Guest Author
The cost of prescription drugs can be a financial burden for Floridians already facing mounting health care costs. Pharmacy benefit managers (PBMs) are doing their part on behalf of patients.
The core mission for each PBM is to reduce prescription drug costs and improve health care quality for patients. PBMs reduce drug costs through negotiations with drug manufacturers and pharmacies. They help health plan sponsors improve the quality of care by helping patients stay on their medications and by preventing harmful drug interactions.
In Florida, PBMs will save consumers and health care programs more than $43 billion over 10 years, and PBMs helped the state Medicaid program save $2.3 billion.
State Rep. Jackie Toledo has introduced a bill, HB 961, that would cause health care costs to skyrocket for many Floridians, their employers, and the state while lining the pockets of independent pharmacists and padding the bottom line of Big Pharma.
The legislation would strip away incentives that health plan sponsors and PBMs use to help patients choose lower-cost, clinically equivalent options to fill their prescriptions while mandating that pharmacists get a guaranteed profit on every drug they dispense, no matter the cost to employers and health plans.
Rather than offer solutions to lower prescription drug costs, the pharmacist’s lobby prefers to vilify PBMs — the only entity in the prescription drug supply chain that is fighting to reduce drug costs for Floridians and patients nationwide. Instead of urging lawmakers to find ways to lower Floridians’ drug costs, these pharmacists are demanding lawmakers to adopt an agenda that would almost certainly increase them.
Indeed, despite independents pharmacists’ claims that PBMs aren’t transparent, PBMs support transparency for patients and their providers, policymakers, employers, unions, and other health plan sponsors so they can make informed decisions that lead to optimal health outcomes and lower costs.
Independent pharmacies are doing just fine in Florida. As one representative from their own national association recently stated, the number of independently-owned pharmacies is “holding pretty steady.” In 2019, the number of independent pharmacies operating in Florida is around 1,541, which is up from 1,164 in 2010.
That’s right: there are over 32% more independent pharmacies open today in Florida than 10 years ago. So why are they calling for lawmakers to impose additional mandates on PBMs? Actually, it’s a pretty easy answer: pharmacy owners want state legislators to guarantee that patients pay more so they can make higher profits.
PBMs understand that pharmacists play an important role in our health care system, but we believe the primary focus for everyone in the prescription drug supply chain, including PBMs and pharmacists, should be on making prescription drugs more affordable and more accessible for patients.
That’s why HB 961 is a bad prescription for Florida’s consumers. If independent pharmacy interests have their way, prescription drug costs will rise significantly. That’s bad for consumers, bad for employers, and bad for Florida’s own state budget.
___
Scott Woods is Assistant Vice President, State Affairs for the Pharmaceutical Care Management Association.
52 comments
Kat perk
December 20, 2019 at 10:53 am
Written by guest author? Aka ghost author aka someone who is paid by the PBMs to cover their ass?
Kathy Baldwin
December 20, 2019 at 1:29 pm
I am a pharmacist. This is fake news.
Kathy baldwin
December 20, 2019 at 1:39 pm
I am a pharmacist. This is fake news
Stephanie
December 21, 2019 at 9:05 am
There’s a new phrase replacing Trump derangement syndrome.
PBM derangement syndrome. PBMDS.
You people are nuts.
Todd
December 20, 2019 at 1:58 pm
Only an idiot would believe that prescription drug price increases are caused by anything other than the manufacturers gouging customers and health insurance companies. I have no idea what this bill is he is talking about but my wife’s HSA plan is billed almost $5,000 for humira. That’s no the pharmacists fault, or my insurance company’s fault. That is the fault of the drug maker.
Blame the people causing this mess. Not the people at the counter or the insurance companies or PMBs. Its the drug makers.
Tim Dunlap
December 20, 2019 at 4:43 pm
Oh the insurance companies and PBMs are driving up the cost as well. Which companies are among the top of the Fortune 100. Caremark, Express Scripts, United Health, and the other players in the drug supply chain. The PBMs extort rebate money from the drug manufacturers. It has been shown that Caremark (CVS) is ripping off the state’s medicaid system to the tune of $250 to $350 million that was not disclosed. No transparency. You are right though it is not they guy or gal behind the pharmacy counter.
Shan
December 22, 2019 at 6:52 pm
Sir, you probably don’t believe This but about 25% of the $5000 goes to PBM (who don’t own the store, wholesale company nor insurance), 10% goes to Drug wholesalers, 10% goes Insurance company in a rebate form and 5% goes to pharmacy owners. Manufacturers keeps the Remaining 50% of $5000
PharmAbuse
December 26, 2019 at 9:18 am
Hey Todd- What if I told you that your insurance company receives (extorts) somewhere around $1000-$1500 of that $5000 billed back from the manufacturer? So when you’re in your deductible phase and you and your wife have to pay some or all of that $5000 charge – the PBM gets $1000-$1500 back from the manufacturer as a “double dip” and you get NOTHING from them. That is happening right now and Rep. Toledo is going to fix it.
Knowledgeable Ghost writer
December 20, 2019 at 2:02 pm
Who ever wrote this don’t know industry at all. PBM are Mafia of Pharmaceutical industry . They collect money from Pharmacies , Payers , Manufactures and By opening Their Own pharmacies they steer more patient their way plus pay their own Pharmacy higher reimbursement then other pharmacies.
James
December 20, 2019 at 2:55 pm
Absolute sham of an article. Just read PBMs own SEC filings and earnings reports to investors. PBMs clearly state they make more money when drug prices increase.
PBMs increase drug prices and rip off tax payers.
Consider in 2017 Florida had to pass a law that made it legal for a pharmacist to inform patients when a prescription would be cheaper by paying cash instead of using insurance. Why would informing patients of the cheapest payment be against a PBM contract?
Because they make money through lack of transparency, that’s why.
Kevin
December 20, 2019 at 2:56 pm
What a dishonest piece. Scott Woods you should be ashamed of yourself. Using a 10 year period of store numbers? The last 4 years pharmacies in Florida are down 15%. Thats from PCMA’s own slide deck. Lining the pockets of independent pharmacies? That’s a joke. Medicaid pays me less than drug cost about 35% of the time. My average profit is less than half what my break even is on Medicaid! And speaking of Medicaid…
Lucas
December 20, 2019 at 2:57 pm
Pharmacist here. This is the second article written by guest authors in Florida defending PBMs that fails to mention anything about DIR fees, claw backs, spread pricing, among other tactics that they use to line their pockets. I’m curious to know how much these PBMs are paying these guys to write these articles that clearly ignore ways that PBMs add to the costs of health care.
Independent Pharmacist
December 20, 2019 at 2:57 pm
This article is a sham! PBM’s clearly paid for this article! HB 961 is the best bill to date on lowering prescription drug pricing and keeping independent pharmacies alive in Florida. The pbms and PCMA want no part in transparency. The want you to keep your blinders on while they hijack hundreds of millions of dollars from the taxpayers of Florida.
PhloridaPharmacist
December 20, 2019 at 3:01 pm
For an org with companies with BIG BUCKs and BIG public relation firms, etc their talking points are so stale, refutable and frankly lame. This wasn’t an “editorial” it was advertising and even though PBMs have no rules they follow don’t companies have to adhere to truth in advertising. Any whoo – it’s just NOT working any longer and their gravy train is pulling up to the final station as Florida is onto them now
Bill
December 20, 2019 at 3:03 pm
PBM’s are crushing small independent pharmacies with their reimbursements. To give general common person an idea what’s happening behind the counter is say for instance cost of insulin is $500 pBM will pay $450 to the pharmacies and the steer these patients to their own mail order pharmacy which is a huge conflict of interest anyways. They are still not happy with that they will throw baseless audits on independent pharmacist to squeeze their hard earned money and shut them down. It’s frustrating at the cost of greed and increasing cost of prescription drugs to the general public.
John
December 20, 2019 at 3:11 pm
PBMs are stealing money at an alarming rate. Their lies are brazen.
Jay
December 20, 2019 at 3:14 pm
Transparency? You didn’t even leave your name “author”. Nuff said on your transparency. Saved $2.8 billion is Pcma made up number, actually costing Florida Medicaid $40 million/year on just one of their schemes. More to come on this. And guarantee a pharmacy a profit on a prescription. I would hope so, but pbms are asking pharmacies to subsidize Medicaid so they keep getting record profits. Have you told all employers and Florida residents what “spread pricing” is. Speaking of Florida residents how many of these pbms have their headquarters located in Florida. That’s right Florida citizens your tax dollars are leaving the state by the billions to pbms. Forgot to mention PBM, YOU HAVE NO PRODUCT.
Darrell
December 20, 2019 at 3:21 pm
I am a pharmacist that has practiced in the independent, chain and hospital/ clinic settings. This article is simply not true. Fake news.
Educated Ghost writer
December 20, 2019 at 3:21 pm
PBM are Stealing money and Are the Reason for Rise in Pharmaceutical .
Example . manufacture sells a drug for 1000 Dollars . Now to be on formulary with PBM in order to have Access to Patient and paid through Payer they have to Pay PBM a “rebate”. Otherwise no PBM will cover it and patients cant afford it . To Pay 1000 Rebate to PBM they have to increase Price to 2500. Now they are on formulary and can Have Access to patient .
Look at any Publicly traded PBM and their Profit Margins . Just being a Middle Man if you can make that much Money. Pharmacies provide Care Insurance Companies take Risk . PBM dont have to Do anything .
Mutiman
December 20, 2019 at 3:32 pm
Representative Toledo lived the problem created by the PBM’s on a personal level so she introduced the bill to stop the problem affecting more Floridians.
The fact that the business practices of the PBM’s in question are predatory and harmful to independents is a side effect of their actions and again harms many Floridians that work and pay taxes in this state.
Illinois Indy
December 20, 2019 at 4:06 pm
This is the biggest collection of garbage I have read lately.
1. PBMs hide everything they can. No transparency.
2. They coerce manufacturers to pay them rebates to get their products in formularies. These rebates drive up costs.
3. They use spread pricing to increase their profits. Pay providers (pharmacies) small amounts and charge payers much higher prices.
4. They use any method they can to steer patients to their company owned mail order or other company owned providers.
5. PBMs can determine winners and losers. They pay different providers different amounts.
These are some of the things PBMs do routinely and why there is blatant conflict of interest.
Van Coble
December 20, 2019 at 3:43 pm
This am article written by someone who works for the PBM trade org, PCMA. The info is preneted to make PBMs look like a savior on the prescription drug side of health insurance. That is the farthest thing from the truth. PBMs do not reimburse at a pharmacy’s cost to dispense at a rate of 75 to 90% of prescriptions filled. They use bogus costs for drugs, audit pharmacies months or even years after prescription is filled, recoup part of the payment via clawbacks or DIR fees, demand price concessions from drug manufacturers that are not shared with the patient or the pharmacy, pay the pharmacy less than what is billed to prescription program, and overall are one of the chief contributing factors to increasing prescription drug costs. Mr. Woods is guilty of disseminating faulty info at the very least. Some would say he is lying through his teeth. One thing for sure he is not presenting all the facts.
Andy
December 20, 2019 at 3:43 pm
I do not know Scott Woods, but if he wishes to be taken seriously as a journalist, he needs to verify facts before stamping him name. I realize that we live in a world where one can tell lies with little accountability, however those of us in the industry that KNOW the truth will easily expose it with FACTS!! This article was clearly written by PCMA or someone on the side of the insurance companies. The TRUTH will prevail with or without you Scott Woods, and you clearly don’t know Jack Schmidt.
venkata ammanabrolu
December 20, 2019 at 3:46 pm
This is totally a game plan created by PBM .did mr.toledo ever entered or spend sometime in the pharmacy.once he does he will understand who is ripping the public.
Frustrated Rph
December 20, 2019 at 3:52 pm
The person who wrote this article clearly got paid by the PBM’s or their lobbyists. Have some conscience. Or atleast look at this … what will your kids and family think about all these lies that you say. What a good example to set for them .
This is totally fake news .
If you have the guts to sign up for an open debate with independent pharmacists and I bet you you will run out of the debate hall with your tail between your legs. Feel like taking on this debate … let us know we are ready
Successful Independent
December 20, 2019 at 4:00 pm
Thanks for your article Scott, but I have to ask one simple question, how is transparency provided to plan sponsors? I work with a municipality that a certain top 3 PBM company won’t provide claims data to them. I would give you my direct contact but I figured I would provide similar “transparency” to the PBMs and give you the smoke and mirrors. And if I disclose name I get a certified letter from my PBM threatening contracts. So to be clear threatening independents, reducing their payments and climbing the Fortune 10 list is their mission. You will be exposed for the liars you are so save your money now you’ll be joining the low unemployment rate. Happy Holidays!
Successful independent
December 20, 2019 at 4:06 pm
It’s me again. Legislators like Jackie Toledo and the many more supporting this legislation are good people and care for people not once did you mention patient care. Obsessed with profits much? Your motto should be “Bottom Line Dwellers”
Byron
December 20, 2019 at 4:27 pm
This is the biggest collection of garbage I have seen written. PBMs are the least transparent business on earth. Their business practices are the biggest drivers of healthcare costs in the prescription market. They coerce manufacturers into paying them rebates to get their drugs in the formulary and no one knows how much these rebates are and how much the PBMs keep for themselves. The rebates force manufacturers to increase prices to keep their profits up and everyone pays. PBMs use spread pricing to increase their profits. They pay providers very small amounts and charge payers much higher prices. They steer people to their company owned providers which is a blatant conflict of interest. They control what they pay their competition and can change reimbursement at the flick of a switch. The payment system in pharmacy is broken and PBMs need to be broken up.
Jack
December 20, 2019 at 4:54 pm
Ready…on the count of 3, all the the independent pharmacists to the article and trash the author!! attack!
PBMs aren’t really autonomous PBMs anymore because almost all of them are now under the health insurance companies who have a job. Their job is to keep health care premiums low, and drug costs are driving up premiums – through the roof. Drug companies have scam after scam to keep people from switching to generic and therapudic equivalents that are MUCH CHEAPER. Nobody wants their health premiums to go up so pharmacists can get a higher dispensing fee and more profits, or Pharma can charge more. They want them to go down. PBMs do in fact fight like hell to get lower drug prices which cut into pharmacy margins. Its the evolution of healthcare. And why pharmacists whine about mail order even though patients LOVE IT.
I think the author’s article makes sense. But what do I know. I work for a hospital and we have our own pharmacy that gouges the hell out of our patients. I’m sure our director read this article too and is steamed.
Lower costs across the board and start by dragging pharma through the streets. PBMs are about .000001% of any healthcare problem because they LOWER COSTS.
Phlorida pharmacist
December 20, 2019 at 8:19 pm
Have a hard to believe a hospital pharmacist really things this. Its subtle but is imbedded here are PBM talking points. Nice try PBMophile. We don’t believe you!
Phlorida pharmacist
December 20, 2019 at 8:39 pm
No one LOVES mail order and any legit
Pharmacist (not a PBM troll) know this.
Dave
December 21, 2019 at 6:24 am
Jack, I recieved a letter fro CVS-Caremark informing me that generics for the following drugs will not be covered: Advair ($495+ and generic is $180), Concerta (bottle of 100 $1,293 and the generic $262) and Adderall (bottle of 100 = $691 and generic is $71). How is that fighting like hell to bring down drug prices?
Kathy baldwin
December 21, 2019 at 12:00 pm
Jack, I’m a hospital pharmacist too. This affects our patients as well. We discharge patients with rxs they can’t get because the pbms increase the cost exponentially. 60% of rxs with copays of >= $250 are abandon. One pt was being charged $441 for lexapro thru pbm insurance but thankfully independent pharmacist filled it for $20 outside of insurance. It’s more than just Lexapro
Please email me. [email protected] I would like to connect with you. Are you a member of ASHP and your state society of health system pharms?
We are all over this travesty of justice while our patients choose between insulin or food, drugs or shelter. Awful choice to have to make and unnecessary in US in 2020.
One comment on Rep Toledo. Thank you for you courage to take this on.
David Bagot
December 20, 2019 at 4:55 pm
Those are some bold claims made by this author. Sadly though, they are nowhere near the truth. Please tell us how the following things equate to PBMs trying to lower the cost of prescription drugs: non-reference based billing number AWP, MAC pricing, GER, clawbacks from pharmacies, manufacturer kickbacks, maximum campaign contributions to every member of the US House of Representatives and US Senate not to mention the majority of each State’s General assembly. If you support transparency why won’t you open your books to your customers and law makers to show who pays you and where all of that money goes. It is one thing to say PBMs lower drug costs, it’s another to open up your books and show us why all three of the largest PBMs are Fortune 20 companies. The closest Big pharma company is #61 on the list and there is not a single independent pharmacy anywhere close to being on the list.
Pharmacy Manager from FL
December 20, 2019 at 5:09 pm
This article is unbelievable and ABSOLUTELY false!!! PBM’s are lining their own pockets at the expense of the customer, the insurance company, AND the pharmacy. They get richer while they put independently owned stores out of business by steering customers to their own pharmacies, paying pharmacies below cost for drugs, using take it or leave it contracts pharmacies cannot negotiate, clawing back money after the fact with baseless “audits” and the list goes on. There is NO transparency by the PBM’s, most consumers do not even realize they exist or what they do, and they write into the contracts that pharmacists are not allowed to discuss it with the customers! PBM’s are ALSO able to base which drugs they cover for their patients on which drug companies will give them big rebates for using their product. SO MANY things the PBM doesn’t want the consumers to know, but they’ve managed to cover themselves by not allowing pharmacists to discuss the details of these ridiculous “contracts” or they risk losing the contract and the patient altogether. I am pure ashamed this article would be posted here, it should have a disclaimer stating that a PBM clearly paid to have it posted. Unbelievable.
David
December 20, 2019 at 5:17 pm
cry harder!!! Let me see if i get this right, “steering” what is that? Are you mad that people are advertising to customers to come to their pharmacy? Are independent pharmacies against competition? Aren’t politicians always saying that they want people to pay less for drugs? Do you want them to pay more? it sounds like it. You want PBMs to not send patients to lower cost drugs?!?!?!?!? sounds like you are trying to line your own pockets! hypocrite much????
Phlorida Pharmacist
December 20, 2019 at 8:23 pm
Who said mail was less expensive (overall)? Got plenty of evidence to the contrary. So steering to themselves so they can get the $.
There is no such thing as competition in a market where your competition sets your price and forces your customers to go to them whether they want to or not (and a LOT don’t go to them as didn’t want to before. Where is consumer choice?
Juan
December 20, 2019 at 5:09 pm
is it true that mail order pharmacy error rates are less than 1 percent of the error rates at retail pharmacies? The answer is yes, maybe some of the whiny people on these comments should get their house in order
Phlorida Pharmacist
December 20, 2019 at 8:26 pm
We see plenty of “errors” from mail order, drugs delivered to wrong patients and drugs stolen from porches.
Using mail order argument based on less mistakes brings us back to Merck or was it Express Scripts CEO who said anyone can slap a label on a bottle of nexium (minimizing pharmacists).
Most independents have an Eyecon or similar technology and “dispensing errors” aren’t even an issue. At all.
Jay
December 20, 2019 at 9:20 pm
Hey Juan in mail order cubicle with no idea of the person who’s health you are supposed to take care of. Nice statement with no study showing that. Oh and by the way I will send the 98% of your mistakes that I have to fix for patients in my community that you never knew you made. Including the waste and fraud your mail order is committing by filling 3 month supply every 2 months even after the patient and doctor called to let you know the patient was no longer on. But then again Juan you probably aren’t even a pharmacist probably cfo for pbm
Vikram Rao
December 20, 2019 at 5:22 pm
PCMA has guts to wrote this kind of entirely fake article. This is based on fiction. Let’s out everything aside.
I challenges PCMA to debate me or any of pharmacist on live TV. DO YOU ACCEPT CHALLENGE?
I bet not.
Ok, easier task for you PCMA! Define following terms for consumers.
1. Spread pricing
2. Drug rebates
3. Clawbacks
4. Restricted networks
Do you want me to keep going?
Just shut up PCMA, you lost your credibility already.
If PBM isnt doing anything then why worry about HB961?
Only thieves would have to worry of cops; not law abiding citizens.
Steven A
December 20, 2019 at 5:27 pm
I love all of these triggered comments. How amazing is it that a pharmacist would actually go online and complain about being audited for over payments!! Are you kidding me!? Welcome to the real world people when you get paid too much money for a product.
If you get audited and you failed the audit and you have been billing the insurance companies too much for the drugs you dispensed, then you should pay the money back!! It’s called a free market people and honest services.
Phlorida Pharmacists
December 20, 2019 at 8:30 pm
When the patient got the right drug,
Right dose, right directions and enjoyed the therapeutic value of that Rx and the PBM comes up with some excuse that the Rx didn’t meet some made up rule and they take back the ENTIRE COST of the DRUG tell us please how pharmacists were overpaid then?
PBMs use audits as a revenue source. They are NOT fulfilling their role in looking at FWA. In fact they miss a TON of that as they are looking for low hanging fruit in order to pad their pockets!
Sara
December 20, 2019 at 5:54 pm
I was literally laughing out loud reading this. It’s absolutely ludicrous. PBM’s are stealing money from independent pharmacies at an alarming rate. They decide what to reimburse pharmacies, which is usually below drug cost. Then they hit pharmacies with DIR fees. This is the sorriest example of journalism I’ve ever seen.
Rut
December 20, 2019 at 6:07 pm
Literally stealing money.
Right. If they are literally stealing money, then have the states attorney investigate them for theft. Otherwise, don’t be ridiculous and discredit yourself by saying something so patently stupid.
This sounds like a lot of complaining from healthcare providers that don’t like to play by the rules of the game.
Phlorida Pharmacist
December 20, 2019 at 8:37 pm
State Attorneys ARE investigating them by the way. Not sure where Florida is though- too focused on opioid lawsuit.
There are NO rules of the game other than what the PBMs make up for THEIR benefit.
Gary
December 21, 2019 at 8:59 am
You people are deranged. No PBMs are being investigated for stealing. Stop whining about free market economics.
Van Coble
December 20, 2019 at 10:28 pm
They have been investigated by several states whose Medicaid programs are using PBMs to adjudicate claims for prescriptions. Ohio started with about $220 million in overcharges. Google the overcharges and educate yourself. If PBMs are not stealing from pharmacies, they are stealing from taxpayers, and then they maybe stealing from patients or the entity providing the prescription coverage. If you are not or have not worked in community retail pharmacy you do not understand the problem.
One of America’s Most Trusted Professionals
December 21, 2019 at 1:12 am
Hmmm…please tell us how much of their “rebate money” or money that they took back from independent pharmacies was used to pay you to write this disgraceful article? How dare you point the blame at Independent Pharmacies!!!
They (PBM’s) have made a mockery of our profession. The profession which was once viewed as “America’s Most Trusted Profession” has been ruined by these unnecessary thieves! I can’t believe that you believe what you wrote here. Shame on those who paid you to write this.
Kirit Patidar
December 21, 2019 at 11:31 am
Love to debate with this author on every single accusations they are making. A complete and utterly false narrative. Bottom line is PBM are not doing the job they were mandated to do and cost of health care has increased due to their greedy ness. They have never lost money since their inception even during recession years. They have NO ROLE to play in healthcare needs of the patients and to the contrary adversely affect the outcome. Not only pharmacist are complaining about PBM and physician are fed up with them. They are literally stealing from Floridian tax players and our politicians need to open their eyes and support Mrs. Toledo.
Shan Patel RPh
December 22, 2019 at 10:37 am
This article is totally biased and funded by PBM lobbyists. Initially PBM came in Pharmacy healthcare segment to reduce the medicine costs for consumers but later they went in opposite directions. PBM uses spread pricing model and made billions of dollars per year. Insulin was available at $50/bottle in 2010 now the same bottle is available at $200/bottle. This is because they pocketting $100 with a spread price model.
Pharmacist
December 23, 2019 at 7:04 am
As a pharmacist working for an independent pharmacy, I can tell you that the Pharmacy Benefit Managers are not doing anything except causing problems for both pharmacies and patients! They have managed to make billions by becoming the middleman between insurance companies and patients, claiming they are increasing patient adherence and the like. They are outsourced with customer service representatives over seas who seem to have orders to do anything other than help the pharmacy calling to resolve a problem they are having filling a patient’s prescription. The amounts reimbursed to the pharmacy is often less than the pharmacy pays to their wholesaler! It is a complete scam! This article is a prime example of the false pretenses these PBMs operate under!
Comments are closed.