PBM Reform Podcast

Tennessee lawmakers have passed a major pharmacy reform bill aimed at pharmacy benefit managers, or PBMs, by barring companies from owning both a PBM and a pharmacy. The legislation is widely seen as targeting CVS Health, which owns Caremark and operates pharmacies across the state. Supporters say the bill is designed to curb vertical integration, restore fair competition, and protect independent pharmacies from reimbursement practices they view as harmful to patient access and community pharmacy survival. CVS has pushed back hard, warning that the new law could force it to shut down its 134 Tennessee pharmacy locations and trigger a legal challenge. The company argues the measure would reduce access for patients and does not directly address broader PBM issues like pricing or formularies. This Tennessee fight reflects a larger national battle over PBM reform, pharmacy ownership, market power, and the future of prescription drug access.

In this episode, listeners get to know the leadership of the California Pharmacists Association (CPhA), exploring their professional journeys, personal backgrounds, and the experiences that shaped their commitment to advancing the pharmacy profession. Susan Bonilla, CEO of the California Pharmacists Association, joins Dr. Sean Kim, PharmD, Vice President of Practice & Professional Development at CPhA, to discuss California’s progress in pharmacy benefit manager (PBM) reform. As the largest state in the nation, California continues to play a significant role in shaping policies that strengthen patient access to pharmacy care and improve transparency within the prescription drug supply chain. Bonilla and Kim share insights into the reforms California has achieved, the legislative and regulatory priorities currently underway, and how these efforts may influence PBM reform conversations across the country. The PBM Reform Podcast is sponsored by the American Pharmacy Cooperative, Inc. (APCI). APCI’s sponsorship supports the production of this program but does not imply affiliation with the individual guests, nor endorsement of the views, opinions, or insights shared by podcast hosts or guests. APCI does not endorse any statements or content discussed on the PBM Reform Podcast or across the Pharmacy Podcast Network. Please reach out to the APCI Communication's team for additional information. 

How Kroger does PBM and the future of community pharmacy is clinical encounters.   

American Pharmacy Cooperative, Inc. (APCI) called on Congress on Thursday, December 11, 2025 to pass the reintroduced Pharmacists Fight Back Act, two coordinated pieces of federal legislation designed to reform pharmacy benefit manager (PBM) practices. The Pharmacy Podcast Network provides exclusive coverage of the event held on Capitol Hill.

In this episode, Greg Reybold speaks with Jake Auchincloss, U.S. Congressman of Massachusetts 4th District.

This week on the PBM Reform Podcast, Breck L. Rice takes listeners inside a major new software upgrade designed to integrate directly with state-level PBM complaint and reporting systems. Breck also recounts his recent meetings with state Insurance Commissioners—where he presented this breakthrough technology while PBM lobbyists pushed back in real time, leaving community pharmacy with only one voice in the room standing up for them. He underscores a critical issue that often goes unaddressed: while states continue to pass legislation aimed at PBM accountability, the real failures are happening in execution and enforcement. Without meaningful oversight, even the strongest laws fall short, and independent pharmacies continue to bear the consequences.  

Dr. Robert Popovian is a pharmacist, and economist with a deep background in research and public policy. In this episode we have a nuanced discussion on policy impacting pharmacy including PBMs, President Trumps Most Favored Nation Executive Order, Rebates, and insurance premiums.    Links to resources referenced in discussion: • Pioneer Institute, 340B tool: https://pioneerinstitute.org/340babuse/ • Pioneer Institute, IRA tool: https://pioneerinstitute.org/the-inflation-reduction-act-ira-overview/ • Editorial regarding TrumpRX: https://www.linkedin.com/pulse/promise-trumprx-robert-popovian-vskne/?trackingId=dtiG1P%2B%2BSDq6adLfFeEbeg%3D%3D • Pioneer Institute, IRA report: https://pioneerinstitute.org/wp-content/uploads/Prescription-Drug-Price-Controls-06252025.pdf  • GHLF tool, Impact of Accumulators and Maximizers on Premiums: https://cutt.ly/Rr9Di7Vf • Conquest Advisors website: https://conquestadvisors.godaddysites.com/

In this episode, we sit down with the President of the American Medical Association to discuss PBM reform and its impact on patients, physicians, and the future of healthcare. From drug pricing transparency to ensuring access to needed medications, this conversation explores why PBM reform is at the center of today’s healthcare policy debates.

Join our co-hosts Todd Eury and Greg Reybold in this exclusive interview with Conor Sheehey, who most recently served as senior health policy advisor to U.S. Senate Finance Committee Chair Mike Crapo (R-ID). In this role, he advised the Committee on a range of health care policy issues, including prescription drug pricing, telehealth, AI, provider coverage and reimbursement, fraud and abuse, medical devices, and Medicare Parts B and D. Sheehey led several bipartisan legislative efforts, including the development of comprehensive PBM reforms and bipartisan proposals on clinician payment reform and drug shortages.

In this relaunch of the PBM Reform Podcast, Greg Reybold returns with a powerful and timely conversation exploring how concentrated economic power—particularly in the form of Pharmacy Benefit Managers (PBMs)—is undermining fair access to prescription medications, driving up drug costs, and crushing independent pharmacies. Greg is joined by Emma Freer, Senior Policy Analyst with the American Economic Liberties Project, a national non-profit and non-partisan organization dedicated to dismantling monopolistic control across critical sectors—including healthcare. Together, they dig deep into how PBMs serve as gatekeepers in the drug supply chain, extracting value at the expense of patients and providers, and how policy reform is urgently needed. Emma outlines how Economic Liberties is driving a new wave of anti-monopoly policy momentum in healthcare by advocating for stronger antitrust enforcement, corporate accountability, and legislative transparency. She highlights how concentrated PBM power not only threatens economic fairness but undermines public health outcomes. 🧠 Key Topics Covered: The history and unchecked growth of PBM power in the U.S. drug supply chain Why market concentration among PBMs is a systemic risk to patient access and competition What Economic Liberties is doing to pressure regulators and lawmakers for structural reforms Why bipartisan PBM reform is gaining traction—and what’s at stake if we fail to act How pharmacists, community leaders, and patients can join the movement for transparency and equity 💥 Why This Episode Matters: PBM dominance is no longer just a pharmacy issue—it’s an economic justice issue. This episode sheds light on the structural forces keeping drug prices high and independent pharmacies on the edge. It offers a compelling call to action for healthcare professionals, lawmakers, and reform advocates to push back against monopolistic control and put patients first. 📢 Call to Action: Visit www.economicliberties.us to explore their policy work and toolkits for reform advocates. Stay tuned to the PBM Reform Podcast as we bring together voices from across the healthcare and policy spectrum to fight for a fairer, more transparent system. Follow, rate, and share the podcast—because real reform starts with awareness and ends with action.

Dr. William Soliman is the founder and CEO of the Accreditation Council for Medical Affairs (ACMA). The ACMA is America’s leader in life sciences accreditation, certification & training.  Soliman is a former pharmaceutical executive who worked in leadership roles at Merck, Abbvie, Gilead and more. He is considered a pharma industry futurist and has been featured on NewsNation, Fox News, Newsmax, Forbes, Al Jazeera, Yahoo Business TV, ABC News Radio & more. The ACMA established the first ever certification standards in the United States and stands as a benchmark of excellence for prior authorization professionals, reimbursement professionals, pharmaceutical sales professionals, medical science liaisons and medical affairs professionals.  Dr. Soliman received his PhD from Columbia University & his BA from New York University.

An insider’s look at the games PBMs play to hid fees and tack profits for community pharmacies. What a true transparent PBM should look like and why it matters.   

Interview with the new CEO of the Arizona Pharmacy Association, Garet Turner

In this critical episode of the PBM Reform Podcast, we are joined by two influential voices leading the charge against abusive pharmacy benefit manager (PBM) practices: State Representative Jake Auchincloss – Congressman from Massachusetts’ Fourth District Greg Reybold – Vice President of Healthcare Policy & General Counsel, American Pharmacy Cooperative, Inc. Topics Discussed: The "Pharmacists Fight Back Act" (HB 9096): Legislation Overview: The bill proposes a transparent pharmacy reimbursement model based on: Market-based pricing benchmarked to the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee equivalent to each state’s Medicaid reimbursement or the lesser of 2% or $25. Eliminating PBMs’ ability to restrict patient choice through network exclusions. Ensuring rebate pass-throughs to patients directly at the pharmacy counter. Prohibiting PBM practices that steer patients toward PBM-owned pharmacies, protecting community pharmacists and preserving patient choice. Guest insights on how HB 9096 seeks to end exploitative PBM tactics and its potential impact on independent pharmacies nationwide. The "Patients Before Monopolies Act": Bipartisan Efforts: Introduced by Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) to dismantle PBMs’ monopoly power. Co-sponsored by Representatives Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN). Key Goals: Break up PBM ownership structures that lead to conflicts of interest. Ensure fair reimbursement practices for all pharmacies, reducing patient drug costs and increasing healthcare access. Discussion on the broader implications for federal programs and the pharmacy industry at large. PBMs and Their Role in Driving Up Drug Costs: Exploring how PBMs contribute to higher drug prices and diminished patient choice. The detrimental effects of PBM practices on independent community pharmacies and patients enrolled in federal healthcare plans. Call to Action: Contact your legislators to express support for the Pharmacists Fight Back Act (HB 9096) and the Patients Before Monopolies Act. Share this episode to spread awareness of the critical need for PBM reform. Resources & Links: Learn more about HB 9096 and its provisions:  https://www.congress.gov/bill/118th-congress/house-bill/9096  Support the Patients Before Monopolies Act:  https://www.drugtopics.com/view/long-awaited-pbm-reform-included-in-congress-end-of-year-spending-package  References:  Intro piece: "Senators Warren and Hawley introduce a bipartisan bill to break up pharmacy-benefit managers" via CNBC Television 

An update from NDPhA and PBM Reform initiatives.   

Openness. Competition. Transparency. Unmask the twisted economics of the American health care system. Price discovery — prior to care — allows patients to shop for care in a competitive market. It empowers them with the information they need to reduce their healthcare costs. And it encourages providers and insurers to compete for their business. Report: Free2Care’s Rx for Reforming America’s Predatory Healthcare System A Physician-Led Roadmap to Patient-Centered Medical Care https://free2care.org/files/report.pdf    The PBM-Insurer Mafia Comes for Community Pharmacies UnitedHealth, CVS, and Cigna’s PBMs are using their market share and pull in Washington to drive one of the key levers to manage health care costs—independent pharmacies—out of business. https://prospect.org/health/2024-03-21-pbm-insurer-mafia-community-pharmacies/ About David Balat: David Balat is the founder of Healthcare Finance Specialists and has broad experience across the healthcare spectrum with special expertise in health care finance. He is a former seasoned hospital executive with over 20 years of healthcare industry leadership and executive management experience. Balat has earned the privilege of being invited to testify before the U.S. House Committee on Oversight and Reform in Washington, D.C., and before various House committees in the Texas state Legislature. He is a published author and op-ed columnist in Newsweek, U.S. News & World Report, Real Clear Politics, and other news outlets. He is also an active speaker and commentator on matters of health policy, health care finance, and health care reform. via decent.com 

Pharmacy owner Tom DePietro, PharmD and Pennsylvania State Representative Jessica Behnam join the PBM Reform Podcast to discuss the major win for Pennsylvania tax payers and Pharmacy Care.  HB 1993 is the result of bipartisan efforts – led by state Rep. Jess Benham (D-36) – to ensure that Pennsylvanians are no longer being screwed and that access to local, independent pharmacies is maintained. Gov. Josh Shapiro last week joined Pennsylvania Insurance Commissioner Michael Humphreys, members of the General Assembly and local pharmacists at Thompson Pharmacy in Blair County for a ceremonial bill signing of bipartisan reforms in the 2024-25 budget. The reforms aim to increase oversight of pharmacy benefit managers (PBMs), the hidden “middlemen” of the pharmaceutical supply chain who largely go unchecked and unregulated as they negotiate the price of prescription drugs, passing the costs down to Pennsylvanians. Shapiro recently signed House Bill (HB) 1993 into law, providing stronger protections for commercially insured patients in the commonwealth and increasing regulatory oversight of PBMs.

Special Guests:  Shanon Schmidtknecht & Loretta Boesing  Cole Schmidtknecht was a 22-year-old young man living in Appleton, Wisconsin who loved video games and sports. His parents Bil and Shanon described him as an inspirational free spirit with a love for being heard. Cole was diagnosed with severe asthma at only a year old. He had just recently moved out on his own with opportunities to chase his dreams, until his life was cut short earlier this year. “January 10th,, he went to the pharmacy to get his prescription and was told it was no longer covered by his insurance,” said Shanon.  He was told there was no alternative option and no generic drug would be covered. Cole didn’t know how to respond and couldn’t cover the extreme out-of-pocket cost of his Advair inhaler on a $19/hour income. An inhaler-dependent patient left the Walgreens Pharmacy with no medication. Five days later he suffered an extreme asthma attack and was taken to the hospital. He arrived at the Emergency Room lifeless and spent the next six days in the ICU on a ventilator.   “We were told he’s never going to wake up again,” said Bil.    A generic version of Advair only costs $15-$20. What happened to Cole is happening all over the country, according to Hometown Pharmacy co-founder Dan Strause. “Unfortunately, we see even the state plan now no longer will allow for the generic, they force people into the brand. Why? It’s not hard to figure out it must be about the profit margin. Unfortunately, they’re making people decide between life-saving medicine [and paying bills, even though] the cost of the actual item is so low,” said Strause. “We find this absolutely wrong, its infuriating we should all be angry, and we hope you tell your legislators this needs to be addressed sooner than later,” said Strause. Hometown Pharmacy had to close a location in St. Germain partially due to the influence of PBMs. A pharmacy benefit manager acts as a middleman between drug manufacturers and pharmacies. In the last state legislative session, the pharmacy benefit manager regulation bill wasn’t brought to a vote. The bill was designed to create transparency in the system and prohibit the PBMs’ control over the pharmaceutical industry as a whole. “We’re very frustrated that it never got a chance to be voted upon,” said Strause. Strause said there is a lot of speculation as to why the bill didn’t make it to the floor. “In politics, there’s a lot of moving parts and we believe that the recent vote for Wisconsin mapping is part of it, because there’s a lot of energy and focus with what the next election is going to be and of course elections are very expensive, and you have to fund those elections. Strause believes that money from lobbying groups associated with PBMs have a strong influence on lawmakers. “Unfortunately, it means that money and influence is a significant factor in us passing bills especially ones that affect all of our lively hoods and our health,” said Strause. Bil and Shanon said after learning of PBMs and the tactics that cost them their son they were angry and decided it was time to speak up. “I don’t want you to ever have to imagine, I don’t want anyone to ever have to experience this,” said Shanon. Their goal is to share Cole’s story and raise awareness.   “We just kind of feel like this is now our fight to fight for him. If we can prevent it for one other person just that alone would be a little solace or a little something I know we can never have our son back, he’s gone,” said Bil. Cole’s situation is not the only one, and this could happen anyone. Everyday life saving medications are becoming inaccessible to patients who need them. “We need our senators and our congressmen to help this process that’s why they’re there in office for our complaints, our concerns our needs and the games that are played are just costing lives,” said Bil.     From Shauna Johnson on Mar 11, 2024 via wjfw.com 3217 County G Rhinelander, WI 54501 Reference Webiste:  https://patientprotector.us/home 

The PBM Reform Podcast on the Pharmacy Podcast Network, with your host, Breck Rice! Breck has had the privilege of being around and working with pharmacies for over 20 years! He loves community pharmacies and will do everything in his power to help them be successful. It’s a privilege to be involved in reforming the industry he loves. Today's guest is Kyle McCormick, owner of Blue Berry Pharmacy, in Pittsburg Aria, PA.  Kyle beats the PBMs by not joining them! He runs a cash-pay-only pharmacy, with no PBM contracts. Kyle believes that if more pharmacies would kick out the PBMs they would have to change their unfair ways and give better reimbursements.

Interview with Howard Danzig, President of Employers Committed to Control Health insurance Costs.

Anthony V. Minniti, RPh FACA joins the PPN on the PBM Reform Podcast to talk about why the PBMs, in their current state need to be removed from pharmacy care. As drug prices soar, the White House is taking action by hosting a pivotal listening session on Monday, aiming to dissect and potentially reform the practices of pharmacy benefit managers (PBMs). This roundtable will unite federal representatives and industry insiders, including Mark Cuban of Cost Plus Drug Company, to scrutinize PBMs' roles in shaping drug coverage and pricing. The focus is on the opaque dealings of PBMs, which many argue contribute to inflated costs for both consumers and the broader healthcare system. Shocking revelations unveil steep markups by the leading #PBM affecting West Virginia's public employees. The mail-order pharmacy owned by the PBM has been reimbursed as much as 100 times more than other pharmacies for specialty medications. This concerning pattern underscores the urgent need for increased transparency and accountability measures for #PBMs.  Pharmacy benefit manager (PBM) reform has emerged as a bipartisan priority in a divided Congress, as both Republicans and Democrats have advanced a myriad of bills that would begin to address PBMs, their lack of transparency, and misalignment of the market. At the same time, lobbyists that represent large PBMs continue to argue that drug companies (not integrated PBMs) are to blame for high employer or patient costs.

Featuring Tennessee State Senator & Pharmacist Shane Reeves "The Volunteer State" has been a Tennessee nickname since the 19th century but wasn't officially voted on until February 2020. Tennessee sent 1,500 volunteer soldiers during the War of 1812, and the nickname stuck. Requiring PBMs to contract with rural independent pharmacies: In Tennessee, there are 70 counties considered rural out of the 95 counties in the state. Tennessee lost 15 rural hospitals over the last few years, so healthcare access is an issue. Most of these towns have a community pharmacy which is the access point for a lot of health care and health care information for many Tennesseans.  About Shane Reeves:  Man of Faith, Husband, Father, CEO, Pharmacist, Public Servant (TN State Senator) As CEO of TwelveStone Health Partners, Shane's mission is to be the regional leader in post-acute chronic care pharmacy management, placing patients and their families at the center of everything he does. As faithful stewards, Shane leads his team to strive every day to glorify God. 

In the Senate, there are 3 committees that have advanced legislation on PBM reforms, with leadership supporting a floor vote before the end of 2023. In the House, a consolidated bill was released in September and although there are plans for a full House vote, they are stalled due to the current issues in Congress. There are 3 key jurisdictions and proposed plans of the Senate that focused on in the session: The Finance Committee, including Medicare and Medicaid; the Health, Education, Labor, and Pension (HELP) Committee, including plans that regulate under the Employee Retirement and Income Security Act and the Affordability Care Act; and the Commerce Committee, including interstate commerce and the Federal Trade Commission (FTC). The Finance Committee Package includes the prohibition of spread pricing in Part D for Medicaid and Medicare managed care. The Part D rebates must also be passed through the prescription drug plan sponsors, used to lower the costs for prescription drugs with a 100% pass-through in Medicaid managed care, according to Andel. Reference: https://www.pharmacytimes.com/view/amcp-session-provides-updates-on-pbm-reform-efforts-currently-stalled-in-congress  Guests Erich Cushey PharmD - Pharmacy Owner  Curtis Pharmacy  Seema Kazmi, PharmD  Seema currently serves on the Board of the Pennsylvania Pharmacists Association as a Practice Setting Director for pharmacists in Managed Care, Pharmaceutical Industry, Government Affairs and other practice settings. Dr. Kazmi has been a pharmacist for over 17 years and started her pharmacy career as an overnight community pharmacist in Levittown, Pa.  Dr. Kazmi is a graduate of Philadelphia College of Pharmacy and is a licensed pharmacist in six states, serving in leadership and management roles in managed care, pharmaceutical industry, community pharmacy, long-term care, and public service. Seema Kazmi, PharmD currently serves on the Board of the Pennsylvania Pharmacists Association as a Practice Setting Director for pharmacists in Managed Care, Pharmaceutical Industry, Government Affairs and other practice settings. 

Antonio Ciaccia is the President of 3 Axis Advisors. He was born and raised in pharmacy, Antonio has been crawling around pharmacies his entire life. After three years as a pharmacy technician and two years of pre-pharmacy curriculum, Antonio diverted course, graduating from The Ohio State University in 2007 with dual degrees in communications and political science before moving into the world of association management. 3 Axis Advisors brings unique approaches to address the individual needs of each or our clients. As researchers and investigators at heart, 3 Axis endeavors are laser-focused on discovery through data-driven analysis and deep industry expertise, resulting in innovative and unique solutions.  Our obsessive passion for understanding complex systems and our immersion in the prescription drug supply chain and the broader healthcare delivery system enables us to arm our clients with the tools they need to accomplish their goals. Reference:  Ohio regulator’s proposed pharmacy rules draw mixed response  New regs meant to promote safety at understaffed stores https://ohiocapitaljournal.com/2023/10/02/ohio-regulators-proposed-pharmacy-rules-draw-mixed-response/ 

Our special guest Wendy Barnes, CEO of RxBenefits and Mark Campbell, the VP of RxBenefits.  From BenefitsPro: https://www.benefitspro.com/2023/03/27/how-dispelling-mistrust-of-generics-will-help-patients-and-plan-sponsors/?slreturn=20240222125659  Health care spending in the United States has increased substantially the past few years, and it isn't likely to slow down any time soon. At this rate, national health care costs could reach $6.2 trillion by 2028. A number of factors, including the cost of medical supplies and drugs, contribute to those rising numbers. The financial pinch many people were already feeling has been intensified by the unsteady economy, leading consumers to call for lowered health plan costs whenever and wherever possible. Some believe reducing prescription drug spending is an easy way to do that. But consumers still deserve access to the medications they need at prices they can afford.  Generic medications: A solution to potential challenges Using generic medications in place of high-priced, brand-name drugs offers the same clinical benefits, and it can save patients and health plan providers significant money in the long run. It's a convenient, simple way to reduce costs while making sure patients have continued access to the treatments and medicines they've been prescribed. But while generics are an obvious answer to many challenges facing the industry, they aren't embraced nearly as often as they should be. According to U.S. Pharmacist, "While generic drugs are extensively prescribed … t some consumers are still hesitant about using generic drugs and believe that they are not as safe or effective as brand-name drugs." Consumers have a variety of reasons for their misgivings, but the skepticism is unwarranted. Many health plan administrators and pharmacy benefit optimizers are working to dispel the myths that can rob consumers of significant savings. 

House Energy and Commerce Committee cleared a PBM bill that seems to contain more transparency loopholes and makes more limited policy tweaks to the drug supply chain middleman than the Senate HELP Committee’s bill, but the House-side legislation would pull back the curtain on specialty-drug reimbursement in a way the Senate version does not.  Two titans of PBM Reform join us today, returning guest Antonio Ciaccia with 3 Axis Advisors and Loretta Boesing with Unite for Safe Medications update our PBM Reform Podcast listeners with the latest progression in PBM Reform.  Reference:  PBM Reform: Vertical Integration, Specialty Drug Tracking Among Differences In House v. Senate Bills https://pink.pharmaintelligence.informa.com/PS148320/PBM-Reform-Vertical-Integration-Specialty-Drug-Tracking-Among-Differences-In-House-v-Senate-Bills 

Let's talk about the current state of the industry. Senior Care Pharmacy Coalition: SCPC just missed getting the LTC Pharmacy Definition passed last year. The PBM issues continue, even with gov't interest and involvement.  Let's discuss LTC pharmacy's value to dual-eligibles, and how some simple policy changes would improve care for this population and save the system millions of dollars, overall.  Let's talk about how LTC pharmacies are in an increasingly tough spot because or drug pricing policies. The patients they serve often rely on price-controlled meds that often leave them serving at a loss. This episode is sponsored by FRAMEWORK LTC: For more information visit frameworkltc.com

Special Guest: Lindsay Bealor Greenleaf, J.D., M.B.A., Vice President and Head of Policy with ADVI Health Inc. Why now: This week U.S. Sens. Chuck Grassley (R-IA) and Maria Cantwell (D-WA) introduced two bills that seek to hold pharmacy benefit managers (PBMs) accountable for opaque practices that contribute to high drug prices for consumers.   Expert commentary: Lindsay Bealor Greenleaf, J.D., M.B.A., vice president and head of policy with ADVI can dive deep into a discussion on PBMs expanding on the following points:   1) PBMs were completely spared in the IRA while the people who actually make drugs got hit with unprecedented government price setting     2) Fortunately, PBMs will now face scrutiny on the Hill, including Prescription Pricing for the People Act (S. 113) and the PBM Transparency Act (S. 127) with new bills and “noisy” hearings   3) PBMs are also in hot seat with the FTC (from Lindsay’s perspective, the FTC is “incredibly hostile towards PBMs right now”) Are these topics areas you’d like to explore? If yes, I’d like to line up a time for you to connect with Lindsay in the coming weeks. I look forward to your feedback on your interest in a podcast episode with our ADVI experts.  Reference:  State Legislatures Lead the Way on Policy Reform to Protect Personalized Medicine Feb 22, 2023 Angela Storseth-Cooper Lalan Wilfong, MD https://www.ajmc.com/view/state-legislatures-lead-the-way-on-policy-reform-to-protect-personalized-medicine  In Blow to PBMs, CMS Floats Reform of Part D Price Concessions https://www.mmitnetwork.com/aishealth/spotlight-on-market-access/in-blow-to-pbms-cms-floats-reform-of-part-d-price-concessions-2/ 

The Express Scripts decision removes the option for Tricare beneficiaries to get prescriptions at the pharmacies of their choice. The National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, PharmD, MBA, warns that “access to needed medications for Tricare beneficiaries is in peril.”   This decision is estimated to impact hundreds of thousands of beneficiaries relying on certain pharmacies (or locations) to get prescriptions—those who cannot get their prescription at the pharmacy of their choice may fall out of care.   Consequently, patients may lose access to the potentially lifesaving treatments that specialty and independent pharmacies can provide, especially for patients with critical illnesses such as HIV, among other illnesses. In a recent analysis, experts suggested that the contract, made with the US Department of Defense (DOD), could shrink the retail pharmaceutical network by 15,000 pharmacies.   Guest  Alan Rosenbloom President & CEO Senior Care Pharmacy Coalition 

Today we are hoping to make sense of the Inflation Reduction Act which is designed to protect Medicare recipients from catastrophic drug costs by phasing in a cap for out-of-pocket costs and establishing a$35 cap for a month's supply of insulin. And, as an historic win, Medicare will be able to negotiate prices for high-cost drugs for the first time ever. Guests:  Mark Blum  Mark is the Executive Director of America's Agenda, an organization he’s led since its founding in 2005. America's Agenda is a national healthcare alliance that brings together labor unions, businesses, healthcare providers, and policymakers who share a common commitment to smart policy and effective action to advance our mission of affordable, high-quality, readily accessible healthcare for every American. Mark currently serves on the State Health Benefits Value and is a former member of the Quality Task Force in New Jersey and previously worked as an economics professor as well as national director of organizing for the American Association of University Professors. He completed his graduate studies at the London School of Economics.   A major focus for Mark in recent years has been the Pharmacy Benefit Manager issues facing our country. Mark is a founding member of the PBM Accountability Project. He works tirelessly to educate the public and advance solutions to help redirect prescription drug savings from very high PBM profits back to patients, employee health plans, and taxpayers. Antonio Ciaccia Antonio Ciaccia (cha-cha) is the President of 3 Axis Advisors, a firm that among many things studies drug pricing. He was recently featured on NBC’s Today Show talking about the lengths PBMs force independent pharmacies to go to find savings for their patients. He’s also spoken publicly about PBMs in the context of the Inflation Reduction Act. Antonio has been in and around pharmacies his entire life. A graduate from The Ohio State University in 2007 with dual degrees in communications and political science. For six years he headed up government affairs for the Ohio Pharmacists Association. After years of studying the pharmacy marketplace, Antonio became increasingly perplexed and concerned as he saw drug costs spiking while payouts to pharmacies were declining. Knowing something was being lost somewhere in the middle of an ever-growing transaction, Antonio has spent years working to crack the drug pricing code and pull the rug out from what he believes is one of the most dysfunctional marketplaces in the world. Learn more about your ad choices. Visit megaphone.fm/adchoices

Congressman Buddy Carter and General Counsel of NCPA Matthew Seiler on PBM Reform. On this episode of the 'PBM Reform Podcast' we discuss the Pharmacy Benefit Manager (PBM) Transparency Act of 2022 (the Act) was recently proposed in the U.S. Senate and intends to incentivize “fair and transparent” PBM practices, prohibit spread pricing and claw backs of payments to pharmacies, and empower the Federal Trade Commission (FTC) and state attorneys general in enforcement actions to stop “unfair and deceptive” PBM business practices. The Act was introduced by Senators Maria Cantwell Chuck Grassley on May 24, 2022, and was approved by the Commerce Committee with bipartisan support (19-9) on June 22, 2022. This summary provides a high-level overview of the Act’s key measures. Prohibition on Unfair or Deceptive Prescription Drug Pricing Practices The Act would make it illegal for PBMs to: Engage in “spread pricing,” which is described as charging a health plan or payer a different amount for a prescription drug’s ingredient cost or dispensing fee than the amount the PBM reimburses a pharmacy for the prescription drug’s ingredient cost or dispensing fee where the PBM retains the amount of any such difference; Arbitrarily, unfairly, or deceptively reduce or rescind (a.k.a. “claw back”) any portion of the reimbursement payment to a pharmacist or pharmacy for a prescription drug’s ingredient cost of dispensing fee; or Arbitrarily, unfairly, or deceptively increase or lower fees and reimbursements to a pharmacy to offset reimbursement changes under any federally funded health plan. The Act would incentivize transparency by stating that a PBM shall not be in violation of the Act if the PBM passes through 100% of price concessions to a health plan or payer and provides complete disclosure of: The cost, price, and reimbursement of prescription drugs to each health plan, payer, and pharmacy; All fees, markups, and discounts the PBM charges or imposes on each health plan, payer, and pharmacy; and The aggregate remuneration PBM receives from drug manufacturers, including nay rebate, discount, administration fee, and any other payment or credit obtained or retained by PBM. Learn more about your ad choices. Visit megaphone.fm/adchoices

Senator Chuck Grassley (R-Iowa) and Maria Cantwell (D-Wash.) introduced the Pharmacy Benefit Manager Transparency Act of 2022 on May 24, which would make it illegal for PBMs to engage in “spread pricing.” Spread pricing occurs when PBMs charge health plans and payers more for a prescription drug than what they reimburse to the pharmacy — and then keep the difference. For example, when a pharmacist fills a prescription, a PBM handles the process, informing the pharmacy it will be reimbursed $90.  The PBM then charges the health insurance plan $100 for processing the same prescription. The spread of $10 is pocketed by the PBMs. Related: New PBM players banking on drug pricing transparency for success The bipartisan legislation would empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold pharmacy benefit managers (PBMs) accountable for unfair and deceptive practices that drive up the costs of prescription drugs at the expense of consumers.  It also would prohibit arbitrary clawbacks of payments made to pharmacies and require PBMs to report to the FTC how much money they make through spread pricing and pharmacy fees. SCPC, CEO, Alan Rosenbloom & Senior Director, Regulatory Policy at APhA, Michael Baxter join Todd Eury with the Pharmacy Podcast Network to discuss the impact of the Pharmacy Benefit Manager Transparency Act of 2022 on the Pharmacy Profession. Learn more about your ad choices. Visit megaphone.fm/adchoices

Pennsylvanians suffer while pharmacy middlemen profit By Suzanna Masartis Pennsylvanians are getting crushed by the costs they face at their neighborhood pharmacy counter. The situation has grown so bad that a shocking one in five Keystone State residents report they are unable to take their medications as prescribed due to the cost burden.[1] As a lawmaker and an advocate who speaks to patients in Pennsylvania every day with liver disease, diabetes and other chronic conditions, I am convinced more strongly than ever that we need to reform the prescription drug supply chain. To understand how we got here we need to understand what’s driving increasing costs. A new report found that, in 2020, manufacturers of brand-name and generic medications received only 37 cents of each dollar of the more than $680 billion spent on medications. If you look exclusively at manufacturers of brand-name medications, the drug makers are taking in just under 50 cents on the dollar. So where is the money going? Turns out that it’s little-known middlemen corporations, Pharmacy Benefit Managers (PBMs), that are taking a bigger and bigger share of the pie.[2] PBMs were created to negotiate with insurers and drug manufacturers and establish which prescription drugs are covered by a health plan. In reality, they demand steep discounts from drug makers off of the original list price as a condition to include those drugs on the approved list of medications – and then keep the savings for themselves. But here's the real rip-off: Patients at the pharmacy counter still face co-insurance charges based on the list price -- not the discounted price insurers actually pay. In other words, PBMs are enriching themselves while hiking prices for the rest of us. {3} Worse still, PBMs manipulate their powerful market position to reduce the availability of prescription medications by excluding them from formularies. PBMs make their money when they demand exorbitant rebates from drugmakers and charge patients full cost, meaning they prefer to include drugs with higher list prices on their formulary over an equally effective drug with a lower list price. As a result, a number of drugs are excluded from formularies because PBMs can’t make as much money from them. In 2020, the three largest PBMs excluded 846 FDA-approved drugs, denying patients access to more medications than ever before. This market manipulation has disastrous results for patients. A study published last year found that these practices, called “drug utilization management,” can lead patients to abandon their prescribed medications and delay treatment. Approximately 20% of prescriptions in the U.S. are never filled, according to the study.[4] This outcome is simply unacceptable, and our leaders need to take action. Congress needs to ensure that any attempt to rein in out-of-pocket prescription drug costs includes taking a close and hard look at PBMs. Doing so would go a long way toward ensuring every patient and healthcare consumer in our state can access and afford to take their medications as prescribed by their doctor. Suzanna Masartis of Pittsburgh is the CEO of the Community Liver Alliance. [1]https://www.healthcarevaluehub.org/advocate-resources/publications/pennsylvania-residents-worried-about-high-drug-costs-support-range-government-solutions [2]https://ecommunications.thinkbrg.com/44/2328/uploads/brg-pharmaceutical-supply-chain-2022.pdf?intIaContactId=24HydQaSTYqd85tTztTDcQ%3d%3d&intExternalSystemId=1 [3] https://www.fiercehealthcare.com/payer/study-drug-utilization-costs-health-industry-93b-a-year-patients-bearing-most-cost [4] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2021.00036 Learn more about your ad choices. Visit megaphone.fm/adchoices

Dave Teckman, Executive Chairman at ActiveRADAR joins the PBM Reform Podcast series about the impact of therapeutic interchange technologies on PBM pricing & the powerful data at the pharmacist's fingertips with ActiveRADAR. Through rigorous clinical evaluation of all drugs in over 112 therapeutic categories, ActiveRADAR first establishes which drugs are clinically equivalent and therefore therapeutic alternatives to one another. This creates our Clinical Catalog of over 26,000+ therapeutically equivalent “perfect pairs”. Then ActiveRADAR determines the economic value using plan specific data to value each drug within its respective therapeutic class and sets pricing and reimbursement accordingly. This type of program has historically been called “reference pricing”, however ActiveRADAR takes it a step further by establishing both THE CLINICAL AND ECONOMIC VALUE OF EACH AND EVERY DRUG IN EACH THERAPEUTIC DRUG CLASS. About ActiveRadar: ActiveRADAR, formerly RxTE Health, is a healthcare analytics and patient education company providing unique data-driven, cost-saving customized prescription options. Using proprietary technology, ActiveRADAR identifies the lowest cost prescription options. Learn more about your ad choices. Visit megaphone.fm/adchoices

Madelaine A. Feldman, MD, FACR Dr. Madelaine Feldman is a rheumatologist in private practice with The Rheumatology Group in New Orleans, LA. She is President of the Coalition of State Rheumatology Organizations, Chair of the Alliance for Safe Biologic Medicines and past member of the American College of Rheumatology insurance subcommittee. Dr. Feldman is a Clinical Assistant Professor of Medicine at Tulane University School of Medicine, and lectures extensively to patients, physicians, regulators, and legislators both locally and nationally, speaking before the Health subcommittee of Energy and Commerce in 2019.  She has spoken and written on the drug supply channel, particularly the effect that formulary construction and utilization management tools have on pricing and access to drugs (availability & affordability). Dr. Feldman is honored to be the recipient of the American College of Rheumatology's 2021 Innovation in Clinical Care award. She received the Distinguished Service Award for Tulane Medical School, was named one of the Top Women in New Orleans by City Business in 2017 and is the former radio talk show host of “Driving with Dr. Mattie.” Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaking to the Pharmacy Podcast Network, Dr. Marion Mass, a pediatrician, patient advocate and founding member of the Practicing Physicians of America, spoke about the original intent of PBMs, which started in 1968, and what they’ve become today. “PBMs were created with the vision that they would act like giant drug-buying networks, with their buying power cutting health care costs and consumers realizing the savings in the end. However, through consolidation, three companies now control 90 percent of the market,” she said. Dr. Mass further explained, “This unhealthy market share has led to an unhealthy control over formularies,” which can cause life-and-death situations for her young patients. “Patients are at risk of death or harm when drugs such as chemotherapies, antibiotics, epinephrine and anesthetics are not available.” Pharm D Mel Brodsky, executive director of the Philadelphia Association of Retail Druggists and former CEO of the Keystone Purchasing Alliance, explained, “This outsized market share takes advantage of drug manufacturers, pharmacists and, most importantly, patients. The result is a net negative for all parties except for the large PBMs.” In his estimation, the net result of this imbalance “has led to an erosion of the doctor-patient relationship and a decimation of Main Street pharmacists throughout the nation.” “With the current system in place, independent pharmacists are being squeezed to the point that many jump when the large groups offer to buy them out. With the depletion of community pharmacists comes the loss of personal touch and a watered-down version of health care to patients,” Brodsky said.  Both participants agreed that action must be taken on the federal level, citing Pennsylvania Sens. Bob Casey and Pat Toomey’s abilities to rein in the large PBM market imbalance Our Guests:  Dr. Marion Mass. Dr. Mass is a pediatrician in the Philadelphia suburbs. She received her medical degree from Duke University School of Medicine and has been in practice for more than 20 years. She is the co-founder of Practicing Physicians of America - and leadership in the Free2Care coalition-a consortium of grassroots physician advocacy groups that believe that the key to good care starts with the relationship between a patient and their doctor. She sits on the editorial board of the Bucks County Courier, Times and is a member of the Bucks County Health Improvement Partnership. Mr. Mel Brodsky is the Executive Director of the Philadelphia Association of Retail Druggists (PARD), an association of community pharmacies representing 250 independently owned pharmacies in Southeast Pennsylvania. PARD works closely with State Associations like the Pennsylvania Pharmacists Association (PPA). Mr. Brodsky is also CEO of the Keystone Pharmacy Purchasing Alliance, headquartered in Philadelphia with 400 member stores in 5 States. Mel has an amazing understanding of how PBMs impact the effectiveness and growth of vital healthcare service providers like Community Pharmacies.   Learn more about your ad choices. Visit megaphone.fm/adchoices

Antonio Ciaccia was born and raised in pharmacy, Antonio has been crawling around pharmacies his entire life.  After three years as a pharmacy technician and two years of pre-pharmacy curriculum, Antonio diverted course, graduating from The Ohio State University in 2007 with dual degrees in communications and political science before moving into the world of association management.   Thinking that pharmacy would be in his rear-view mirror forever, he ended up making his way back to his pharmacy home, heading up government affairs for the Ohio Pharmacists Association, a trade organization with a strong track record of advocating for drug pricing transparency. After years of studying the pharmacy marketplace, Antonio became increasingly perplexed and concerned as he saw drug costs spiking while payouts to pharmacies were declining. Knowing something was being lost somewhere in the middle of an ever-growing transaction, Antonio has spent years working to crack the drug pricing code and pull the rug out from what he believes is one of the most dysfunctional marketplaces in the world. Sunshine in the Black Box of Pharmacy Benefits Management: Florida Medicaid Pharmacy Claims Analysis https://www.3axisadvisors.com/projects/2020/1/29/sunshine-in-the-black-box-of-pharmacy-benefits-management  This podcast episode was sponsored by P.U.T.T.  https://www.truthrx.org/about.html  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

A PROPOSAL FOR SMALL TOWN INDEPENDENT PHARMACISTS A new trend has independent pharmacist = working directly with the businesses that are right there in the same community. While the small town environment is by its nature a concise marketplace, too often those local businesses get themselves into situations that does not make logical or financial success. Big insurance companies get involved, and suddenly money is going all over the country when it should be staying in your community.  When we set up our managed care pharmacy programs, the pharmacist is no longer competing with mail order houses, and the locals are no longer paying up to 40 percent more for these prescriptions than you need to. The money is being kept in the community. Another big advantage is you take a system that has been depersonalized over the years and personalize it once again. Imagine – getting better care at a better price from your local pharmacist who is also your neighbor. For more information contact: [email protected]  Call (412) 585-4001  Sponsored by UltiGuard Safe Pack The UltiGuard Safe Pack is the only pen needle product that comes with an all-in-one sharps container. Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy. Learn more UltiGuard Safe Pack https://www.ulticare.com/ultiguard-safe-pack/podcast  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Special Guest: Jackie Toledo - Florida State House of Representatives 60th District  A product of Tampa’s public schools, Jackie graduated from Gaither High School and was awarded an academic engineering scholarship to the University of South Florida from the Latino Scholarship program. In 2000, she received her degree in Civil Engineering from USF and wanted to stay in Tampa so she could help give back to our community that has given her so much. In 2011, she became the first scholarship recipient to establish a scholarship at USF to help and mentor a Latino student. After graduating, Jackie became a Licensed Professional Engineer and worked on several transportation plans in the Tampa Bay area, including master plans for the University of South Florida and Hillsborough Community College, as well as Hillsborough County’s Long Range Transportation Plan, the Florida Aviation Systems, and the 2012 Olympic bid process. Recognized professionally as a Professional Traffic Operations Engineer (PTOE) and the recipient of the 2002 Florida State Institute of Transportation Engineer of the Year, she has made great strides in her field and has a unique perspective on solving Tampa’s infrastructure and transportation challenges. Today, she works at NUE Urban Concepts. Jackie has worked tirelessly for the people of Hillsborough County, advocating for common sense solutions for our community. She has served as the Deputy Majority Whip, Co-Chair of the Women’s Caucus, the State Director of the National Foundation for Women Legislators and on numerous legislative committees. Sponsored by UltiGuard Safe Pack Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy.  https://www.ulticare.com/ultiguard-safe-pack/podcast  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

The seventh episode in the PBM Reform Podcast Series features guest host Monique Whitney, the Excutive Director of Pharmacists United for Truth and Transparency (PUTT) interviewing pharmacy owners, Oliver's Express Pharmacy Oliver Lackey, PharmD and Main Street Pharmacy Owner, Jeremy Counts, PharmD.  Two major trends are driving decreasing reimbursement to pharmacies: DIR fees and copay clawbacks. Direct and indirect remuneration (DIR) fees imposed on community pharmacies, sometimes weeks or months after a medication is dispensed, can eat up the pharmacy’s profit on a prescription transaction, and sometimes even lead to a loss. According to a survey by the National Community Pharmacists Association (NCPA), 53 percent of pharmacists said DIR fees are assessed quarterly; 67 percent of those surveyed said no information is given as to how much and when DIR fees will be collected or assessed. DIR fees began when Medicare Part D was established, but they now appear in many commercial health insurance plans as well. Episode & Summary sponsored by RxSafe https://rxsafe.com/declining-reimbursement-the-facts/  Sponsored by the UltiGuard Safe Pack  https://www.ulticare.com/ultiguard-safe-pack/podcast  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Pharmacists are trapped in a system that threatens patient safety. Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA APhA Executive Vice President and CEO writes: If you ask me what keeps me up at night, I’d say it’s the kinds of mistakes that Ellen Gabler described in her January 31 New York Times story, “How Chaos at Chain Pharmacies Is Putting Patients at Risk.”  During my time as a community pharmacist, I cherished the relationships I established with patients and understood the great responsibility that came with the trust they placed in me. Pharmacists take an oath to, among other things, “assure optimal outcomes” for patients. I can attest to the emphasis our profession places on patient safety. When it comes to medication-related errors, even one is too many.  Unfortunately, the current system sets pharmacists up to fail, and in turn, pharmacists are burning out at high rates. This is an issue that not only puts patients at risk but deprives pharmacists of the opportunity to provide the kind of patient care we all got into pharmacy to provide. You can see it in the desperate pleas for change to state boards of pharmacy Gabler highlighted in her story. And we’re seeing it in the responses to those who have taken our Well-being Index for Pharmacists: The weight of the potentially dire consequences of filling the wrong prescription or missing dangerous drug interactions is crushing too many pharmacists.  Special Guest: Mike Schwab Executive Vice President North Dakota Pharmacists Association See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

On the 5th interview of the PBM Reform Podcast Series we talk with Scott Pace, Pharm.D., J.D. pharmacy owner and advocate for PBM Change.  Scott is a Partner at Impact Management Group where he focuses on the Government Relations and Public Affairs practice areas.   Scott joined IMG following more than 12 years with the Arkansas Pharmacists Association, most recently serving as the organization’s Executive Vice President and CEO.While at the APA, Pace successfully worked with the legislature to pass scope of practice legislation for pharmacists, legislation to amend the Arkansas Constitution to require a pharmacist consultant be a part of the Arkansas medical marijuana dispensaries, and most recently he worked with Governor Hutchinson and the legislature to pass legislation to license and oversee pharmacy benefits managers (PBMs) in Arkansas. Scott is a licensed pharmacist and attorney.  He holds a bachelor’s degree in biology from Arkansas State University, a Doctor of Pharmacy from the University of Arkansas for Medical Sciences and a Juris Doctorate with High Honors from the University of Arkansas at Little Rock William H. Bowen School of Law. He served as the consumer representative on the Arkansas State Medical Board from 2012-2015 and he serves on the Arkansas Prescription Drug Monitoring Program (PDMP) Advisory Panel. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

IN DATA WE TRUST Special Guest: ANTONIO CIACCIA with 3 Axis Advisors.  Born and raised in pharmacy, Antonio has been crawling around pharmacies his entire life.  After three years as a pharmacy technician and two years of pre-pharmacy curriculum, Antonio diverted course, graduating from The Ohio State University in 2007 with dual degrees in communications and political science before moving into the world of association management. Thinking that pharmacy would be in his rear-view mirror forever, he ended up making his way back to his pharmacy home, heading up government affairs for the Ohio Pharmacists Association, a trade organization with a strong track record of advocating for drug pricing transparency. After years of studying the pharmacy marketplace, Antonio became increasingly perplexed and concerned as he saw drug costs spiking while payouts to pharmacies were declining. Knowing something was being lost somewhere in the middle of an ever-growing transaction, Antonio has spent years working to crack the drug pricing code and pull the rug out from what he believes is one of the most dysfunctional marketplaces in the world. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

On Part Three of the PBM Reform Podcast Series we talk with Mary Ellen S. Jones a PSEA UniServ Representative and Anthony J. Loiacono / Chief Executive Officer of Capital Rx, a pass-thru Pharmacy Benefit Management company.  PSEA is 181,000 members strong – a community of education professionals who make a difference in the lives of Pennsylvania’s students every day.   PSEA members are teachers, education support professionals, higher education staff, nurses in health care facilities, retired educators, and college students preparing to become teachers.  PSEA’s strength comes not only from our members, but from our beliefs, our values, and our passion. Every time we speak up for what we believe, we harness the power of collective action. Anthony J. Loiacono / AJ is a successful entrepreneur, with over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administrated in the US. Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for eight years as CEO, Chief Innovation Officer, and Board Member, leading the company to record growth (Deloitte FAST 500 and Crain’s Fast50). Prior to Truveris, AJ co-founded SMS Partners, a joint venture with Realogy (RLGY), and in 2010 exited the partnership with a buyout. In his first venture, AJ started Victrix, a supply chain consultancy, and successfully sold the company to Chrysalis Solutions in 2007.  https://www.cap-rx.com/company#leadership-team  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Part Two of the PBM Reform Podcast Series features an interview with Monique Whitney, the Excutive Director of Pharmacists United for Truth and Transparency (PUTT).  Pharmacists United for Truth and Transparency (PUTT) is a non-profit advocacy organization founded by independent pharmacists and pharmacy owners devoted to exposing the truth about the anti-competitive tactics of pharmacy benefits managers (PBMs). Known to most Americans as their "prescription drug benefit plan" provider, PBMs are in reality a $300 billion industry - giant corporate middlemen driving up the cost of medications with huge mark ups and commissions on every prescription covered under their "benefits plan."  ​ Working with local and national traditional and digital media that includes The New York Times, USA Today, CBS News, Bloomberg, NBC Nightly News with Lester Holt and Business Insider, PUTT seeks to educate patients, lawmakers, health plan sponsors and the public about the deeply negative effects of the PBM industry on U.S. healthcare and the escalating price of prescription medications. PUTT serves as an industry watchdog, collecting evidence of PBM fraudulent practices and abuse and using this information to educate and inform consumers, taxpayers, employers and health plan sponsors of the truth about the unregulated, unmonitored PBM industry. Through PUTT's efforts, PBMs have begun to experience greater public awareness and scrutiny of their actions and come under fire for questionable practices including the use of gag clauses at the pharmacy counter, gross over-billing of health plans (called "spread pricing"), forcing patients to use PBM-owned pharmacies instead of allowing patients to choose their own pharmacies and interjecting unnecessary bureaucratic practices such as prior authorizations between patients and their doctors in the matter of prescription refills. Monique Whitney Pharmacists United for Truth and Transparency [email protected] m. (505) 480-4150 See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Anne CassityVice President, Federal and State Government Affairs at National Community Pharmacists Association (NCPA) joins Todd Eury, CEO of the Pharmacy Podcast Network, on part one of the new series:  PBM Reform Podcast Series  Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. Over time, PBMs have been allowed to operate virtually unchecked. A lack of transparency in PBM practices has led several states to implement licensure/registration, fair pharmacy audit, or generic drug pricing legislation to try to level the playing field for pharmacies and patients.  NCPA: https://www.ncpanet.org/advocacy/state-advocacy/pbm-reform  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices