr. Jeremy Counts’ op-ed “Where’s the Vaccine?” inspired by our newest editorial cartoon. 

Thank you for your support of PUTT. As always, we welcome your input. YOU are the source of our goals and best ideas! 

Stay safe and well,

Monique Whitney
Executive Director