https://fox2now.com/news/contact-2/protesters-gather-to-speak-out-against-pharmacy-benefit-managers/

ST. LOUIS – Dozens of protestors are making sure they were seen and heard Friday morning outside Express Scripts in north St. Louis County. 

They say pharmacy benefit managers, like Express Scripts, are manipulating drug prices, steering patients to their own mail and retail pharmacies and creating obstacles for patient access. Park Hills, Mo., resident Loretta Boesing organized the event.

“The fight will continue until we get justice, until we get protection as patients, until there’s justice for every pharmacy that’s closed due to their monopolistic practices,” Boesing said.

FOX 2 first met Boesing in 2018 after her family was forced by insurance to switch to a mail-order pharmacy. Her son’s medication was poorly packaged and damaged in the heat. The dose sent him into liver rejection, and he was lucky to survive. The experience spurred her activism.

“We need more protection. We need the FTC and our legislators to do more,” she said.

Local independent pharmacy owner Jerry Callhan took part in the protest. Since 2019, we’ve chronicled his growing criticism of pharmacy benefit managers, the impact on his patients and his business.

“People need to understand how they’re getting shafted by the PBM industry” Callahan said.

Friday’s protest had national reach. Himanshu Patel owns an independent pharmacy in Chattanooga, Tenn.

“It’s about life and death for me. It’s either come here and fight or stop working as a pharmacist and do something else,” Patel said.

Doug Hoey is CEO of the National Community Pharmacists Association.

“There’s legislation that’s been passed in the house, but we need the senate to take it up. And there’s also legislation that would help with Medicare, which is a third of the business of the average pharmacy,” he said.

Missouri Democrat Lucas Kunce, who attended the protest, says he’d fight for it if elected to the U.S. Senate.

“We need to use the Federal Trade Commission, the Department of Justice, we need to use all the tools at our disposal to just enforce the monopoly laws we have, break these guys up and protect us from their predatory actions,” Kunce said.

Express Scripts gave FOX 2 the following statement:

“The health of our customers is at the center of all we do. We work relentlessly to ensure our customers can access their medications at the lowest possible cost and in the way that is most convenient for them. Our flexible pharmacy networks include pharmacies of all scales and sizes, including large chains, regional and independent pharmacies, as well as home delivery options.”

Express Scripts

“We hadn’t had something that brought us all together and united us against these corporations. That is my goal here today. This is just the start. This is only the beginning,” Boesing said.

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On ‘This Week in Pharmacy’ we’re blowing the doors off the story in Georgia how Owners of independent pharmacies are criticizing Governor Brian Kemp’s decision this week to veto legislation aimed at rectifying a situation that has left them at a competitive disadvantage with pharmacy chains. We’re also talking about Identification Technolgies driven by A.I., by Alitheon, with a huge impact to the world of counterfeit medications. Independent Pharmacy Owners in Georgia take another blow to the face as their businesses and PublicHealth Services to their communities are threatened by the latest decisions on Senate Bill 198. Owners of independent pharmacies in Georgia are criticizing Gov. Office of Governor Brian P. Kemp ’s decision this week to veto legislation aimed at rectifying a situation that has left them at a competitive disadvantage with pharmacy chains. Senate Bill 198, which the state House and Senate passed with only one “no” vote, would have required the State Health Benefit Plan (SHBP) covering teachers and state employees to reimburse independent pharmacies filling prescriptions at rates no less than the average reimbursement provided to chain pharmacies. Full article here: https://lnkd.in/epQsshEB This is State Representative Buddy Carter’s home state and as a pharmacy owner, I am sure he’s in disagreement with this decision which will exacerbate the problems our Georgia State Independent pharmacies are facing, causing many to face financial problems and some pharmacies will be forced to close. To add to this story, PPN was informed that the President of the Georgia Pharmacy Association Mr. Joe Ed Holt was fired from PruittHealth for publicly disagreeing with the decisions of Georgia State Governor Kemp vetoing SB198 which makes reimbursement for Independent Community Pharmacies unfair compared to mail order and chains?? “Fraudulent and unidentified goods infiltrate nearly every industry, damaging businesses, economies and livelihoods, as well as risking public health and safety,” said Roei Ganzarski, CEO of Alitheon. “TIME’s recognition of FeaturePrint as a leading invention puts this growing problem in the spotlight, where it should be.” Alitheon’s FeaturePrint enables you to trace and authenticate any individual items wherever they go and along the way, including medications. On the assembly line or in the marketplace, track and trace the one in the millions and know with certainty, that they are not being swapped, changed, or faked along the way.

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A shocking revelation by Congress is calling into question Americans’ right to privacy about their health, and if private medical data can be used criminally against you. In a letter to the Department of Health and Human Services, lawmakers share their concerns over how the nation’s largest pharmacy chains handle requests for records from law enforcement, which do not require a warrant. Healthcare attorney Harry Nelson breaks down what is happening. #Health #Pharmacies #medicalrecords “NewsNation Now” is a no fluff, no filler newscast hosted by Nichole Berlie and Connell McShane featuring up-to-the-minute news drawing from a network of journalists across the U.S. Weekdays starting at 1p/12C. NewsNation is your source for fact-based, unbiased news for all America. More from NewsNation: https://www.newsnationnow.com/ Get our app: https://trib.al/TBXgYpp Find us on cable: https://trib.al/YDOpGyG How to watch on TV or streaming: https://trib.al/Vu0Ikij

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https://www.wjfw.com/news/it-has-everything-to-do-with-politics-and-money-and-had-nothing-to-do-with/article_65021442-0f0b-11ef-8231-7fc629d78536.html

Pharmacy benefit managers or PBMs for short, now wield nearly limitless power and influence over the prescription drug market owning at least 85% of pharmaceutical industry. Their tight grip on the market has allowed them to engage in unfair pricing practices with very little oversight. They can raise the price you and your insurance company pay for medications, and instead of passing that revenue along to pharmacies, they keep it for themselves. Without having to answer to anyone, they rake in the cash off consumers backs and hurt patients in the process.

Which leaves the question, what is being done about it and how are they not being regulated? Well, let’s dive in …shall we.

A bill was presented at the state level during last session to demand PBM reform, unfortunately it didn’t even get called to vote.

“Why it didn’t get voted upon is something that will anger me forever, because it has everything to do with politics and money and had nothing to do with the right thing,” said Dan Strause former CEO of Hometown Pharmacy. 

Wisconsin Representative Micheal Schraa, shares some insight.

“The general public has no clue. I spoke at a Republican Lincoln day dinner about three weeks ago. And I said how many people in this room, and there were about 140 people, how many in this room know what a PBM is, pharmacy benefit manager, six hands went up,” said Schraa. 

Yet the negative Impact PBMs have on the nation’s healthcare system is growing daily. As more and more small pharmacies are getting smothered out of the equation.

Schraa said his drive to push PBM Reform legislation started about 10 years go when his pharmacist Ken brought it to his attention.

“I walked in one day and Ken just said, you got to sit down with me, and I got to tell you what’s going on. Were getting killed by these things, by these PBMs, and I’m like what’s a PBM, I never heard of it before,” said Schraa. 

Micheal said he started doing his own research and asking questions, the more he learned the more eye opening it was to him. That something needed to be done.

“There we a lot of powerful statements and a powerful testimony from people that had personal experiences with how the PBMs have negatively affected them. So, it’s just been my mission. I knew I would be coming again this session with another bill. Senator Felzkowski and I worked on it and it was really frustrating at the end, not having it go anywhere.

Bill 737 had 104 co-sponsors on it out of 132 legislators. Schraa personally went to every single democrat and republican office in efforts to get as much bipartisan support on the bill as possible.  But it never even got called to the floor to be voted upon during the last legislative session. There were 13 separate asks in the bill and there were even efforts made to amend a single one of these asks into a separate bill, pertaining to hospitals, that would demand some transparency from PBMs regarding formularies. (Called MAC Pricing Language which is a spread showing the average cost of a drug across all companies that manufacture that drug.) In hopes that it would be the most beneficial piece to independent pharmacies.

“So, we had this amendment and we added it to another bill that the hospitals really needed. We felt this was a bill that couldn’t be killed and wasn’t going to have an issue in the Senate,” said Schraa. 

“The Mac language was kind of watered down a little bit, but we still got a chunk of it in there. I thought this is great. The governor’s office was in they didn’t like a little bit of wording so we changed it to appease them so they would sign the bill, or sign the bill that this amendment went to, and we passed it. And it went over the senate and died,” said Schraa. 

There are many speculations as to why the PBM reform bill, has been avoided.

“The ugly part of politics is that campaigns cost a lot of money to run and not everybody can self-finance especially in the assembly or the senate,” said Schraa. 

However, Schraa said there are still those willing to fight for the people and what’s right.

“That’s where the heart of this issue comes in. There’s 30-some other states that have passed pretty significant PBM reform. The decision makers in those states have made a decision, we’re going to stand up for the people,” said Schraa.

Schraa has a plan for the next legislative session to break down this complex bill and get it passed.

“It’s a complicated issue,” said Schraa. Unless you’re a pharmacist or someone who works with this everyday it can be really hard to focus on the several different things this bill highlights. Schraa plans to break it down to have a legislator for each section.

“That way I think the health plans and PBMs that are against this, its going to be a lot harder for them to come in and trash 12 or 13 different legislators. They were going around lobbying in each office saying, you know Schraa’s PBM bill is going to raise prescription drug costs, out right lying,” said Schraa. 

Schraa said he understand lobbyists and their job is to protect their clients.

“There’s so much money in this game for them and they’re so powerful and the lobbying core is so well paid,” said Schraa.

Schraa said it’s frustrating because he sees the net effect that PBMs are having on so many people including his own family, who have fallen victim to adverse medical reactions due to wrongful practices. Schraa said, he and fellow supporters will continue to bang their fists on the desk until PBM reform is accomplished.

“The education process is huge, and I think this patient protector will be a game changer. It’s going to be super hard for them to continue to shovel this underneath the table and try to hide it. When you have so many different avenues bringing the light out and exposing, you know light is the best disinfected and that’s starting to happen,” said Schraa.

That’s why patientprotector.us was created, if you or a loved one are being affected, share your stories on the online portal so they can be heard by legislators and a difference can be made. 

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A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges

https://www.dailyitem.com/wire/business/a-philadelphia-pharmacy-s-closure-after-26-years-highlights-the-industry-s-growing-challenges/article_156e7cfc-4a50-522d-b99a-2212bb3b1f92.amp.html

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FDA issues ‘most serious type of recall’ for insulin pump-related iOS app

https://www.msn.com/en-us/health/other/fda-issues-most-serious-type-of-recall-for-insulin-pump-related-ios-app/ar-BB1mg98J

The U.S. Food and Drug Administration has issued a Class I “most serious type of recall” for an iOS app used in conjunction with an insulin pump.

The “correction” as referred to by the FDA on Wednesday, rather than a product removal, relates to the t:connect Mobile App iOS v2.7. It was confirmed by Tandem Diabetes Care the following day, which stated that Android app users are not included in the recall.

“The t:connect mobile app works with the t:slim X2 insulin pump with Control-IQ technology,” the FDA states. The pump delivers insulin under the skin at set and variable rates for the management of diabetes. 

The app recall is due to a software issue that may cause the app to crash and be automatically relaunched which “may result in pump battery drain and may lead to the pump shutting down sooner than typically expected.”

The FDA says pump shutdown “could lead to an under-delivery of insulin and may result in hyperglycemia or even diabetic ketoacidosis, which can be a life-threatening condition due to high blood sugars and lack of insulin,” and encourages those with diabetes who use insulin pumps to carry backup supplies in case of pump failure.

“The correction highlighted in the recall notice was addressed in the t:connect app update for the Apple iOS platform (v2.7.1) released on March 18th,” Tandem Diabetes Care said in a press release. “Affected customers were notified by Tandem on March 26th, and more than 98% of affected customers had already updated their devices as of April 15th. We continue to make every effort to contact everyone who has not yet updated their iOS app to the new version.”

Tandem Diabetes Care gives detailed instructions to customers who wish to check their mobile app versions here. 

“Ensuring the safety of our patients is our top priority, and we take any safety concerns with our products very seriously,” Tandem Diabetes Care said in its release. “No deaths have been reported, and we will continue monitoring the new version of the t:connect app released in March to ensure the concerns described in the recent recall notice from the FDA have been addressed.” 

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Be careful what you post in titles. I  have a post concerning a chronic pain pt Robert Charles Foster who had lost his pain meds and ended up getting cops to end his pain FOR GOOD.

Apparently, there was a couple of words in the title that did not meet FB’s “community standards” and they deleted them.

They seem to have a problem with intractable chronic pain pts resolving their untreated torturous level of pain via some sort of self-inflicted means.

The hyperlink above points to the one post on FB, they have not found yet.  See how far they go to see if the community standards are met!

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Editorial: To save local pharmacies, state must rein in the middlemen

https://www.post-gazette.com/opinion/editorials/2024/05/09/pharmacy-benefit-manager-reform-insurance-reimbursements-express-scripts/stories/202405090037

Pharmacies in Western Pennsylvania are closing at an alarming clip, pushed out of business by a complex, opaque and utterly broken medication reimbursement system. The state legislature, following the recommendation of Gov. Josh Shapiro, must act to bring transparency and accountability to the important, but little-known, health care middlemen called pharmacy benefit managers, or PBMs.

PBMs are corporations — sometimes associated with major pharmacy chains, like CVS subsidiary Caremark, but more often independent — who manage the relationships between the makers of prescription drugs, the insurance companies who pay for them (including Medicaid and Medicare), the pharmacies that distribute them, and the people who need them. In particular, PBMs set terms and pricing.

The original purpose of PBMs was simply to process claims for prescription medicines, but over time they evolved, and now they negotiate prices at every stage of the process. In theory, this give patients and their insurers bargaining power against drug manufacturers. In practice, PBMs cut deals with manufacturers and insurers, including steering patients toward preferred drugs, and have near-total power to set the terms of their contracts with pharmacies.

For many everyday drugs, pharmacists are forced to accept a loss, sometimes in the hundreds of dollars, on each prescription they fill. The result: reimbursement rates that are ruinous for pharmacies, especially independent businesses in underserved areas, leading to closures and reducing vulnerable people’s access to life-enriching, -sustaining and -saving medicines.

Against the spread

PBMs originally made money by charging insurers to process claims and manage prescription benefits. But now they make money from all parts of the process, most notably through a practice known as “spread pricing.” To understand spread pricing, you have to understand how prescriptions are priced. The problem is that PBMs consider this a trade secret.

Even if we can’t know how they do it, we can know what they do: PBMs negotiate the price insurance companies pay for prescriptions, the price pharmacies are reimbursed for prescriptions and the copays charged to patients. The pharmacy has essentially no control over any aspect of the pricing for the products most important to its own bottom line (and in many cases their survival): When the pharmacist plugs prescription information into the computer, the PBM spits out the dollar amounts.

The “spread” in “spread pricing” is the difference between the amount PBMs charge insurers — including Medicaid and Medicare — and the amount they reimburse pharmacies. PBMs pocket the difference without even handling the drugs in question.

Spread pricing is why PBMs are now often more profitable than the drug manufacturers and insurance companies they work with. In 2017, the largest PBM in the nation, Express Scripts, made over $100 billion; the drug manufacturer Pfizer, only $52 billion.

When Ohio investigated the PBMs handling the state’s Medicaid program in 2018, they found that spread pricing was costing taxpayers a cool $223 million per year. When the state banned spread pricing and contracted with a single PBM, it charged only $25 million for its services. The PBMs had been skimming $200 million of pure profit off medications for the state’s poorest patients.

Banning spread pricing in Ohio also resulted in reimbursements for pharmacists rising by $38 million — reflecting better pay for pharmacies and huge net savings for everyday people.

No other choice

PBMs hold all the cards against pharmacies, including chains, because they gatekeep access to major insurers and drug manufacturers in their exclusive networks. It’s even worse in the Pittsburgh region, where healthcare giants UPMC and Highmark both use the same PBM, Express Scripts.

If a Pittsburgh pharmacy doesn’t like the terms Express Scripts offers, it’s free to turn them down — and lose access to about two-thirds of local patients.

This means pharmacies often sign on to unfair pricing structures, controlling everything from reimbursement rates to preferred medications. When pharmacists are forced to accept a loss on so many prescriptions they fill, they must choose between dropping patients whose prescriptions are draining the company and risking the viability of the entire business. In either case, the people they serve lose.

Last month, at least 12 pharmacies closed their doors across Western Pennsylvania alone. There’s no reason to believe we won’t keep losing more. Advocates say that the U.S. loses one pharmacy branch per day. This results in prescription deserts, usually in already underserved urban and rural communities.

No incentive to change

The fact is a shuttered pharmacy isn’t a threat to business for PBMs. Patients will always need their medications. Some PBMs even argue they are providing the remaining pharmacies with a boost in business.

But if a pharmacy closes, it’s likely because the patients it served needed medicines for which PBMs reimbursed unfairly. They’ll have to go somewhere, and the financial contagion will spread. One of the pillars of the health care system — one that seems simple compared to hospitals and other providers — is slowly collapsing.

The state can do something about it. Pennsylvania should follow Ohio’s example and ban spread pricing. Companion bills HB 1993 and SB 1000 would do just that, while forcing PBMs to submit details of their pricing schemes to the state Insurance Department. The bills would also ban PBMs from “patient steering” by creating exclusive networks of contracted pharmacies or charging higher co-pays at pharmacies they don’t contract with.

PBMs claim that their aggressive tactics translate to big savings for their clients, and that spread pricing covers the cost of their services. If that’s true, they should have no issues opening up their books for the public to take a look. The future of access to essential medicines depends on it. People’s health, even their lives, depend upon it.

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you may have to click on graphic to properly enlarge it

Vertical integration visualized

https://ncpa.org/newsroom/qam/2024/05/08/vertical-integration-visualized

We all know what it means, but what does it look like? Each year Drug Channels updates its chart of vertically integrated insurers, PBMs, specialty pharmacies, and providers—all of which, Drug Channels editors point out, face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. As the FTC, in particular, takes strides to hold insurer-PBMs accountable, and we’re finding more and more evidence of PBM greed, study this chart so you can help your patients understand the health care world they live in (and one that profoundly affects all of us).

If a practitioner refers you to another healthcare organization or practitioner, this chart may explain why you are being referred!  This chart will show everyone where the referral is to another healthcare organization owned by the same corporation. It is called SELF-REFERRAL and most likely the practitioner that you are seeing is an employee of that same corporation.

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