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Pharmacists call for bailout | News

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PLATSBURGH – State Assembly Member D. Billy Jones joined local pharmacists on Wednesday in calling on Governor Kathy Hochul to sign three bills in the “Pharmacy Rescue Package” to regulate managers of Pharmaceutical Benefits (PBM) in law.

“It’s basically leveling the playing field,” Jones (D-Chateaugay Lake) told Condo Pharmacy on Montcalm Avenue in Plattsburgh. “This provides transparency and fairness to our local pharmacies. “

DISTRIBUTED PRICING

According to a press release from Jones’ office, PBMs decide how much to charge health insurance companies per prescription as well as how much to reimburse pharmacies for dispensing the drugs.

In a practice called “pay-as-you-go pricing,” they pocket the difference between what insurance companies pay and what PBMs pay pharmacists, which can often cause pharmacists to dispense at a loss.

“It’s a complicated problem, but at the end of the day I think we can simplify it by saying that there is a price imposed on pharmacies over which they have no control and the middlemen, the PBMs, are negotiating – This is not the case. even a negotiation is a one-sided negotiation and they take the money, ”Jones said.

Condo Pharmacy co-owner and pharmacist Steve Moore said PBMs began operating in the state in the early 1980s as claims processors and have since evolved beyond that original function to become “dark intermediaries”.

He pointed to a study that estimates that there is a difference of $ 5 per prescription between what a pharmacy is paid for and what state programs pay for drugs.

“You think, ‘five dollars? Well that doesn’t sound like a lot. Multiply that by the number of prescriptions in New York State’s Medicaid program, it’s huge, ”Moore said.

THREE INVOICES

All three bills in the package have been passed by both the Senate and the State Assembly with broad bipartisan support.

Jones described A1396 / S3762 as a transparency bill, which he co-sponsored. According to its memo, it “would require a license for (PBM) and specify their duties and obligations as service providers”.

The assembly member also co-sponsored the A7598 / S6603 which, according to his memo, aims to “address unfair and unsustainable practices of managed care providers and PBMs to provide patients with access to care services. essential pharmaceuticals “.

Among other provisions, this bill “would require that Medicaid-managed care plans reimburse retail pharmacies an amount equal to the fee-for-service rate” and prohibit PBMs “from limiting an individual’s ability to pay. receive drugs from pharmacies not sold by mail order ”.

Finally, A5854 / S3566 “would clarify and strengthen the provisions of the current law to ensure that consumers have the ability to access all covered medicines from a participating pharmacy in the local network and are not forced into compulsory mail order sales. “, we read in his note.

TAKE BILLIONS

PBMs end up taking billions from health care providers, Moore said.

“These are Fortune 15 companies making record profits during the pandemic. We have suppliers that go bankrupt, you have patients that go without services.”

Unregulated PBMs present a nationwide and pharmacy-wide problem, Moore continued, highlighting the shutdown of chains in the region like Rite Aid, which was acquired by Walgreens.

Because of reimbursement issues with Medicare and Medicaid managed care plans, pharmacies in areas where such plans are prevalent tend to be the ones that close, he said.

“So it is our most vulnerable patients who are going to be the ones who suffer.”

CHRISTMAS GIFT

The regulation of PBMs will provide much needed help to “hometown, local and independent pharmacies” and save taxpayers’ money on Medicaid costs, Jones said.

The assembly member said local pharmacies have stepped up throughout the pandemic, offering COVID tests and vaccines.

“The least we can do is give these pharmacies and the community a Christmas present. “

Hochul has until the end of the year to sign the bills, otherwise the legislature must pass them again in the next session.

“THE BEST OF EVERYTHING”

While the bills together are called the “Pharmacy Rescue Package,” they relate to patient access, Moore said.

“Health care is very personal and you should have access to the health professionals with whom you feel most comfortable dealing. “

Long-time Condo Pharmacy customer Martha Bachman said she can have her medications ordered by mail order, but loves coming to the store, where everyone knows her name and will do their best to get her the medications. that she needs.

“They’re efficient, they’re very, very good at what they do and I would be really upset to see this pharmacy close.”

Leo “Skip” Maggy, the founder of Maggy Pharmacy in Dannemora, said he has enjoyed every part of the business for over 50 years.

“We try to give the best of everything to every customer, you know, all independent pharmacies, and we’re going to continue to do that. This legislation is very, very important to pass and I believe, with the support of everyone here, that it can be done. “

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