Association Perspective
Scott J. Knoer, MS, PharmD, FASHP, APhA executive vice president and CEO
Payment reform is a top priority for our profession. Appropriate financial incentives are necessary to fund the practice resources and FTEs to safely staff our pharmacies and reduce burnout, to eliminate exploitative pricing practices that close pharmacies and create pharmacy deserts in underserved communities, and to adequately fund new services that transform the provider and patient experience.
To change the way pharmacies are paid, we must first change the laws and policies that govern payment and we must change the policies and practices companies use to determine how pharmacies are paid.
We’re pleased to report that our efforts are successful thanks to incredible work being done by state and national pharmacy organizations. Recently, Georgia, New Jersey, Colorado, Illinois, Texas, Tennessee, Wisconsin, Alabama, Arkansas, and Arizona had legislative victories.
This was accelerated after the Ohio Pharmacists Association (OPA) brought transparency and accountability to PBMs when they showed that egregious spread pricing overbilled taxpayers and underpaid pharmacies by $244 million in one year alone. This was accomplished through relentless advocacy, outstanding local journalism, high-level data analytics, and aggressive lawmakers. Eventually, Ohio fired their PBMs and moved to a new model that will provide a more fair, predictable reimbursement model for pharmacies; recognize pharmacists as providers; and save taxpayers hundreds of millions of dollars annually. As a result of OPA’s success, Ohio state attorney general Dave Yost sued Centene, the largest Medicaid–managed care provider in the country, over their spread pricing practices. It was recently announced that Centene is settling with Yost and several other state attorneys general for over a billion dollars. This is the first settlement of its kind in the PBM industry! This damage was so bad for Centene, that they just announced that they’re getting out of the PBM business altogether.
This isn’t just a Centene problem. It’s an industry problem. In fact, despite its actions on the PBM side, Centene is one of Ohio’s greatest advocates in advancing pharmacist provider status that pays pharmacists for clinical services.
Success breeds success, and states across the country are taking advantage of new opportunities and making big advances in the fight for PBM reform and provider status. Trailblazing states like Arkansas and Washington started this fight years ago so that we could build upon their success. Professional associations such as APhA and National Community Pharmacists Association teamed up with the warriors in Arkansas and landed a serious blow to the PBMs at the U.S. Supreme Court—and that was just last year!
Despite ongoing challenges, our profession has made serious strides in reshaping the marketplace for the better, and we’re just getting started.
The message from pharmacy is clear: Any industry or company that exploits our profession and compromises our ability to safely and effectively serve patients will eventually be exposed and held accountable for their egregious actions.