In a year vividly marked by unfathomable loss of life, business and livelihood, we find ourselves saying an unexpected goodbye to the fledgling Indy Health, an unpredictable casualty of, among other things, the pandemic and its unforeseen forces that have left our world reeling in tragedy and uncertainty.
For legal reasons, the founders, investors and executives of Indy Health cannot speak for themselves (read here for additional information), and this message is not an attempt by PUTT to speak for anyone at Indy Health.
Though the post-mortems have only just begun, we can be sure of one thing: Indy Health was a good idea, a strong idea, a not-improbable nor pie-in-the-sky shot at a better approach to pharmacy benefit management. It was an opportunity for pharmacists to take control of their destiny, if not to head off the well-documented anticompetitive tactics by PBMs that are driving out small pharmacies while making a handsome profit for themselves and their shareholders at literally everyone else's expense.
How to Achieve a Drug Formulary That Reduces Costs and Maintains Access to Care
Wasteful drugs could be driving up your pharmacy benefits spend-here's how to evaluate, identify and establish a high-performance formulary.
Since the start of the year and at the apex of the pandemic, nearly 600 drugs have seenprice hikes, and more increases from major drug makers are expected soon. Given the continued cost increases, and with many employers looking to ensure affordable access to prescriptions for their members, it's more important than ever for plan sponsors and benefits professionals to evaluate their formulary to ensure that it provides clinically sound, cost-effective alternatives that can reduce overall plan costs. Read More
We Need Greater Transparency to Improve the U.S. Healthcare System
The time has come for us to think about incremental, evolutionary, and targeted changes to the healthcare system to reduce costs rather than focusing on grand bargains. It is time for practical solutions that will likely have broad consensus amongst patients, providers, employers, and policymakers.
..One reform that will enhance the effectiveness of all of the proposed solutions across the healthcare ecosystem is transparency. Without this fundamental principle, none of the proposals can reach their full potential, thus, raising the question of whether the most vital healthcare reform is transparency. Read More
Overworked, Understaffed: Pharmacists say Industry in Crisis Puts Patient Safety at Risk
NBC News spoke to 31 retail pharmacists and pharmacy technicians in 15 states...
Most pharmacists spoke anonymously out of fear of losing their jobs. Declining profit margins for pharmacies, corporate consolidation, and an influx of new pharmacy school graduates in the past decade have led to stagnant or falling wages and fewer employment options, according to pharmacists, experts, and recent studies. Read More
Pharma Giants Get Their Pennies Pinched on Drug Pricing
Drug companies do have wide freedom to set their own sticker prices for their products in the lucrative U.S. market. That hardly means they have carte blanche. To actually sell medication, a drugmaker needs to persuade public and private health plans to place their product on the plan's formulary, which is a list of drugs the plan is willing to purchase. That means paying middlemen rebates and discounts to choose their drug over any other rival treatments. Failure to secure favorable formulary access could mean low sales even for a highly-effective and safe medication. Read More
How GoodRx's Rapid Growth Creates Conflict between PBMs and Payers
Pharmacy pricing and benefit design are fundamentally broken.
For proof, look at GoodRx's 2020 financial results for its discount card business. The company accounted for an estimated $3.4 billion in U.S. prescription revenues-and earned nearly $500 million in fees from PBMs.
Incredibly, three out of four consumers who used GoodRx already had commercial, Medicare, or Medicaid insurance... Read More
President Biden's Bipartisan Opportunity to Reduce Patients' Drug Costs
President Joe Biden should take advantage of a bipartisan opportunity to meaningfully reduce patients' out-of-pocket spending on biopharmaceuticals. Seizing this opportunity requires the president to recognize that the drug cost problem exists because the current system inappropriately shifts too much of its expenditures to patients.
Consider that hospitals' total expenditure in 2019 was $1.2 trillion, or three times the total of the spend on pharmaceuticals. However, patients' out-of-pocket spending on drugs in 2019 was $54 billion, or 50 percent higher than their out-of-pocket spending for hospital care.
Here are five policy solutions that the administration ought to pursue to lift this unfair burden on patients.. Read More
Taking a PUNCH at PBM Abuse: Q&A with Attorney Mark Cuker on the Class Action Suit
Below-cost reimbursements. Price manipulation. Discriminatory treatment. These are independent pharmacies' allegations in the class action suit against OptumRx spearheaded by attorney Mark Cuker.
The latest in the PUTTlive webinar series explores the issues behind the lawsuit, with opportunities for attendees to engage in real-time Q & A.
Should you join the lawsuit? Register for the webinar and get the facts.
Hosted by PUTT Board member Nathan Mair, make plans to join us as we delve into the purpose of this litigation, how to particpate, and why it's so important that independent pharmacy owners have a voice in reforming federal arbitration laws.
Yost Sues Healthcare Giant Centene, Saying it Charged Ohio Taxpayers Millions for Duplicate Medicaid Pharmacy Benefits Services
Ohio Attorney General Dave Yost is going after a $101 billion corporation that used $20 million in taxpayer money to hire a pharmacy benefits manager to provide services for Medicaid recipients that essentially already were covered by another PBM paid by the state.
"Corporate greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of millions. This conspiracy to obtain Medicaid payments through deceptive means stops now," Yost said in an emailed statement. Read More
Mississippi Investigating its Largest Medicaid Provider Over Pharmacy Benefits
Mississippi officials are investigating whether Fortune 500 company Centene and possibly other firms may have significantly overcharged taxpayers as they managed billions of dollars worth of state Medicaid health insurance benefits.
The Mississippi Division of Medicaid confirmed the probe to the Daily Journal on Monday. Medicaid officials said the attorney general's office hired outside attorneys to "investigate and potentially pursue claims" that include Centene's management of pharmacy benefits.
Bipartisan Bill Cracks Down on Pharmacy Benefit Managers, Should Result in Lower Drug Costs
The state Assembly unanimously passed a bill Tuesday to remove Wisconsin from the few remaining states that do not regulate Pharmacy Benefit Managers, commonly known as PBMs, from banning pharmacies from offering cheaper drugs not covered by someone's insurance plan.
The bill, which already cleared the Senate, now heads to Governor Tony Evers who is expected to sign it into law.
PBMs are currently able to operate largely as they wish. Thad Schumacher, owner of Fitchburg Family Pharmacy, said Tuesday the bill would allow him to suggest generic drugs in cases where it would cost less than a customer's co-pay. Read More
Michigan House Unveils Bipartisan Health Care Plan Aimed at Cutting Costs, Boosting Access
Capping insulin costs, making it easier for patients to understand medication prices and trying to crack down on drug companies influencing doctors through extravagant gifts are some of the proposals included in a sweeping new bipartisan health care legislative package unveiled Wednesday.
..The proposals include:
Reeling in prescription drug "middlemen": In December, the U.S. Supreme Court unanimously ruled that states can regulate the power of pharmacy benefit managers. The bills would require the industry submit quarterly "transparency reports," and bans spread pricing, a tactic that allows managers to recoup additional fees intended for pharmacies. Read More
Direct & Indirect Remuneration fees aren't just a pharmacy problem. They affect almost every area of the healthcare spectrum.
Join PUTTcast hosts Lauren Young and Monique Whitney as they chat with special guests; oncologist Dr. Michael Diaz, legal counsel Mark Cuker, and IL independent pharmacist & pharmacy owner Byron Berry to discuss the widespread effects and legalities of DIR fees - and what can (and should!) be done about them going forward.
CMS Boosts Reimbursement for Administering COVID-19 Vaccinations
CMS boosted the average payment for COVID-19 immunizations from $28 to $40 for single-dose vaccines and $45 to $80 for two-dose vaccines. But the amount each provider receives varies depending on what type of entity carries out the immunization and where it's located, according to the agency. The changes take effect immediately. Read More
And Now This ...
Just Spit on It - Courtesy of GPhA Buzz
Back in the Before Times - November 2018, in fact - we told you how researchers were hoping to use llamas' antibodies to create a universal flu vaccine. (Llamas are like alpacas but with anger management issues.)