How Specialty Pharmacists Can Bridge the Gap in PBM Reform
JD: It’s not 100%, it’s not across the board. There are obviously going to be some states that we may never see any form of state-level PBM legislation. I think of Rode Island, Missouri, and Arizona perhaps. Areas where there’s a strong PBM or payer presence there that is going to effectively block any kind of grassroots effort from an independent pharmacy level. We do however see many states–Louisiana, Georgia– coming out with new laws. And the other thing that we’re seeing too beyond just the legislative fix is scrutiny at an investigational level, and we’re seeing congressional investigations, we’re seeing Department of Banking and Insurance Investigations. Ohio is a great example where they’ve been covered. The PBM was eseentially taking 245 million dollars a year in just spread price. The difference between what they paid the pharmacy and what they charged the state health plan so this is happening across the country and I think the state attorney general’s and state regulators are finally starting to wake up to this realize that that’s out there and it puts a great opportunity for the pharmacy community–the independent pharmacy community– to work with and educate those policy makers, whether it be legislators, whether it be the regulators, the Attorney General’s on kind of these practices.