In the midst of one of the most actively healthcare-focused legislative seasons in years, several states have begun to address the issue of PBM abuse by introducing legislation that attempts to rein in the unchecked power of the middlemen.
In Maryland, Brian Hose and Steve Wienner - two seriously committed pharmacists - led the fight along with the Maryland Pharmacists Association, Epic Pharmacies, and the Independent Pharmacies of Maryland for PBM reform that culminated in the recent passage of three bills that target unfair PBM practices and now require pricing transparency, and the elimination of DIR fees.
Because every big legislative win has its roots in small past victories, PUTT asked Brian and Steve to share their story and advice for other pharmacists working at the state level to enact change.
"This year was out of the ordinary," said Brian. "A lot of it was due to small changes that have been taking place in the years prior, when the PBMs would give us a small concession and then find a way to skirt the law, which would then set us back two steps. The legislators finally started to see what was going on and made some measurable changes this year."
“It's been years and years in front of the legislature,” said Steve. “I think a lot of people don’t realize that you’re not going to be involved for one year and get everything you want.”
Both Steve and Brian have spent more than five years actively testifying in front of the Maryland state legislature. They have participated in legislative work groups tasked with finding common ground and/or compromises between independent pharmacies and the PBMs; educated legislators on the intricacies and importance of NADAC; and driven home the value of independent audit firms as non-partisan, trustworthy resources for pending legislation.
Since PBM contracts prohibit pharmacies from informing the end payer about pricing and fees, they and their fellow pharmacists worked toward legislation that would allow a work-around. Said Steve, “If I pick up a phone and call them, I can’t say ‘your PBM is screwing me,’ but when the Maryland Insurance Administration drops 50 to 100 appeals on them and says ‘this is a problem and these are the drugs,’ now you have a 3rd party saying ‘you need to investigate that’.”
Insight, “outside the box” thinking and absolute tenacity have fueled their motivation to bring about real change in Maryland, which, like other states, has seen the closure of scores of pharmacies as PBMs cut reimbursements, increase DIR fees and use audit penalties as a means to improve their own bottom line.
Both Steve and Brian advise pharmacists to stay actively involved throughout the entire legislative process to achieve their ultimate goal. “We saw a big shift this year in the way that government agencies were behind us,” says Brian. “Before, they would try to be an impartial mediator through the process, this year they testified on behalf of these bills, they drafted language that strengthened the bills -- they were very involved.”
An added benefit to pharmacists remaining actively involved: Maryland legislators are beginning to understand the added value independent pharmacies provide patients. This is especially important in a state where, on average, there’s a chain drugstore within 10 miles of every citizen.
The proof is in the legislation passed. While HB 754 was not passed in its original form, (a sore point for many) these two feel that the combination of all 3 bills lay a solid groundwork for building upon next session.
Their advice for pharmacists entrenched in legislative battles in other states? Make sure you have someone in every step of the process. From the hearing to the work groups to the sub-hearing. It’s not easy, but someone’s got to be involved.
“We are advocates for our profession. We’ve been doing it for a long time, and we’re glad to see the success,” said Brian.
“Everyone has to give back to their profession in some way,” says Steve. “Some do it in academia, teaching, or study; some do trials in their store; the way we personally give back to our profession is through legislative activism.”
Some superheroes wear capes. This dynamic duo proudly wears lab coats!