TrueCare Has Asked For Transparency In Government Contracts For Years
Maybe so. Both members of the House and Senate are moving ahead with provisions that would force PBMs to be more transparent.
After learning that CVS Caremark and Medco Health Systems pays 15 to 45 percent more for prescription drugs than comparable programs at the Defense Department and the Veterans Administration, at least some Congressional leaders are taking notice.
“For several years, the TrueCare Texas Legislative Council has urged state and federal officials to demand transparency in their PBM contracts,” said Government Affairs Director John Heal. “We have maintained all along that these governmental agencies could be in a better bargaining position if more information was available under these contracts.”
In addition to transparency, Heal said state and federal agencies should have the right kind of auditing powers to ensure they are getting their money’s worth from PBM contracts.
Now someone is taking notice. After a study found that a $10 billion contract for federal employee drug programs shared by CVS Caremark Corp. and Medco Health Systems Inc. costs more than other government prescription programs, officials want to know why.
In fact a House of Representatives subcommittee is now discussing ways to revamp the program after the Congressional Budget Office released the study.
“We are not opposed to someone making a reasonable profit, but under the circumstances we’re really concerned that the current profit is exorbitant,” Rep. Stephen Lynch, a Massachusetts Democrat said recently in an interview. “We’ve delivered the message that this isn’t going to continue. Either they come forward with some ideas or we will do it on our own.”
Additionally, members of the U.S. Senate Finance Committee unanimously voted late last month for an amendment to lower health care costs through common-sense disclosure requirements for PBMs participating in a proposed health care reform package.
Lynch is chairman of the House subcommittee on Federal Workforce, Postal Service and the District of Columbia. His panel is part of the House Committee on Oversight and Government Reform which now is looking at possible options for restructuring the CVS and Medco plan.
One of the options being considered would turn prescription-drug managers into federal subcontractors, requiring them to provide proof of their costs and pricing under federal guidelines to ensure they aren’t overcharging the government.
PBMs could be eliminated entirely, which means the government would negotiate prices directly with drug manufacturers and retailers. Other options under consideration include stronger contract language to require more thorough cost disclosures or using a price structure similar to those of the Defense Department and Veterans Administration.
In the Senate Finance Committee, the amendment by U.S. Sen. Maria Cantwell, D-WA, would require PBMs to provide basic aggregate information so that health plan sponsors could determine which PBM offered the best value for the plan and patients. It would only apply to those PBMs operating in a health insurance exchange.
“PBMs routinely gobble up significant shares of nearly every prescription drug transaction, passing the costs on to patients and plan sponsors are often left in the dark as premiums increase,” said NCPA Executive Vice President Bruce Roberts. “Increasingly, public and private payers are rightly asking questions and demanding more equitable pharmacy benefit arrangements. Medicare, the Pentagon, state governments and major companies are all moving in this direction.”
2009 PBA Conference Features New Ideas On How To Grow Your Business
Nationally known sales expert and motivational speaker Jack Daly told community pharmacists in August that their mission for independent pharmacy was to “thrive and survive.”
Speaking at the 2009 PBA Health Conference in Overland Park, Kansas, Daly was the keynote speaker in an action packed conference that featured some of the country’s top pharmacy experts as well as new ideas for growth in the pharmacy industry. His speech provided pharmacists with new strategies for more effective sales, service levels and workplaces.
The theme for 2009 was Ready, Set, Grow—and just as intended, the conference brought about a heightened enthusiasm for the business of community pharmacy. “It’s not worth just working in your business,” Daly told pharmacists. “You’ve got to work on your business.”
Daly spread a message of change to meet changing circumstances and warned pharmacists to make sure to set the right priorities. “Sometimes we rush to the urgent, at the expense of the important,” Daly said in discussing the necessity of taking care of the small things that are important to employees and customers.
The PBA event, which took place August 14-16, started with the annual PBA Health Golf Tournament at Falcon Ridge, a top-rated course in the Kansas City area. The opening session featured PBA Health CEO Nick Smock who discussed the variety of programs and services offered by PBA Health to enhance the buying effectiveness, operating efficiencies and selling profitability of community pharmacies.
“We sincerely hope everyone left with a bounty of new ideas for business development and future growth,” said Smock, noting that the services offered by PBA Health continue to grow.
Among the many services offered by the company to community pharmacists around the country are the TriNet Third Party Network, EnsurePay electronic reconciliation, wholesaler and generic manufacturer contracting, backup distribution, CSOS Advantage electronic CII ordering system, ScriptCard and ScriptCard Plus prescription savings programs, dispensing systems, switching services, marketing and finance solutions, wholesaler negotiations, and pharmacy automation.
Other speakers at the conference included NCPA executive vice president and CEO Bruce Roberts who returned to the conference this year to discuss the expanding role of community pharmacy in improving overall patient care.
“PBA health has been one of the drivers” in the expanding influence of community pharmacy, Roberts said. “This is one of the sharpest pharmacy groups in the country, bar none,” he said. “You are fortunate to be a part of this group.”
Roberts told the group that one of the biggest selling points to federal opinion leaders was to convince them to recognize pharmacists as health care providers and “to get recognition for all the value we can bring to the health care system.”
Additionally, David Balto of the Center for American Progress spoke about perspectives on Capitol Hill regarding health care reform and the PBM industry. Other CE topics included how to improve profits through more effective accounts-receivables management by Patric Rademaker, the increasing importance of specialty pharmacy presented by John Lundquist, and maximizing performance through automation and robotics by Russell Wheeler.
Finally, Texas Government Affairs Director John Heal lead a roundtable discussion with pharmacists Bob Atkins from Fairbury, Nebraska, Brian Bates from Marshall, Texas, and Randy Newberry from Jerseyville, Illinois. PBA Governmental Affairs Director Jorgen Schlemeier and David Balto were also on the panel.
On Saturday night, many guests and PBA Health representatives headed out together to enjoy a live performance of “The Sound of Music” at the New Theatre Restaurant in Overland Park.
Don’t miss the 2010 Winter CE Trip in San Antonio, Texas scheduled for February 18-21 and plans are already underway for the 2010 PBA Health Conference on August 13-15, 2010.
With Congress gearing up for what is expected to a controversial and ongoing battle on health care reform, Texas pharmacists are working to shape the reform effort.
Policymakers are discussing options ranging from providing coverage to millions of uninsured Americans to how to meet the challenges of the health care needs of aging population.
As top medication experts and the most accessible member of a patient’s health care team, community pharmacists led by groups like the National Community Pharmacists Association (NCPA), PBA Health and TrueCare Pharmacy are expanding efforts to influence what may become one of the most critical changes in health care policy in generations.
Additionally, NCPA has been active in pushing positions that will improve pharmacy’s role in delivering health care under any acceptable reforms. And they have joined with groups like PBA Health and TrueCare to encourage members to respond to the health care reform agenda with new ideas.
“Even though the fate of health care reform is still undecided, we must continue our efforts to let Congress know where we stand on these key issues important to pharmacy,” said TrueCare’s Texas Government Affairs Director John Heal, who continues to monitor the federal legislation on behalf of Texas TrueCare. “This is an ever changing piece of legislation and there are still many issues on the table such as PBM transparency, generic reimbursements, accreditation and the possibility of a public insurance health care option.”
TrueCare public Affairs Director Steve Ray said that Texas pharmacists need to show their muscle by letting lawmakers know that the federal legislation must support compensation for medication therapy management, provide an acceptable AMP fix and give assurance that PBM activities will become more transparent.
“In the past we have successfully focused a lot of time and effort on working with state legislators on a pro pharmacy agenda,” Ray said. “Now PBA Health/TrueCare is becoming a strong pharmacy advocate on the national front as well.”
Grassroots involvement by community pharmacists has helped issues important to independents to gain momentum in Congress. Texas pharmacists have been active in providing information to Congress on how health care proposals could affect them and their patients.
Minnesota Lawsuit Cites Patient Access, Quality of Care Issues
Pharmacy groups have filed lawsuits in four states charging that patients will lose access to health care and citing numerous quality of care issues under a settlement over the Average Wholesale Price (AWP) approved in federal court. That ruling will cause significant cuts to pharmacy reimbursements to community pharmacies across the nation.
The suits were filed in federal court in Minnesota, California, New York and Washington by the National Association of Chain Drug Stores (NACDS), the National Community Pharmacists Association (NCPA), the Minnesota Pharmacists Association, the Minnesota Retailers Association and numerous businesses.
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While suits are being filed in several states, there is no reason to believe that Texas will be among the states where lawsuits will be needed. As reported two weeks ago by TrueCare, Texas will not see an immediate impact from the AWP settlement. The Texas Medicaid Vendor Drug Program performs its own drug pricing and is not dependent on private pricing services, such as FDB. They receive pricing information directly from drug manufacturers and will not, according to VDP officials, make immediate, automatic changes to the AWP in Texas.
Among other charges, the lawsuits challenge the states’ failure to take action to prevent pharmacies from being reimbursed at below cost for prescription drugs under state Medicaid programs. “The failure to act by Minnesota has produced a perverse outcome whereby underserved patients who need access to health care the most, will get it the least,” said NCPA Executive Vice President and CEO Bruce T. Roberts, RPh. “Independent community pharmacies frequently serve urban or rural areas where a disproportionate share of Medicaid beneficiaries live. In some of these communities, the pharmacy is the only health care provider for miles around. Left unchecked, these unfair cuts could push some community pharmacies to the breaking point. Even in tough budget times, the reductions are short-sighted. Faced with diminished pharmacy access, Medicaid patients will turn to more expensive doctor’s offices or emergency rooms – driving up costs to the state.” |
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The narrow margin of Texas Pharmacist Chuck Hopson’s victory is another example of how one election can make a difference in independent pharmacy’s ability to get its message to the decision makers of the future. We must be ready and able to work with both political parties and with a variety of different lawmakers to ensure that our voice will be heard. Today we must decide if we want to be participants, or spectators in the legislativeand regulatory arenas. Participants have a say in their destiny. Spectators watch from the sidelines and read tomorrow’s newspaper to find out what happened. We must be proactive, and not reactive. In the past, many of you have shown a commitment to the future of pharmacy by supporting the Texas Pharmacy Survival Fund, which has been instrumental in protecting the interests of independent pharmacy. Today pharmacies continue to reap the rewards from the work of the Survival Fund as it expands its grassroots efforts to educate legislators, opinion makers and the general public on issues important to independent pharmacy. We need your help again. In January we will face another legislative session and we cannot afford to wait two months to begin getting out pharmacy’s message to new legislators and legislative leaders. There is much work to be done and pharmacy needs your help to ensure that we maintain our momentum. Our voices must be heard in Austin. Please make a contribution to the future of independent pharmacy through the Pharmacy Survival Fund. The stakes have never been so high. Respectfully,
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