PBM Reform Podcast

Coverage is not Care with David Balat | PBM Reform Podcast

Openness. Competition. Transparency.
Unmask the twisted economics of the American health care system.
Price discovery — prior to care — allows patients to shop for care in a competitive market. It empowers them with the information they need to reduce their healthcare costs. And it encourages providers and insurers to compete for their business.Report: Free2Care’s Rx for Reforming America’s Predatory Healthcare System A Physician-Led Roadmap to Patient-Centered Medical Carehttps://free2care.org/files/report.pdf 
 
The PBM-Insurer Mafia Comes for Community Pharmacies
UnitedHealth, CVS, and Cigna’s PBMs are using their market share and pull in Washington to drive one of the key levers to manage health care costs—independent pharmacies—out of business.https://prospect.org/health/2024-03-21-pbm-insurer-mafia-community-pharmacies/About David Balat:David Balat is the founder of Healthcare Finance Specialists and has broad experience across the healthcare spectrum with special expertise in health care finance. He is a former seasoned hospital executive with over 20 years of healthcare industry leadership and executive management experience.
Balat has earned the privilege of being invited to testify before the U.S. House Committee on Oversight and Reform in Washington, D.C., and before various House committees in the Texas state Legislature. He is a published author and op-ed columnist in Newsweek, U.S. News & World Report, Real Clear Politics, and other news outlets. He is also an active speaker and commentator on matters of health policy, health care finance, and health care reform.via decent.com 

Pennsylvania Moves Forward with PBM Reform | PBM Reform Podcast

Pharmacy owner Tom DePietro, PharmD and Pennsylvania State Representative Jessica Behnam join the PBM Reform Podcast to discuss the major win for Pennsylvania tax payers and Pharmacy Care. HB 1993 is the result of bipartisan efforts – led by state Rep. Jess Benham (D-36) – to ensure that Pennsylvanians are no longer being screwed and that access to local, independent pharmacies is maintained.Gov. Josh Shapiro last week joined Pennsylvania Insurance Commissioner Michael Humphreys, members of the General Assembly and local pharmacists at Thompson Pharmacy in Blair County for a ceremonial bill signing of bipartisan reforms in the 2024-25 budget. The reforms aim to increase oversight of pharmacy benefit managers (PBMs), the hidden “middlemen” of the pharmaceutical supply chain who largely go unchecked and unregulated as they negotiate the price of prescription drugs, passing the costs down to Pennsylvanians.Shapiro recently signed House Bill (HB) 1993 into law, providing stronger protections for commercially insured patients in the commonwealth and increasing regulatory oversight of PBMs.

Broken Insurance & the Loss of a Son | PBM Reform Podcast

Special Guests: Shanon Schmidtknecht & Loretta Boesing Cole Schmidtknecht was a 22-year-old young man living in Appleton, Wisconsin who loved video games and sports. His parents Bil and Shanon described him as an inspirational free spirit with a love for being heard. Cole was diagnosed with severe asthma at only a year old. He had just recently moved out on his own with opportunities to chase his dreams, until his life was cut short earlier this year. “January 10th,, he went to the pharmacy to get his prescription and was told it was no longer covered by his insurance,” said Shanon. He was told there was no alternative option and no generic drug would be covered. Cole didn’t know how to respond and couldn’t cover the extreme out-of-pocket cost of his Advair inhaler on a $19/hour income. An inhaler-dependent patient left the Walgreens Pharmacy with no medication. Five days later he suffered an extreme asthma attack and was taken to the hospital. He arrived at the Emergency Room lifeless and spent the next six days in the ICU on a ventilator.  
“We were told he’s never going to wake up again,” said Bil.   
A generic version of Advair only costs $15-$20. What happened to Cole is happening all over the country, according to Hometown Pharmacy co-founder Dan Strause.
“Unfortunately, we see even the state plan now no longer will allow for the generic, they force people into the brand. Why? It’s not hard to figure out it must be about the profit margin. Unfortunately, they’re making people decide between life-saving medicine [and paying bills, even though] the cost of the actual item is so low,” said Strause.
“We find this absolutely wrong, its infuriating we should all be angry, and we hope you tell your legislators this needs to be addressed sooner than later,” said Strause.
Hometown Pharmacy had to close a location in St. Germain partially due to the influence of PBMs. A pharmacy benefit manager acts as a middleman between drug manufacturers and pharmacies.
In the last state legislative session, the pharmacy benefit manager regulation bill wasn’t brought to a vote. The bill was designed to create transparency in the system and prohibit the PBMs’ control over the pharmaceutical industry as a whole.
“We’re very frustrated that it never got a chance to be voted upon,” said Strause.
Strause said there is a lot of speculation as to why the bill didn’t make it to the floor.
“In politics, there’s a lot of moving parts and we believe that the recent vote for Wisconsin mapping is part of it, because there’s a lot of energy and focus with what the next election is going to be and of course elections are very expensive, and you have to fund those elections.
Strause believes that money from lobbying groups associated with PBMs have a strong influence on lawmakers.
“Unfortunately, it means that money and influence is a significant factor in us passing bills especially ones that affect all of our lively hoods and our health,” said Strause.
Bil and Shanon said after learning of PBMs and the tactics that cost them their son they were angry and decided it was time to speak up.
“I don’t want you to ever have to imagine, I don’t want anyone to ever have to experience this,” said Shanon.
Their goal is to share Cole’s story and raise awareness.  
“We just kind of feel like this is now our fight to fight for him. If we can prevent it for one other person just that alone would be a little solace or a little something I know we can never have our son back, he’s gone,” said Bil.
Cole’s situation is not the only one, and this could happen anyone. Everyday life saving medications are becoming inaccessible to patients who need them.
“We need our senators and our congressmen to help this process that’s why they’re there in office for our complaints, our concerns our needs and the games that are played are just costing lives,” said Bil.    
From Shauna Johnson on Mar 11, 2024 via wjfw.com 3217 County G Rhinelander, WI 54501Reference Webiste: https://patientprotector.us/home 

If You Can't Beat Them, Don't Join Them? | PBM Reform

The PBM Reform Podcast on the Pharmacy Podcast Network, with your host, Breck Rice! Breck has had the privilege of being around and working with pharmacies for over 20 years! He loves community pharmacies and will do everything in his power to help them be successful. It’s a privilege to be involved in reforming the industry he loves. Today's guest is Kyle McCormick, owner of Blue Berry Pharmacy, in Pittsburg Aria, PA. Kyle beats the PBMs by not joining them! He runs a cash-pay-only pharmacy, with no PBM contracts. Kyle believes that if more pharmacies would kick out the PBMs they would have to change their unfair ways and give better reimbursements.

The Role PBMs has in Driving Up Drug Costs for Patients | PBM Reform

Interview with Howard Danzig, President of Employers Committed to Control Health insurance Costs.

What is Congress doing to help with PBM Reform? | PBM Reform

Are the PBMs a threat to Public Health? | PBM Reform Podcast| PBM Reform Updates

Anthony V. Minniti, RPh FACA joins the PPN on the PBM Reform Podcast to talk about why the PBMs, in their current state need to be removed from pharmacy care.As drug prices soar, the White House is taking action by hosting a pivotal listening session on Monday, aiming to dissect and potentially reform the practices of pharmacy benefit managers (PBMs). This roundtable will unite federal representatives and industry insiders, including Mark Cuban of Cost Plus Drug Company, to scrutinize PBMs' roles in shaping drug coverage and pricing. The focus is on the opaque dealings of PBMs, which many argue contribute to inflated costs for both consumers and the broader healthcare system.Shocking revelations unveil steep markups by the leading #PBM affecting West Virginia's public employees. The mail-order pharmacy owned by the PBM has been reimbursed as much as 100 times more than other pharmacies for specialty medications. This concerning pattern underscores the urgent need for increased transparency and accountability measures for #PBMs. Pharmacy benefit manager (PBM) reform has emerged as a bipartisan priority in a divided Congress, as both Republicans and Democrats have advanced a myriad of bills that would begin to address PBMs, their lack of transparency, and misalignment of the market. At the same time, lobbyists that represent large PBMs continue to argue that drug companies (not integrated PBMs) are to blame for high employer or patient costs.

The Volunteer State takes a Stand on PBMs | PBM Reform

Featuring Tennessee State Senator & Pharmacist Shane Reeves"The Volunteer State" has been a Tennessee nickname since the 19th century but wasn't officially voted on until February 2020. Tennessee sent 1,500 volunteer soldiers during the War of 1812, and the nickname stuck.Requiring PBMs to contract with rural independent pharmacies: In Tennessee, there are 70 counties considered rural out of the 95 counties in the state. Tennessee lost 15 rural hospitals over the last few years, so healthcare access is an issue. Most of these towns have a community pharmacy which is the access point for a lot of health care and health care information for many Tennesseans. About Shane Reeves: Man of Faith, Husband, Father, CEO, Pharmacist, Public Servant (TN State Senator)As CEO of TwelveStone Health Partners, Shane's mission is to be the regional leader in post-acute chronic care pharmacy management, placing patients and their families at the center of everything he does. As faithful stewards, Shane leads his team to strive every day to glorify God. 

PBM Reform Efforts Stalled in Congress | PBM Reform

In the Senate, there are 3 committees that have advanced legislation on PBM reforms, with leadership supporting a floor vote before the end of 2023. In the House, a consolidated bill was released in September and although there are plans for a full House vote, they are stalled due to the current issues in Congress.There are 3 key jurisdictions and proposed plans of the Senate that focused on in the session: The Finance Committee, including Medicare and Medicaid; the Health, Education, Labor, and Pension (HELP) Committee, including plans that regulate under the Employee Retirement and Income Security Act and the Affordability Care Act; and the Commerce Committee, including interstate commerce and the Federal Trade Commission (FTC).
The Finance Committee Package includes the prohibition of spread pricing in Part D for Medicaid and Medicare managed care. The Part D rebates must also be passed through the prescription drug plan sponsors, used to lower the costs for prescription drugs with a 100% pass-through in Medicaid managed care, according to Andel.Reference:https://www.pharmacytimes.com/view/amcp-session-provides-updates-on-pbm-reform-efforts-currently-stalled-in-congress GuestsErich Cushey PharmD - Pharmacy Owner Curtis Pharmacy Seema Kazmi, PharmD Seema currently serves on the Board of the Pennsylvania Pharmacists Association as a Practice Setting Director for pharmacists in Managed Care, Pharmaceutical Industry, Government Affairs and other practice settings. Dr. Kazmi has been a pharmacist for over 17 years and started her pharmacy career as an overnight community pharmacist in Levittown, Pa.  Dr. Kazmi is a graduate of Philadelphia College of Pharmacy and is a licensed pharmacist in six states, serving in leadership and management roles in managed care, pharmaceutical industry, community pharmacy, long-term care, and public service. Seema Kazmi, PharmD currently serves on the Board of the Pennsylvania Pharmacists Association as a Practice Setting Director for pharmacists in Managed Care, Pharmaceutical Industry, Government Affairs and other practice settings. 

MISSION CRITICAL: Reform the Mysterious PBM System with Antonio Ciaccia | PBM Reform

Antonio Ciaccia is the President of 3 Axis Advisors. He was born and raised in pharmacy, Antonio has been crawling around pharmacies his entire life. After three years as a pharmacy technician and two years of pre-pharmacy curriculum, Antonio diverted course, graduating from The Ohio State University in 2007 with dual degrees in communications and political science before moving into the world of association management.3 Axis Advisors brings unique approaches to address the individual needs of each or our clients. As researchers and investigators at heart, 3 Axis endeavors are laser-focused on discovery through data-driven analysis and deep industry expertise, resulting in innovative and unique solutions. 
Our obsessive passion for understanding complex systems and our immersion in the prescription drug supply chain and the broader healthcare delivery system enables us to arm our clients with the tools they need to accomplish their goals.Reference: Ohio regulator’s proposed pharmacy rules draw mixed response New regs meant to promote safety at understaffed storeshttps://ohiocapitaljournal.com/2023/10/02/ohio-regulators-proposed-pharmacy-rules-draw-mixed-response/