PBM Reform Podcast

The Implications of Rutledge v. PCMA | PBM Reform Podcast Series

We talk with Community Pharmacy owner Dr. Steve Moore, PharmD about the Implications of the Rutledge versus PCMA Supreme Court decision on Independent Pharmacy. 
About Condo Pharmacy: 
Condo Pharmacy is an independently owned and operated pharmacy dedicated to meeting the unique healthcare needs of each individual patient. In addition to providing both traditional and specialty pharmacy services, Condo Pharmacy is proud to be a part of the CPESN USA network of pharmacies and offer enhanced pharmacy services and care management protocols.
Special guest: Steve Moore, PharmD
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What You Need to Know about U.S. Supreme Court Rutledge vs PCMA | PBM Reform Podcast Series

Georgia House of Representatives Earl L. “Buddy” Carter joins CEO of RxSafe Bill Holmes to summarize the The Supreme Court of The United States (SCOTUS) has rescheduled the Rutledge v. The Pharmaceutical Care Management Association (PCMA) hearing for October 6, 2020.1 The initial April hearing date had been postponed due to the coronavirus disease 2019 pandemic (COVID-19)
Rutledge v. PCMA revolves around whether states have the right to regulate pharmacy benefit managers (PBMS). Arkansas Attorney General Leslie Rutledge has petitioned the court to overturn the US Court of Appeals for the Eight District’s earlier decision to maintain Arkansas’ statute regulating PBMs’ drug reimbursement rates. In a legal brief filed in February 2020, however, Rutledge argues the statute is preempted by the Employee Retirement Income Security Act of 1974.3
At least 4 pharmacy groups, The American Pharmacists Association, The Arkansas Pharmacist Association, The National Alliance of State Pharmacy Associations, and the National Community Pharmacists Association have publicly expressed their support for states’ rights to regulate PBMs.3 According to an earlier report, these 4 groups have jointly argued that unregulated PBM business practices limits access to pharmacists care and prevents the optimal use of medications.3
In April 2020, the Academy of Managed Care Pharmacy (AMCP) filed an amicus brief in support of the Eighth District’s decision.4 The brief argues that ruling in favor of Rutledge will drive up health care costs, and also will have a big effect on patients too by limiting their ability to access affordable medications, hindering health outcomes.4
The AMCP brief also argues that ruling in favor of Rutledge can lead to issues at the administrative level, and can lead to varying and possibly contradictory state laws as well.4
Supreme Court to hear Rutledge v. PCMA Oct. 6
The US Supreme Court has released its October 2020 oral argument calendar, with Rutledge v. PCMA now scheduled to be heard on Tuesday, Oct. 6. The case was originally scheduled to be argued in April but was postponed due to the coronavirus pandemic. Rutledge v. PCMA is a landmark case on whether states can adopt meaningful regulations on pharmacy benefit managers.
If you would like to contribute to the NCPA Legislative/Legal Defense Fund, your support would be much appreciated.
Resources
Brief of Arkansas Pharmacists Association, National Community Pharmacists Association, American Pharmacists Association, National Alliance Of State Pharmacy Associations, and Fifty-One Other Pharmacist Associations As Amici Curiae Supporting Petitioner
Latest Information on Rutledge v. PCMA
NCPA Analysis of Rutledge v. PCMA
Rutledge v. PCMA: 15 Years in the Making
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Creative Strategies to fight the PBMs | Anthony Reznik w/ IPA

Director of Government and Public Affairs for Independent Pharmacy Alliance (IPA) Anthony Reznik joins us on the PBM Reform Podcast Series to discuss strategies Pharmacy can implement to fight the PBMs while we wait for legal reform at the state & federal levels. 
Independent Pharmacy Alliance, est. 1988, is a trade group and retail pharmacy buying cooperative representing over 3,100 independent pharmacies in New Jersey, New York, Connecticut and Pennsylvania.  IPA represents its members for the purpose of combined purchasing to lower a pharmacy’s “cost of goods and services” as well as to provide them with comprehensive legislative advocacy, third party resolution support and free continuing education.
Additionally, IPA offers a Generic Source Program and competitive co-op contract pricing on such items as vitamins/nutritional supplements, diabetic supplies, greeting cards, managed care network, credit card processing, pharmaceutical returns, prescription vials and many other products/services.
Philly Inquirer: When insurers drop medications for cheap alternatives, the effects can be devastating for some patients
https://www.inquirer.com/philly/health/health-costs/step-therapy-formulary-changes-affect-patients-20180718.html-2
NYT: How Insurers are shifting high costs to the sick
https://www.nytimes.com/2014/09/18/upshot/how-insurers-are-finding-ways-to-shift-costs-to-the-sick.html
 
Anthony Reznik
Director of Government and Public Affairs
Independent Pharmacy Alliance
3 Cedar Brook Drive
Cranbury, NJ  08512
800-575-2667 Toll Free
Web:  www.ipa-rx.org
Twitter: @IPAPharmacies
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Georgia State Representative David Knight & GPhA Greg Reybold | PBM Reform Podcast Series

Georgia Gov. Brian Kemp (R) has signed three innovative PBM reform bills into law. HB 946 and SB 313 require the reporting of drugs paid 10 percent above and 10 percent below National Average Drug Acquisition Cost every four months, prohibit PBMs from tying a pharmacy’s drug reimbursement to a patient’s health outcomes, and require PBMs to offer drug coverage plans that do not include spread pricing and plans that allow plan sponsors to receive 100 percent of rebates negotiated by PBMs. 
HB 918 strengthens existing anti-steering provisions and the Pharmacy Audit Bill of Rights. Congratulations to the Georgia Pharmacy Association and all pharmacy advocates for these wins which will protect pharmacies, patients, and payers. 
Guests: Georgia State Representative David Knight
Greg Reybold Vice President of Public Policy and Association Counsel
Hosted by Lauren (Colee) Young 
Sponsored by The Georgia Pharmacy Association & Pharmacists United for Truth and Transparency (PUTT) 
 
http://www.gpha.org/membership/ 
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Antonio Ciaccia | PBM Reform Podcast

Antonio Ciaccia 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.  
Thinking that pharmacy would be in his rear-view mirror forever, he ended up making his way back to his pharmacy home, heading up government affairs for the Ohio Pharmacists Association, a trade organization with a strong track record of advocating for drug pricing transparency. After years of studying the pharmacy marketplace, Antonio became increasingly perplexed and concerned as he saw drug costs spiking while payouts to pharmacies were declining.
Knowing something was being lost somewhere in the middle of an ever-growing transaction, Antonio has spent years working to crack the drug pricing code and pull the rug out from what he believes is one of the most dysfunctional marketplaces in the world.
Sunshine in the Black Box of Pharmacy Benefits Management: Florida Medicaid Pharmacy Claims Analysis
https://www.3axisadvisors.com/projects/2020/1/29/sunshine-in-the-black-box-of-pharmacy-benefits-management 
This podcast episode was sponsored by P.U.T.T. 
https://www.truthrx.org/about.html 
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The Managed Care PBM Option | PBM Reform Podcast Series

A PROPOSAL FOR SMALL TOWN INDEPENDENT PHARMACISTS
A new trend has independent pharmacist = working directly with the businesses that are right there in the same community. While the small town environment is by its nature a concise marketplace, too often those local businesses get themselves into situations that does not make logical or financial success. Big insurance companies get involved, and suddenly money is going all over the country when it should be staying in your community.  When we set up our managed care pharmacy programs, the pharmacist is no longer competing with mail order houses, and the locals are no longer paying up to 40 percent more for these prescriptions than you need to. The money is being kept in the community. Another big advantage is you take a system that has been depersonalized over the years and personalize it once again. Imagine – getting better care at a better price from your local pharmacist who is also your neighbor.
For more information contact:
Publisher@PharmacyPodcast.com 
Call (412) 585-4001 
Sponsored by UltiGuard Safe Pack
The UltiGuard Safe Pack is the only pen needle product that comes with an all-in-one sharps container. Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy.
Learn more UltiGuard Safe Pack
https://www.ulticare.com/ultiguard-safe-pack/podcast 
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FL State Representative Jackie Toledo & Putt President Scott Newman | PBM Reform Podcast Series

Special Guest:
Jackie Toledo - Florida State House of Representatives 60th District 
A product of Tampa’s public schools, Jackie graduated from Gaither High School and was awarded an academic engineering scholarship to the University of South Florida from the Latino Scholarship program. In 2000, she received her degree in Civil Engineering from USF and wanted to stay in Tampa so she could help give back to our community that has given her so much. In 2011, she became the first scholarship recipient to establish a scholarship at USF to help and mentor a Latino student.
After graduating, Jackie became a Licensed Professional Engineer and worked on several transportation plans in the Tampa Bay area, including master plans for the University of South Florida and Hillsborough Community College, as well as Hillsborough County’s Long Range Transportation Plan, the Florida Aviation Systems, and the 2012 Olympic bid process. Recognized professionally as a Professional Traffic Operations Engineer (PTOE) and the recipient of the 2002 Florida State Institute of Transportation Engineer of the Year, she has made great strides in her field and has a unique perspective on solving Tampa’s infrastructure and transportation challenges. Today, she works at NUE Urban Concepts.
Jackie has worked tirelessly for the people of Hillsborough County, advocating for common sense solutions for our community. She has served as the Deputy Majority Whip, Co-Chair of the Women’s Caucus, the State Director of the National Foundation for Women Legislators and on numerous legislative committees.
Sponsored by UltiGuard Safe Pack
Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy. 
https://www.ulticare.com/ultiguard-safe-pack/podcast 
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Pharmacy Reimbursements Impact on Public Health | PBM Reform Podcast Series

The seventh episode in the PBM Reform Podcast Series features guest host Monique Whitney, the Excutive Director of Pharmacists United for Truth and Transparency (PUTT) interviewing pharmacy owners, Oliver's Express Pharmacy Oliver Lackey, PharmD and Main Street Pharmacy Owner, Jeremy Counts, PharmD. 
Two major trends are driving decreasing reimbursement to pharmacies: DIR fees and copay clawbacks. Direct and indirect remuneration (DIR) fees imposed on community pharmacies, sometimes weeks or months after a medication is dispensed, can eat up the pharmacy’s profit on a prescription transaction, and sometimes even lead to a loss.
According to a survey by the National Community Pharmacists Association (NCPA), 53 percent of pharmacists said DIR fees are assessed quarterly; 67 percent of those surveyed said no information is given as to how much and when DIR fees will be collected or assessed. DIR fees began when Medicare Part D was established, but they now appear in many commercial health insurance plans as well.
Episode & Summary sponsored by RxSafe
https://rxsafe.com/declining-reimbursement-the-facts/ 
Sponsored by the UltiGuard Safe Pack 
https://www.ulticare.com/ultiguard-safe-pack/podcast 
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The Unregulated PBM is a Danger to Public Health | PBM Reform Podcast Series

Pharmacists are trapped in a system that threatens patient safety.
Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA APhA Executive Vice President and CEO writes: If you ask me what keeps me up at night, I’d say it’s the kinds of mistakes that Ellen Gabler described in her January 31 New York Times story, “How Chaos at Chain Pharmacies Is Putting Patients at Risk.”  During my time as a community pharmacist, I cherished the relationships I established with patients and understood the great responsibility that came with the trust they placed in me.
Pharmacists take an oath to, among other things, “assure optimal outcomes” for patients. I can attest to the emphasis our profession places on patient safety. When it comes to medication-related errors, even one is too many.  Unfortunately, the current system sets pharmacists up to fail, and in turn, pharmacists are burning out at high rates.
This is an issue that not only puts patients at risk but deprives pharmacists of the opportunity to provide the kind of patient care we all got into pharmacy to provide. You can see it in the desperate pleas for change to state boards of pharmacy Gabler highlighted in her story. And we’re seeing it in the responses to those who have taken our Well-being Index for Pharmacists: The weight of the potentially dire consequences of filling the wrong prescription or missing dangerous drug interactions is crushing too many pharmacists. 
Special Guest:
Mike Schwab Executive Vice President
North Dakota Pharmacists Association
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A Pharmacy Owner’s Perspective | PBM Reform Podcast Series

On the 5th interview of the PBM Reform Podcast Series we talk with Scott Pace, Pharm.D., J.D. pharmacy owner and advocate for PBM Change. 
Scott is a Partner at Impact Management Group where he focuses on the Government Relations and Public Affairs practice areas.  
Scott joined IMG following more than 12 years with the Arkansas Pharmacists Association, most recently serving as the organization’s Executive Vice President and CEO.While at the APA, Pace successfully worked with the legislature to pass scope of practice legislation for pharmacists, legislation to amend the Arkansas Constitution to require a pharmacist consultant be a part of the Arkansas medical marijuana dispensaries, and most recently he worked with Governor Hutchinson and the legislature to pass legislation to license and oversee pharmacy benefits managers (PBMs) in Arkansas.
Scott is a licensed pharmacist and attorney.  He holds a bachelor’s degree in biology from Arkansas State University, a Doctor of Pharmacy from the University of Arkansas for Medical Sciences and a Juris Doctorate with High Honors from the University of Arkansas at Little Rock William H. Bowen School of Law. He served as the consumer representative on the Arkansas State Medical Board from 2012-2015 and he serves on the Arkansas Prescription Drug Monitoring Program (PDMP) Advisory Panel.
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