Executive Insight BY MICHAEL JACKSON, RPH MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION
D
Fixing a Broken PBM Marketplace
uring the 2020 legislative session, the Florida Pharmacy Association along with a coalition of a number of pharmacy stakeholder entities, got heavily engaged in awareness of problems within the pharmacy benefit manager marketplace. There is no need to pour a lot of ink on this article describing the nature of the problem because much has been made available to our readers for many years. Annually, we march on the Florida Capitol and also travel to Washington, D.C., to try to convince policy makers to do something about this nightmare we are living in. DIR fees, network exclusion, unfair audits, onerous contract terms, mail order restrictions and preferential reimbursement are just a small list of the disruptions in the market. These issues affect pharmacy businesses we work in whether you own it or are employed by it. In the first three months of this year, the FPA working with the National Alliance of State Pharmacy Associations and American Pharmacy Cooperative Inc., commissioned a massive educational campaign to shine the light on PBMs. We got in front of the news media (both radio and television) and blew up social media with real, hard evidence that was discovered from a study of more than 350 million prescription drug claims in the Medicaid program.1 We can’t stop talking about the findings of this study because it was so obvious that something needs to be done. We understand that the Agency for Health Care Administration, the agency that is over Florida Medicaid, is about to release its own analysis of the Medicaid program as this article is be-
ing prepared for the Journal. We wait with guarded interest to see what those findings will be. During the 2019 House of Delegates meeting, a resolution was adopted asking that the FPA call on the governor, Florida’s attorney general, the state legislature and the insurance commissioner to mandate and ensure that compensation for pharmacists and
There is no need to pour a lot of ink on this article describing the nature of the problem because much has been made available to our readers for many years. pharmacy services who meet network qualifications be consistent and equal among providers. Prior to and during the 2020 session, we knocked on all those doors and exposed the critical issues related to PBMs. The adopted resolution above is a fair question to ask of any benefits manager, payer or governmental entity. If given the same qualifications, licensure and credentials, why is reimbursement
Michael Jackson, B.Pharm
and access so variable across pharmacy networks? If Pharmacy A can demonstrate exceptional outcomes and great care comparable to Pharmacy B, why is it that Pharmacy B gets better terms or is even admitted to a network when Pharmacy A may be excluded? Regardless of the outcome, no one can argue that change must happen. Health care cannot survive in this environment and the need for a new model should be the main topic of discussion. There are opportunities and challenges ahead of us. We are diving towards a general election this fall on Nov. 3. We just completed our state’s primary on Aug. 18 and know who the candidates will be. The November election will likely be the most polarized political campaign yet with candidates likely spending their resources swinging at each other. It is also an election year where most SEPTEMBER 2020
|
5
