Initially, pharmacy benefit managers (PBMs) played a contributing role in controlling prescription drug costs by negotiating prices with pharmaceutical manufacturers. Health care plans as well as consumers benefited from these negotiations. However, all of this has changed now that just three PBMs controll 85 percent of the market. PBMs now receive “kickbacks” from some drug manufacturers in exchange for giving special treatment to manufacturers’ products. U.S. Health and Human Services Secretary Alex Azar wants to end rebates in the pharmacy distribution chain that are costing Medicare and taxpayers billions of dollars.
Neighboring states Ohio and Pennsylvania are addressing PBM abusive practices in Medicaid managed care. The Ohio State Auditor reported PBMs pocket over $224 million annually off spread pricing in that state’s Medicaid managed care program. The Ohio Dept. of Medicaid directed the state’s five managed care plans to terminate all contracts with all PBMs. (WV Medicaid took this action in July 2017.)
Pennsylvania’s Auditor has also decided to look into PBM practices in the Medicaid managed care program, scheduling hearing throughout September to hear from pharmacists and other stake holders about PBM issues.
Representatives of NCPA and NACDS met with HHS to discuss community pharmacy perspective on elimination of post point of sale pharmacy DIR fees.
Appearing before the U.S. House Energy and Commerce Subcommittee on Health last week, pharmacist-owner Hugh Chancy told lawmakers how so-called “gag clauses” have impacted his patients and his business. He asked for legislation to prohibit language in PBM contracts that ban “gag clauses” and result in patients being charged inflated prices for their medications.
The U.S. Senate unanimously passed S. 2553 last week — Know the Lowest Price Act — allowing pharmacists to tell Medicare Part D beneficiaries if the cash price for a prescription drug is lower than the price through their insurance coverage.
CMS issued a memo outlining that Medicare Advantage plans may apply a “step therapy” approach to Part B drugs provided under their plans in 2019. Step therapy is a form of prior authorization where an insurance company has to give prior authorization before more costly medications are administered.
Increases in health insurance premiums are expected to be minimal in most states in 2019. Not in West Virginia, however. While premiums in New Hampshire are to decline 15%, premiums in West Virginia are to increase 15%, the second highest increase in the country. Almost nine in 10 affordable care act (ACA) customers get government subsidies based on income, shielding most from premium increases. It is reported people with higher incomes are dropping their insurance since the Trump administration dropped the ACA requirement that everyone has to have insurance.
APhA Foundation initiated the pilot program, Project IMPACT Immunizations — an initiative where pharmacists use innovative, two-way information sharing technology know as IIS (immunization information systems) to access CDC data that forecast which vaccinations a patient might need. Having access to a patient’s vaccination history at the point-of-care allows the pharmacist to knowingly administer additional, recommended vaccines — within their scope of practice — and immediately update the patient’s vaccine record into IIS, which is available to all members of the professional healthcare team who subscribe to the system.
The pilot phase of APhA Foundation’s Project IMPACT Immunizations was globally recognized with the International Pharmaceutical Federation Pharmacy Practice Improvement Award, September 2, 2018 in Glasgow, Scotland. Congratulations APhA!