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“Whatever happened to good old common sense?” asks Jim Bates, R. Ph., of Marshall, TX.
Jim has seen the independent pharmacy industry dramatically change during his 45 years as a community pharmacist. “With the rise of HMO’s and PPO’s our industry started being controlled by insurance companies which eventually took away our independence,” he said. “Managed Care is really just managed cost and our customers are the losers.”
Jim squarely places responsibility on un-informed legislators for negatively impacting independent pharmacists which is why he has agreed to become the newest member of the TrueCare Legislative Council.
PBA Health/TrueCare is the leading independent source of legislative information and lobbying for community pharmacists in Texas. A three-member governmental affairs team supported by volunteer members of the legislative council have positively affected pharmacy issues both in the legislature and with regulatory agencies |
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Jim spent years volunteering with the Texas Pharmacy Association and has an impressive history of working tirelessly on local, state and national issues. He states: “I believe as health care professionals it is our responsibility to work on issues that are beneficial to our industry and professional organizations while supporting the best legislative process.”
He relayed a story about a congresswoman who voted for legislation that negatively impacted the industry. When asked about her motive, she clearly had no understanding of the issue, nor did she show interest. “Pharmacists are perceived as being at the tail-end of the medical profession and have historically been under-represented at the capitol. As a result we have always been the first to be impacted by legislators trying to slim the budget, and it is important for pharmacists to be involved at the grassroots level to fight for our industry.”
When asked why pharmacists have historically not proactively protected their industry he stated: “Independent pharmacists have no time and as a result apathy can run rampant. We get so tired it is easy to be disgusted in the political process. And the more insidious problem is many of us just don’t see value in building a coalition and gaining power through numbers.”
When asked to summarize his thoughts on the importance of pharmacists working to shape legislation he stated: “We are the most technically advanced healthcare system in the history of the world but we are losing our humanity. Access to the independent pharmacist is of real benefit to the healing process of our patients and we have an obligation to make our voices heard.”
Jim says he wants to help pharmacy move forward after spending years in what he thinks is the best profession around. And he believes the way to do it is by being involved with the TrueCare Texas Legislative Council.
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The Texas Medicaid Vendor Drug Program will require pharmacy providers to bill any other known insurance before Vendor Drug will process submitted claims beginning Jan. 20, 2009.
To assist pharmacies, the Vendor Drug point-of-sale process will return billing information for any client claims that must be billed to another carrier. The pharmacy provider is to accept the combined payment from the other payer(s) and Texas Medicaid as payment in full and may neither charge nor take other recourse against the client. Medicaid recipients will continue to receive their medications with no out of pocket expenses.
A letter was sent December 10, 2008, to contracted pharmacy providers about this processing change, including information about training sessions that will be available online for pharmacists via the internet. A copy of this letter is available for download at the Vendor Drug Program website at www.txvendordrug.com/costavoidance.html or by going to the truecare texas website at www.truecaretexas.com.
If you are a contracted pharmacy but did not receive a copy of the cost avoidance letter or are not receiving copies of our quarterly newsletter, please verify your address on file with vendor drug is correct. Changes should be reported to the Medicaid/CHIP contract management unit in accordance with the terms and conditions of the Medicaid contract. Please submit corrections by fax to 512-491-1974.
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Texas community pharmacists, in February, will get a first-of-its kind sneak peek at the future of pharmacy benefit managers and the pharmacy industry when three of the country’s leading experts on PBMs come together at the PBA Health/TrueCare winter conference in San Antonio.
Headquartered at the festive Omni La Mansion del Rio located right next to the Riverwalk, the conference lineup includes such national luminaries as David Balto, Robert Garis, and Gerry Purcell. These extraordinary experts will share inside views on the impacts of the PBM industry on the business of pharmacy.
Some of this year’s speakers have been closely linked to groups helping President elect Barak Obama define his health care policy as it relates to pharmacy and other issues and their insight will prove invaluable to Texas pharmacy in the coming weeks.
The CE at this year’s conference will take a hard hitting look at the issues surrounding the PBM industry. Part of the discussion will focus on how independent pharmacies can educate plan sponsors on the intricacies of their plans, and how this will work to benefit pharmacies and their patients. |
Mr. Balto brings a vast array of knowledge that includes competition policy, health care, pharmaceuticals, and medical devices. He has over 20 years of experience as an antitrust attorney in the private sector, the Antitrust Division of the Department of Justice, and the Federal Trade Commission.
Also presenting will be Dr. Robert I. Garis who has received national acclaim for his research and publications on PBMs and the impact of mail-order pharmacies and has spoken extensively on pharmacy benefit issues. Dr. Garis has been retained as a PBM consultant by private employers, state and federal government, unions and the legal profession. He is also founder and CEO of Win-Rx, LLC a pharmacy benefit audit firm whose mission is to assist sponsors select appropriate PBM vendors. Dr. Garis has recently developed PBM monitoring software designed for oversight by plan sponsors, TPA and health plan consultants. |
Rounding out our panel will be Gerry Purcell. Mr. Purcell is known for his expertise on how PBMs reap huge profits through undisclosed pricing practices. He has testified before many state legislatures and is a nationally recognized expert on PBM contracting and author of "10 Things to Ask Your PBM".
“The ability to get these three experts on the same panel is a testimony to the growing influence of PBA Health and the TrueCare Texas Legislative Council in the pharmacy industry,” said John Heal, Texas governmental affairs director. “Their expertise is respected across the country and by any standard, their collective presence and participation will set the bar for future panels of expert discussing the PBM industry and its economic ramifications.”
During the luncheon, conference attendees will hear from the PBA Health / TrueCare Legislative team, lead by national Lobbyist Jorgen Schlemeier. Mr. Schlemeier is a nationally respected authority on pharmacy related issues and brings far-reaching expertise to TrueCare’s Texas legislative affairs efforts.
Also speaking at the luncheon will be Texas TrueCare’s legislative director, John C. Heal, Jr. Over the last nine years, he has worked on various legal, legislative and administrative matters for Legend Pharmacy and TrueCare Pharmacy, giving him valuable background and insight to the issues that now face independent pharmacy.
In addition, TrueCare’s lead Texas lobbyist Robert Culley will give insights on the 2009 Texas Legislature. His long-time service at the Capitol has left him with strong relationships among members and staff alike. Robert brings a wealth of Capitol and trade association experience to his role as a partner at Polan Culley Advocacy Group, a firm that is frequently rated as one of the top firms in Texas.
Joining Jorgen, John, and Robert will be Steve Ray. Mr. Ray leads TrueCare’s public affairs efforts. As Capitol Bureau Chief for Scripps Howard Newspapers, Mr. Ray was one of the most recognizable journalists in the state. In addition, Mr. Ray served as Deputy Executive Director for Planning and Information at the Texas Department of Economic Development before establishing his firm.
Registration is $189 for a single registration and $349 for a double. The registration fee includes opening night cocktail reception and banquet, and five CE contact hours, with breakfast, lunch and refreshments provided on the day of the CE sessions. For anyone attending only one day, the day rate registration is $99. |
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For reservations call 1-888-444-6664. For more information on the Winter CE Conference call PBA Health at 816-245-5700 or 800-333-8097. |
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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 legislative and 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,
The TrueCare Legislative Council
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