Dear Colleague,
Have you ever searched high and low for something (keys, cellphone, remotes come to mind) and you finally found it right in front of you? When that happens, someone invariably says, "If it was a snake it would've bit you."
I thought about that old phrase the other day as I pondered the "discoveries" being made about PBM business practices. The business practices — for lack of a better word — of PBMs are not new. Far from it. These discoveries are consistent with NCPA's objective of changing the pharmacy payment model. NCPA has been shining a light on examples of PBM malfeasance for decades. Lately, we're seeing more and more PBM investigations across the country and there's a temptation to think, "We've been telling you this for years. Better late than never."
This week, The Wall Street Journal reported that state officials in Ohio, Oklahoma, Georgia, New Mexico, Kansas, Arkansas, and Mississippi, as well as the District of Columbia, are looking at PBMs that operate in their states. Details of the investigations are not available, but some states said they were looking at companies in their Medicaid programs and state-employee plans. Among the companies under scrutiny are units of Centene Corp., UnitedHealth Group Inc. and CVS Health Corp.
"I'm aware of many states that are looking at this," Ohio Attorney General Dave Yost (R) told the newspaper. His office recently sued Centene, alleging it had misled the state's Medicaid program about its pharmacy-related costs, resulting in overpayments by the state. Yost told the paper that he expects a couple of new suits to be filed this summer, and "before this is all done, I will be surprised if we don't have a dozen or more states" bringing complaints against PBMs.
Why now? I think part of it may be due to the unanimous ruling handed down by the Supreme Court in Rutledge v. PCMA last year. That decision made a lot of heads turn. (I still love Chief Justice John Roberts' description of PBMs' behavior as "byzantine.") Their lack of transparency and greed caught up with them. It didn't automatically change the world of community pharmacy. But I believe that it's a canary in the coal mine for PBMs.
NCPA has led advocacy efforts to support the work of the National Council of Insurance Legislators and the National Association of Insurance Commissioners on model PBM regulations. NCPA attended and testified at multiple NCOIL meetings to present pharmacy's perspective on the need for PBM regulations in the states. NCPA quarterbacked efforts from multiple state-based pharmacy groups that led to the adoption of model language that has been implemented in numerous states.
NCPA has similarly worked with NAIC on their proposed model PBM legislation. NCPA presented information on PBMs' impact on rising drug costs and decreased patient access to community pharmacy services. NCPA led of a coalition of pharmacy groups that submitted written comments supporting efforts to adopt the model legislation. The process is ongoing.
Our campaign, The Truth, has shined a bright light on how PBMs operate, and that effort has led to tremendous grassroots support (10,000 new patient advocates who sent more than 27,0000 letters to state legislators urging them to regulate the PBMs.) for Fight4Rx.
Credit the pandemic as well. More than ever, community pharmacies have proven their worth to patients and their communities as essential businesses, and that opens the door even wider for us to continue to change the pharmacy payment model.
As for NCPA, we're going to continue to tell The Truth.
That reminds me of Harry Truman's response when, after one of his fiery stump speeches, a supporter yelled out, "Give 'em hell, Harry!" Truman's retort: "I never did give them hell. I just told the truth, and they thought it was hell."
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
P.S. Speaking of opening the door even wider to continue the quest to change the pharmacy payment model, the CDC is holding a webinar today on What Clinicians Need to Know About Pfizer-BioNTech COVID-19 Vaccination of Adolescents. No need to register. Check it out here.
