2023: New Year, New Leadership and an Intensified Focus on Ending PBM Abuse

2023 could be a harsh karmic lesson for pharmacy benefit managers and their corporate insurance parent companies

January’s come and gone while here at PUTT we’ve been actively developing PBM education programs and meeting with industry leaders and influencers over the last 4 weeks. With so many freshman legislators at the state level (and a few federal ones too), there’s never been a greater need for education and materials that explain the true nature of the PBM business model — and why PBM reform is needed NOW.

We’re starting with the announcement of our new administration, but keep reading about some “January Surprises”, our 2023 focus and more:

New PUTT Board Leadership

We welcome a new slate of officers, beginning with our newly elected president, Deborah Keaveny (MN)! Charged with directing how PUTT will work to achieve our mission of ending PBM abuse, she will be assisted by Vice President Lauren Young (IL), Board Chair Scott Newman (LA), and Directors at Large Van Coble (KS), Jeremy Counts (VA), Bryan Keifer (MO), Oliver Lackey (OK), and Jerry Shapiro (CA). Dawn Butterfield (FL), who serves as president of Florida Small Business Pharmacies Aligned for Reform (SPAR) will step into the role of Chairwoman of PUTT’s Advisory Board.

In 2023 We’re Focused on PBM Practices that Harm Pharmacies and Protect the Status Quo

You’ll see us speaking out on the issues that affect our industry most: poor reimbursement, which affects patient access; DIRs and other unfair, nontransparent and burdensome fees (which also affect patient access); programs that lessen pharmacies’ dependence on PBMs; and exposing PBM lies, double-speak, revenue generation schemes and the many ways PBMs fool large employers into overpaying for prescription drug benefits.

January Surprises: PBM 101, Mark Cuban and Florida’s New Push for PBM Legislation

Along with PUTT members Teresa Dickenson and Ken Patel (also founders of the Arizona Independent Pharmacy Coalition), we worked with Arizona patient groups to create a “PBM 101” hour for the state’s 40+ new state legislators. The session — which consisted of a brief explanation of the role PBMs play and how vertically integrated the healthcare market has become, also included patients and physicians sharing their stories of treatment delays; costly and often outrageous treatment protocols (like surgery!) in lieu of medication; and ended with a plea to help “end the madness.” The session was so powerful, PUTT will organize a virtual “PBM 101” in February to help members educate their new lawmakers.

Coincidentally, we had the opportunity to meet celebrity billionaire (and now pharmacy owner) Mark Cuban at a student healthcare policy event organized by an Arizona patient advocate. Teresa, Ken and I spoke with Cuban one-on-one about the challenges facing pharmacies by PBMs, and were struck by his deep understanding and knowledge of the issues (though in hindsight, we shouldn’t have been surprised. He’s in the business now too). Cuban’s Cost Plus Drugs is a competitor, but one that seeks to partner with independent pharmacies and per Mark Cuban’s talk that night, wants to direct patient traffic to their local pharmacies. PUTT is currently working to understand the nature of the partnership and will report back in an upcoming newsletter.

Last, but never least, we were surprised and delighted to hear Florida Governor Ron DeSantis announce a sweeping package of legislation designed to curtail the rampant PBM abuse that previous studies have shown is happening in Florida. Curious about what led to the change, we spoke with PUTT member Ben Levene, who is also Vice President of Florida SPAR. The story follows below in this issue of the PUTTBulletin.

This Year We’re Looking Forward To …

Educating the many freshman legislators at the state and federal level who may not have heard of PBMs, but are actively taking up the cause of improving the healthcare system for patients and their providers

Partnering with patient and provider organizations, publishing new educational programs, transparency reports and other materials aimed at dispelling PBM propaganda

Assisting members in states actively taking up new legislation that limits the (so far) unchecked, mostly unregulated power PBMs exert over prescription medication cost, price and access

The introduction of new wellness programs that accelerate patient healing and help lessen dependency on medications, while also helping to diminish pharmacies’ dependence on PBMs

… and What We’re Watching Closely

The new law that moves DIR fees to the point of sale, effective January 1, 2024, but also leaves pharmacies on the hook for the 2023 retroactive DIR fees that are clawed back much later. So far no relief plan to assist pharmacies during the transition has been announced.

Congressional PBM Investigations: From the bipartisan Patient Access Caucus lead by Representative Buddy Carter, to PBM-focused hearings in the House Oversight & Accountability Committee, reintroduction of Senators Grassley & Cantwell’s Prescription Pricing for the People Act (S.113) & Pharmacy Benefit Manager Transparency Act (S.127), and even the appointment of Senator Bernie Sanders as Chair of the Senate Health Committee — the 118th Congress is shaping up to be a whole new level of schadenfreude for pharmacy benefit managers.

Thank you for your support of PUTT. We look forward to partnering with you this year to end PBM abuse and overreach!

Yours in Advocacy,

Monique Whitney, Executive Director

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Pharmacists United for Truth & Transparency

PUTT is a nonprofit organization dedicated to advocating on behalf of independent pharmacy & fighting against PBM anti-competitive business tactics. TruthRx.org