NEWS RELEASES & STATEMENTS  
  AND HERE WE GO AGAIN: EXPRESS SCRIPTS TARGETS PHARMACIES CITING "VALIDITY OF DOCTOR-PATIENT-RELATIONSHIP" AS JUSTIFICATION FOR RECLAIMING PAYMENTS FROM 2015  
 

In what may be the latest version of blame-shifting, Express Scripts appears to be clawing back tens of thousands of dollars on 5-year-old Tricare claims for certain prescriptions, according to complaints recently received from PUTT members. 

​The Department of Defense made their dissatisfaction clear regarding Express Scripts' failure to handle compounds appropriately, ultimately costing the government billions of dollars in 2015. Since then, the handful of pharmacies that had engaged in the fraudulent scheme were shut down and the pharmacy owners sent to jail.

However, Express Scripts appears to be ramping up its efforts to claim the money it lost on the government's behalf by dredging up old claims and forcing innocent pharmacies to pay for the PBM's past failure. 

At issue, according to Express Scripts, is the validity of the doctor-patient relationship. Express Scripts justifies reclaiming payments (taking back money for prescriptions) made 5 years ago by accusing pharmacies of not verifying the patient's relationship with the prescribing doctor prior to filling the prescription. This rationale allows them to take payments back on claims on which Express Scripts itself failed to contain costs for the TRICARE program.   Continue Reading
 
  STAYING THE COURSE  
  SURVEY SHOWS PBM PRACTICES COULD FORCE FLORIDA PHARMACIES OUT OF MEDICAID  
 
According to a recent survey of Florida independent pharmacies conducted jointly by PUTT and Small Businesses Aligned for Pharmacy Reform (SPAR), a Florida advocacy group, more than 60% of pharmacies surveyed may be forced to discontinue Medicaid if changes to the state's current Medicaid reimbursement structure are not implemented soon. 

Survey results indicated that 93% of the 123 Florida pharmacies that responded have had to turn away at least one Medicaid patient per month because the loss per prescription was too great, and almost one-third reported having to turn away 10 or more patients per month for the same reason.

Results also showed that pharmacy benefit managers (PBMs), who have publicly claimed to 'put patients first' throughout the COVID-19 crisis, blatantly ignored Governor DeSantis' early refill executive order and current Florida statutes on patient medications, denying authorization to 61% of respondents' Medicaid patients for 90-day supply pre-fills and/or refills during the pandemic.   Continue Reading
 
  ON THE FRONT LINES  
  PHARMACIES OVERCOMING ADVERSITY  
 



Muralists Turn Vandalism Into Messages of Peace in Little Rock
June 2, 2020 CBS THV11

After several buildings in Little Rock were vandalized, the owners decided to turn their boarded-up walls into something beautiful.

However, their owners turned them into messages of peace.

CEO of the Arkansas Pharmacist Association John Vinson said the last few days haven't been easy.

He decided to turn their boarded-up wall into something beautiful.
Continue Reading & Watch The News Report


Bronx Pharmacy Reopens A Week After Store Was Devastated by Looters
June 8, 2020 ABC Eyewitness News

A small, family-owned pharmacy in the Bronx has made an amazing recovery just one week after looters ravaged their store.

It is an impressive turn around. Watch the News Story


Independent Pharmacies Stay Strong During Pandemic
June 7, 2020 Chillicothe Gazette

As businesses start to re-open that have been devastated financially the past few months due to closings caused by the coronavirus, local, independent pharmacies, thrive due to solid family foundations and community ties.

McFadden Pharmacy in Bainbridge and Allen's Medical Pharmacy in Chillicothe are two locally-owned, independent pharmacies that have weathered the storm caused by the coronavirus.

... Considered essential, local pharmacists have been open during the coronavirus pandemic and have been serving their customers even in modified ways. They have used their community connections and reliability to field questions and help their customers through an unknown situation.

"I feel that my job is to provide healthcare to the community and go above and beyond then just filling prescriptions," said McFadden. "My cell phone is on my answering machine."  Continue Reading
 

Skippack Pharmacy's Owner, Pharmacist Dons Superhero Costume
May 23, 2020 The Reporter

The saying goes "not all heroes wear capes," but some do wear costumes.

Mayank Amin, or "Dr. Mak" as he's fondly called by his customers, is a pharmacist and owner of Skippack Pharmacy.

Over the past several months, patrons of the pharmacy or followers of the business's social media platforms may have seen him looking like many of the ever-so popular protagonists from comic books and Marvel movies.
His cast of characters include Batman, Iron Man, Spider-Man, and Superman.
Continue Reading


 
  STAYING INFORMED  
  NEWS & STORIES FROM ACROSS THE NATION  
 

Data Proves PBM Industry Maximized Profit At Patient Expense
June 15, 2020 Cision Newswire

The Alliance for Transparent and Affordable Prescriptions (ATAP) reacted today to a report issued by the Texas Department of Insurance (TDI) showing the financial activity of the pharmacy benefit manager (PBM) industry in the Lone Star State. Texas law requires that PBMs annually report to the Insurance Commissioner aggregate data on rebates.

"The Texas rebate report is unambiguous. The PBM industry has been generating significant profits while patients struggle to afford the cost of prescription drugs," stated ATAP's President Dr. Robert Levin. "Since 2016, through a complex rebate and price concession, the PBM industry in Texas pocketed more than $350 million in revenue, while passing a mere $16 million in savings to enrollees."  Continue Reading

 

Pharmacy Steering Detrimental to Patient Care
June 8, 2020 The Newnan Times-Herald

I purchased Lee King Pharmacy because I wanted to provide world-class care for people in my community with a personal touch. 

Since purchasing the pharmacy in January of this year, I have had the privilege of providing care under the most trying health care crisis this country has seen in our lifetime.

In doing so, I have seen the best this country has to offer ... But I have also seen a darker side to America's health care system - PATIENT STEERING. During this COVID-19 pandemic, I've had more than 15 patients who were steered from my pharmacy to pharmacies owned or affiliated with the patient's insurance company or their pharmacy benefits manager.  Continue Reading

 

Oklahoma Insurance Dept Wants to Regulate PBMs ASAP
June 4, 2020 Law360

The Oklahoma Insurance Department wants to start regulating pharmacy benefit managers as soon as possible, urging a federal judge to deny a PBM lobby's attempt to block a state law that targets the industry's allegedly unfair reimbursement practices.

The state agency told U.S. District Judge Bernard Jones on Wednesday that it has received more than 100 complaints about PBMs' conduct in the past month alone, and the time to enforce the Patient's Right to Pharmacy Choice Act is now.  Continue Reading


 
  OPINIONS  
  TO A PHARMACIST, A PATIENT IS A FRIEND, NEIGHBOR, OR COMMUNITY MEMBER - WHO IS THE PATIENT TO A PBM?  
  Frontline healthcare providers have a unique insight into the depths of systemic injustice. As independent frontline healthcare providers, we have first-hand experience of systemic injustice, and just how brutally it affects patients, especially those in communities of color, in rural areas, or those of lower socioeconomic status.

While the rest of the country is just beginning to examine how these communities have been disproportionately affected by COVID-19, the independent pharmacies who serve those populations have long been sounding the alarm about how much more damaging it will be if these patients lose their neighborhood pharmacies. 

JAMA Internal Medicine letter published last fall explored the impact of "pharmacy deserts" on poor and minority communities, gaining much media attention but little change. Last year this compelling Al Jezeera story shed light on the problem, but again, no change. As pharmacists, we are tired of the platitudes and excuses, and as we have seen in our fight against PBMs, we must work together to see progress across our country. 

Pharmacy deserts are the result of the PBM business model, which relies on secrecy,  exploiting loopholes, abusing pharmacies, and playing patient-steering games in the name of saving somebody - no one knows for sure who - money. These PBM-created pharmacy deserts will cause larger divides in healthcare access, inevitably creating problems across our communities that we won't be able to fix.   Continue Reading
 
  MEMOS FROM THE WATERCOOLER  
  NOTEWORTHY NEWS  
 

A Governor That Gets It!

North Carolina Governor Roy Cooper recently issued an official proclamation proclaiming June 15th Healthcare Heroes Day in honor of "the doctors, nurses, EMS workers, first responders, pharmacists, technicians, and other critical medical personnel and staff who provide quality care, often in our most vulnerable moments in life". A special flag was commissioned and will fly at the North Carolina capitol until July 15th.




Express Scripts Giving Refunds on Incorrectly Assessed DIR Fees

PSAOs are notifying pharmacies of an error by Express Scripts on their DIR fee calculations on Cigna Medicare Part D claims processed between January 2020 and March 2020. The internal error apparently occurred during the setup of the Cigna transition to Express Scripts and the root cause was not corrected until March of this year.

For more information, contact your pharmacy's PSAO.
 


Re-Emerging State Legislation

According to a recent blog by FiscalNote, the top 5 stalled healthcare initiatives likely to re-emerge in 2021 state sessions are: 

  1. Medicaid Expansions
  2. Medicaid Reformation/Innovation
  3. Scope of Practice/Telehealth
  4. Prescription Drug Access/Price Transparency
  5. PBM Gag Clauses/Clawbacks/Spread Pricing 
To read their assessment of the state political healthcare landscape click here.

*Did You Know: that PUTT members have access to FiscalNote through our VoterVoice system? For more information visit the members section of our website at TruthRx.org
 
  LAUGHTER IS THE BEST MEDICINE  
  ASTEROID OR PBM?  
 
 
 
  PUTT POLITICAL SUMMIT  
  GOING DIGITAL  
   


This year's Summit is going digital - all the information and networking you love without ever leaving your living room!

PUTT's Digital Political Summit is FREE to members. Be sure to watch your inbox for registration details!



Not a member of PUTT? Click here to join now!












 
 
  AROUND PUTT  
  WORTH YOUR TIME  
 
In our newest PUTTcast episode, special guests VPhA Executive Director Christina Barrelle and their attorney & lobbyist Howard Estes chat with PUTT about building relationships with state legislators, Virginia's recent win in PBM reform, and how they managed to catch the PBM lobby off guard to get things done.

To Listen Click Here








The most recent episode of PBM reform features PUTT President Scott Newman & Executive Director Monique Whitney as guest hosts in an ear-opening chat with Florida State Representative Jackie Toledo about Florida's ongoing battles for PBM reform and how their fight may reflect what's happening in other states as well.
 




You can now find the PUTTcast on Apple iTunes!

Subscribe to the PUTTcast on Apple iTunes or subscribe on the Pharmacy Podcast Network - either way you'll never miss an episode! To catch up on past episodes be sure to visit the Podcast Library on our website at TruthRx.org.
 
  ADDITIONAL WORTHWHILE READS & STORIES  
  ICYMI  
 

In the era of COVID-19, states need practical solutions to address health care costs
June 6, 2020
The Hill

Reforming the Prior Authorization Process
June 5, 2020
Medical Economics

BCBS Sues CVS Over Inflated Drug Prices
June 2, 2020
Benefits Pro

Optimizing Patient Access to Medications: The American Dermatological Association's Position Statement on Pharmacy Benefit Managers (PBMs) and Patient Access to Affordable and Appropriate Medications
May 25, 2020
News Wise