Executive Insight

Executive InsightBY MICHAEL JACKSON, RPH MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION

Fixing a Broken PBM Marketplace

During 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 being 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 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 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 of the seats in the House and Senate are in play. The task before us is to navigate through the rhetoric and get candidates to reveal their positions on pharmacy issues. Now is the time to have that conversation with your local incumbent politicians and candidates while they are soliciting your support for their campaigns.

The Florida Pharmacist Political Committee is actively engaged on this issue. There were nine campaigns watched during the primary supported by the FPPC, and 8 of the 9 won their races. It is always risky when participating in primary races because the outcomes are less predictable. When we do engage and pick the right horse, the candidate remembers and generally has more empathy to what policies may be needed that we put before them.

As we get closer to the fall election, you will see candidates on street corners holding signs and participating in virtual and live town hall meetings. It is not unusual for me to see a candidate in my community and engage in conversations about the issues. Right now, they are open to hearing what you have to say. They will have no clue of what’s wrong until you take the time to talk with them.

Let’s not wait until October or November to make that conversation happen. They should not get glassy-eyed or confused if you tell them what a PBM is.

Would you like to find out who is running for office in your community? This web site link (https://dos.elections.myflorida.com/candidates/) lists all federal and state candidates by legislative district. Just take a peek at your voter registration card and it will tell you what district that you live in. Find your candidate and look them up. Don’t wait for them to call you.

A connection that you make today will pay huge dividends for you in the future.

1. https://www.floridapharmacy.org/news/487161/Shining-the-Light-on-PBMs.htm