Dear Colleague,
I was pulling my suitcase out of the closet in anticipation of the NCPA Annual Convention, which starts this Saturday in New Orleans, when I heard news that California Gov. Gavin Newsom signed into law a PBM reform bill (SB 41) that he vetoed twice before. At first, I thought it must be an early Halloween trick. The California Pharmacists Association and its members, with support from NCPA, worked hard to get it passed by the legislature, only to watch it die on the governor's desk. But despite our frustration, we kept plugging away, calling lawmakers, hosting pharmacy visits, writing letters, testifying in committees, running ads, and meeting with the governor's team.
It was before my time, but the Frank Sinatra classic, High Hopes, is a cheerful allegory about being persistent in the face of impossible odds. One verse tells the story of "a silly old ram" trying to punch a hole in a dam. Everyone knew he couldn't do it, until he did it. "So, any time you're feelin' bad, 'stead of feelin' sad, just remember that ram, oops there goes a billion kilowatt dam!" Silly? Perhaps. But it's a good metaphor for the tenacity of independent pharmacy owners.
The new law bans spread pricing and patient steering. It requires PBMs to be licensed with the California Department of Insurance. It imposes transparency requirements. And it includes penalties for PBMs that make untrue or deceptive statements. It's an astonishing victory, and if community pharmacies had allowed themselves to give up, it would still be bottled up in the legislature.
California is just the latest in a string of victories in the states. Illinois, Arkansas, Alabama, Iowa, Virginia, and many others passed important reforms this year after many years of discouraging setbacks. And it's all because independent pharmacists kept pushing forward through uncharted territory.
Well, there's a lot more of that ahead of us. As of this writing, the federal government is still shut down and neither side seems willing to budge. Our top legislative priorities have strong bipartisan support, but until Congress figures out how to fund the government, nothing else can progress.
As part of his agenda to lower drug prices, President Donald Trump announced TrumpRx, a website the White House says will aggregate discount programs that patients can shop all in one place. There are still no details, but we met with the administration to warn them against severing the patient-pharmacist relationship and relying on the notoriously unreliable mail system. We also gave them a blueprint for making the new program work with independent pharmacies.
Meanwhile, the drug manufacturers are tripping over each other trying to come up with direct-to-consumer programs to bypass the PBMs. Patients shouldn't have to scavenge the internet chasing deals. They should be able to get the lowest price offered along with the benefits of the local medication expert who can help them, counsel them, assess their health, or make sure they're taking their medications on time and in the right amount.
The only solution that makes sense for patients and taxpayers is comprehensive PBM reform. The PBMs and their Big Insurance masters have completely distorted the market. Their shady and predatory practices are why Americans pay more for drugs than people anywhere else in the world. Just like our counterparts in the states, and like the ram in Frank's song, we're going to keep butting the dam until it falls.
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
