PCMA Failures, Frozen Pizza and a Former PBM Auditor Confesses All: Welcome to PUTT’s 2023 Year in Review

Happy Holidays! 2023 was a very busy year for the business of pharmacy, with important wins in key areas including contracts; PBM regulation and enforcement; patient advocacy; a focus on better working conditions for pharmacists and staff; and perhaps best of all, a U.S. Congress nearly fully aligned on reining in PBM profiteering at consumer, taxpayer and provider expense.

Looking back at the last year:

In January, PUTT welcomed a new slate of officers, with Deborah Keaveny, founder of Minnesota’s independent pharmacy association, MNIndys, stepping into the role of President and second-generation Illinois pharmacy owner Lauren Young taking on the Vice Presidency. With most states commencing legislative sessions, we watched the federal government with interest as the handful of PBM regulation bills introduced in Congress turned into what would become some 40+ anti-PBM abuse bills. The same month, Mark Cuban spoke to students at a gathering at Arizona State University, describing in detail his transformation from tech billionaire and NBA team owner to drug company magnate (spoiler alert: he believes PBM reform is greatly overdue), and why he chose to put his name on what would become Mark Cuban Cost Plus Drug Company. Though we didn’t know it then, Mark Cuban, with his vision for safe, affordable medication at transparent prices, would become a regular topic of conversations among independent pharmacy owners and advocates throughout 2023.

February saw PCMA’s PBM-to-PBC rebrand fall flat, though they certainly kept trying to make PBCs a thing. Meanwhile PUTT launched a new happy-hour style podcast, PBM on the Rocks, (called by some “the Howard Stern of pharmacy podcasts” … we’ll take that praise). Centene reached its highest Medicaid managed care fraud settlement to date, paying the State of California $215 million, bringing its total payout to more than $900 million toward the $1 billion it set aside to settle 20 state lawsuits. The U.S. Senate Committee on Commerce, Science and Transportation held the “Bringing Transparency and Accountability to Pharmacy Benefit Managers” hearing, demonstrating a remarkable understanding of the PBM business model and disdain for the way in which that model has affected patients; community pharmacies; prescription drug costs; and reasonable, safe access to medication. Watching our elected officials ask PBMs the tough questions made us very, very proud.

At the end of Q1 we broke out our State Legislative March Madness brackets and celebrated significant legislative wins in Texas, Arizona, California and Oklahoma while cheering Cinderella-story contenders like Nevada (keep pushing for reform! 2025 is fast approaching), New Mexico, Massachusetts and Minnesota. The California Court of Appeals earned our full standing ovation for holding up an earlier ruling that OptumRx pharmacy contracts with their draconian arbitration requirements are, indeed, unconscionable. It was a hard-won victory for attorney Mark Cuker, Jacobs Law Group and the pharmacy plaintiffs, and we thank everyone of you for your courage to pursue justice for small business pharmacies.

In April, our good friends at American Pharmacy Cooperative, Inc. took a novel approach to PBM reform: calling out the Board of Directors of Vanguard, the largest investor in the “Big 3” PBMs’ parent companies. Appealing to very real concerns about the sustainability of financing the single biggest drivers of high drug costs at the pharmacy counter, APCI’s Greg Reybold wrote “APCI’s explicit request is that Vanguard stand with patients, providers, and lawmakers and demand that large PBMs end these practices that drive up the cost of prescription drugs at the counter, take away patient choice, and create barriers to care that lead to fragmentation, poorer adherence, and poorer patient outcomes.”

Even the Hollywood Writers’ Strike couldn’t dim our joy at watching Florida Governor Ron DeSantis sign the Prescription Drug Reform Act into law. Championed by the indomitable Representative Linda Chaney, and demanding PBM accountability as only Florida can, the new law includes patient protections; demands PBMs adhere to price transparency reporting; and empowers patient choice of pharmacy. Florida’s new law was the result of years of advocacy by local pharmacies including SPAR, PUTT and the Florida Pharmacy Association’s Independent Pharmacy Academy members. This month PUTT proudly debuted a new sponsor program, with Datascan Pharmacy Software and GRX Marketing underwriting PUTT’s flagship podcast, the PUTTcast, and PUTT’s webinar series, “PUTTLive”.

NASA declared June the hottest month on record, but we still felt pretty cool when the Wisconsin Circuit Court, Branch II affirmed California’s earlier ruling of the unconscionability of OptumRx contracts. For reasons still unknown, the Illinois Appellate Court reversed the California decision (technically this happened in May) and PUTT called on the Illinois Supreme Court to hear the case on behalf of the 42 pharmacies who would be compelled to follow OptumRx’s contract arbitration terms. Also pretty cool — SCOTUS gave a pair of independent pharmacy whistleblowers — and by extension independent pharmacy — a win in a Medicare and Medicaid fraud lawsuit involving a couple of well known national pharmacy chains. Janssen released its 2022 transparency report, disclosing commercial health plans and PBMs had received $11.2 billion of $39 billion the drugmaker paid in rebates. Noting the marked increase in rebates paid to commercial plans and PBMs, we spoke out about just how deadly the addiction to rebate kickbacks is becoming. With all that money being paid back to the plans, did anyone notice if your prescription drug copays decreased in 2022?

PUTT’s Summit was the highpoint of July and featured a most engaging keynote presentation by our good friends and fellow PBM reform crusaders AIDS Healthcare Foundation. AHF’s Associate Director of Advocacy, John Farina and Rhiannon Klein, National Director of Advocacy, shared their secrets for creating interesting and visually arresting patient-provider advocacy, giving us an inside look at how literally showing up and raising our voices really does make a difference. Greg Reybold gave an overview of the many bills in play in Congress, helping attendees to distinguish among bills and why grassroots support is necessary to keep up our collective momentum. Later in the month we joined the chorus of voices calling for the FTC to withdraw outdated documents that once supported PBM opacity, and were delighted when the Commissioners voted in favor of issuing a statement cautioning PBMs to stop relying on the old materials.

In August, the biggest surprise breakup of the year wasn’t Joe Jonas and Sophie Turner, but rather Blue Shield of California and CVS Caremark. With a goal to save millions in prescription drug costs, Blue Shield dropped Caremark in favor of Amazon Pharmacy and Mark Cuban Cost Plus Drugs (whose model includes allowing patients to use their local pharmacy) as a way to help their beneficiaries access lower-cost medications. The other (unhappy) surprise: the Tenth Circuit Court struck down Oklahoma’s anti-patient steering law citing “ERISA pre-emption” In the meantime, PUTT’s #GetTheFacts social media campaign hit full swing with this unforgettable graphic correcting PCMA’s misstatement about PBM value.

September was a total “Netflix and chill’’ month, starting with Rep. Jake Auchincloss’ epic Netflix metaphor explaining how the PBM business model works. We thought we’d help CVS “chill” after the Kansas City pharmacists, who were beyond fed up with the impossible working conditions, walked out. Taking a page from the Big 3’s “how to placate pissed off employees” handbook, PUTT sent 78 frozen pizzas to CVS headquarters in Woonsocket, RI, with a note of encouragement, basically saying we hoped the pizzas would help and we were sorry they were frozen but that’s all we could afford after years of below-cost reimbursements. They never got back to us, but you’re still welcome, CVS. PUTT President Deborah Keaveny and PUTT Board member and co-chair of the Arizona Independent Pharmacy Coalition Teresa Dickinson, joined a select group of pharmacy owners to meet with Rep. Buddy Carter for lunch in DC followed by visits with several members of the House and Senate. The event was organized and hosted by American Pharmacies, Inc (APRx). Deb and Teresa, along with several other PUTT members, sit on APRx’s federal advisory panel.

October is American Pharmacists Month, and also that time of year when we have the pleasure and privilege of seeing many of our members and friends at NCPA’s annual convention. This year we were honored to hold our 3rd PBM Reform Cocktail Party with our partners at American Pharmacies (who know how to throw a party!) The same month, we participated in 2 high-profile panels in Washington, DC, — Janssen’s IDEA Summit and The Capitol Forum’s Healthcare Competition Conference. Many of you responded with encouragement and ideas for Deborah Keaveny’s “how to better work with independent pharmacy” letter to Express Scripts, which we did indeed send to Dr. Stephanie Cooney, the independent pharmacy liaison for ESI. Concurrently, ESI was sued by independent pharmacies for price fixing in collusion with second-tier big PBM Prime Therapeutics.

Price fixing. We’re all so surprised.

In November, PUTT members were treated to a rare inside look at the mind of a PBM auditor in our webinar, Confessions of a PBM Auditor (available in the PUTT member library. If you’re not a member, click here to join!). The event was so well received, we’re planning a PBM Audit Town Hall in early 2024. And, grateful as we were to see 2 very big strikes end (SAG-AFTRA and UAW) we were more grateful to see the media take on covering the harsh working conditions that led retail chain pharmacists to Pharmageddon walkouts. The truth can be a bitter pill to swallow, but the untenable demands managers have been making of pharmacists and pharmacy staff have their roots in corporate greed and slashed PBM reimbursements. It’s not sustainable, not even for the largest pharmacies.

So far, December has given us quite the holiday sideshow, with former exes Cigna and Humana on a Kim Kardashian — Pete Davidson relationship trajectory. The former exes, who tried merging in 2015 to no avail, were exes once again after Cigna stopped talks of a second shot at merging. A skittish market rewarded the halted engagement with soaring Cigna share prices and a promised $10B stock buyback, proving the old B-school adage the market is smarter than you think. Choosing the not-busy-at-all end of the 4th quarter to premier its allegedly pharmacy-and-consumer-friendly CostVantage” and “TrueCost” plans, CVS went Big Hat, No Cattle with promises of a “cost-plus” pricing program that won’t help consumers at the pharmacy counter but as a bonus includes no public disclosure of their drug acquisition cost or “plus” markup, and no insight into how drug prices on their plans will be formulated. Still, they’re telling their shareholders to expect even greater profits in 2024 so it should be business as usual in 2024.

From all of us at PUTT, thank you for your support this year!

Wishing you joyful holidays,

Monique Whitney, Executive Director

Pharmacists United for Truth & Transparency

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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