Yesterday, two NCPA pharmacy owners participated in a special White House roundtable discussion on lowering health care costs, with a special emphasis on addressing pharma “middlemen” in the process. NCPA board member and pharmacist from Winfield, Kan., Dared Price (pictured at left), addressed PBMs and vertical integration in his remarks, calling the practice of patient steering detrimental to pharmacists and patients. “We need to end take-it-or-leave-it PBM contracts and cut-throat reimbursements,” said Price, who runs the transparent, pass-through PBM Oread Rx. Citing his experience filling the life-changing GLP-1s for people with diabetes, Price said his pharmacy was reimbursed $12,000 under cost in January, which is not unique to his experience, but “indicative of most brand name specialty reimbursement rates.” Chichi Ilonzo Momah, a pharmacist and owner of Springfield Pharmacy in Delaware County, Penn. (pictured at right), joined Price in raising the issue of “shrinking prescription reimbursements from PBMs when drug costs were increasing,” she said. “Reimbursements continued to decline, and now negative reimbursements below the amount I pay for the medication are all too common.” Momah also addressed the gaps that vertical integration leaves for America’s most vulnerable populations by offering a window in the experiences of two of her patients.
“I implore CMS to consider a cost-plus reimbursement model not only in Medicaid fee-for-service which exists today, but also in Medicaid managed care programs and Medicare Part D. Pharmacies must be paid transparently and fairly based on acquisition cost plus a cost to dispense fee,” she concluded. “This will save health care dollars and keep independent pharmacies in business to serve our patients."
The most colorful quote, however, came from billionaire celebrity and Cost Plus owner Mark Cuban, who told the White House that the big three PBMs are (sounds like knitting) on independent pharmacies. Yep. He went there. And he’s not wrong.
