Infectious Disease

Pharmacists cheer “historic victory” towards efficiency managers within the pharmacy

January 08, 2021

2 min read

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Several pharmacy associations welcomed a recent Supreme Court ruling on how much pharmacy performance managers reimburse pharmacies for the cost of medication covered by employer-sponsored health plans.

Arkansas, Texas and 44 other states argued in court that they – not the Federal Employee Retirement Income Security Act of 1974 or ERISA – should regulate PBMs to “prevent harmful health care business practices and protect consumer access to medicines” . A. Texas Pharmacy Association press release said.

The Supreme Court ruled unanimously last month in favor of an Arkansas law requiring PBMs to reimburse pharmacies for drugs at a price “equal to or greater than” the wholesale cost, stating that state law is not excluded from federal law.

“This is a historic victory for independent pharmacies and their patients.” B. Douglas Hoey, MBA, said a pharmacist and CEO of the National Community Pharmacists Association in a press release.

The ruling increases transparency of drug prices and access to pharmacies for patients, and improves patient choice and health care, the Arkansas Pharmacists Association said in a press release.

Conversely, the Pharmaceutical Care Management Association (PCMA) issued a statement saying it was “disappointed” with the Supreme Court’s decision, claiming it was lifting federal protection under ESIRA. The PCMA also said that ERISA is helping ensure “access to affordable, high-quality coverage for prescription drugs” and that providing reimbursement powers to states is “an impractical patchwork of regulations regarding the benefits of prescription drugs Will create drugs ”.

“As states across the country take this finding into account, we encourage them to exercise caution and avoid any regulations regarding the benefits of prescription drugs,” said PCMA.

References:

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C. Michael White, PharmD, FCP, FCCP)

C. Michael White, PharmD, FCP, FCCP

The benefits of Arkansas winning this Supreme Court case, particularly improved access to pharmacies and pricing transparency, are evident when we look at the impact PBM contracts have on patient outcomes.

Since widespread PBM consolidation has taken place, reimbursements for pharmacies in the community have decreased, increasing the number of prescriptions to be filled out every hour and reducing the time it takes a pharmacist to serve patients without delivering services. Since medication non-compliance is a major national health concern, minimizing the time for pharmacist-patient interactions is dangerous. When patients are forced to use mail order pharmacies for all chronic drugs and only prescribe prescriptions for new drugs in community pharmacies, they cannot build a trusting relationship with their pharmacist. If they are directed to community pharmacies for a chain linked to the PBM, it will lead to unfair competition in the market for smaller pharmacies which have been shown to provide more convenient care. This reduces the depth of patient trust and makes it difficult and difficult to identify drug intake, drug interactions, and adverse events.

Community pharmacies offer a safety net, especially for patients with different access to care. Vaccinations, counseling, drug interaction detection, and access to non-prescription drugs in community stores promote health and wellbeing.

References:

C. Michael White, PharmD, FCP, FCCP

Professor of Pharmaceutical Practice at the University of Connecticut

Disclosure: White does not report any relevant financial information.

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Michael C. Schweitz, MD

This opinion clearly states that states can regulate PBMs without violating ERISA. It will hopefully encourage states to curb abusive practices in the PBM industry for supply chain actors beyond pharmacies as well. With 45 other states and the District of Columbia backing Arkansas in the lawsuit, we’re sure to see renewed enthusiasm from state lawmakers for the issue, opening the door to improvement Access to pharmacies and adequate, necessary treatment for our patients.

Michael C. Schweitz, MD

Arthritis and Rheumatology Associate in Palm Beach

Head of the Department of Rheumatology at Good Samaritan Medical Center in West Palm Beach, Florida

Member of the Medical Policy Committee of the United Rheumatology

Disclosure: Schweitz does not report any relevant financial information.

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