,QGHSHQGHQW Tennessee Pharmacists Association ZZZWQSKDUPRUJWSD#WQSKDUPRUJ /LQN April 19, 2019 ADVOCACY UPDATE: Comprehensive PBM Reform Will Be Heard in House and Senate Finance Committees Next Week! THANK YOU for your continued advocacy and engagement, ing law in Tennessee. Your continued engagement is criti- including emails and calls to key legislators to gain support cally important. Stand up and advocate on behalf of your for House Bill 786 and Senate Bill 650! Your voices of sup- patients, and share the importance and value of the phar- port are being heard loud and clear at the Capitol in Nash- macy profession with YOUR state Representative and state ville! Watch Representative Cameron Sexton’s testimony Senator! on HB 786 [bit.ly/2CWRZWz] and Senator Shane Reeves’ More about this legislation: testimony on SB 987 and SB 650 [bit.ly/2K2VW3G]. TPA has worked with Representative Cameron Sexton, Sen- What is the current status of the legislation? ator Shane Reeves, Senator Ferrell Haile, Representative • House Bill 786: House Finance, Ways, and Means Bryan Terry, and other pharmacy champion legislators, to Committee [bit.ly/2KhMwQP] (Thursday, April 25, 2019) introduce several pieces of legislation which would provide • Senate Bill 650: Senate Finance, Ways, and Means support to the pharmacy profession and bring increased Committee [bit.ly/2uL5iVY] (Tuesday, April 23, 2019) transparency within the prescription drug delivery system. HB 786 and SB 650 are critically important to increase pre- What actions are needed TODAY? scription drug pricing transparency to the state and our pa- This important legislation has cleared a major hurdle and is tients, as well as level the playing ȴ eld between PBMs and moving forward, but it still has a ways to go before becom- pharmacies. ACTION NEEDED NOW ʇ SEE PAGE 2 SUPPORT: Pharmacy Contract and Audit Protections, Ban on Retroactive Fees, and Increased PBM Transparency TPA has worked with state legislators to introduce compre- • Prohibits PBMs from recouping the cost of the drug or dis- hensive PBM reform legislation that includes pharmacy con- pensed product through audit, except in cases of fraud, tract and audit protections, a ban on PBM use of retroactive excess dispensing, and dispensing outside of prescriber’s fees, and increased PBM transparency. orders. • Prohibits PBMs from charging retroactive or non-appar- Legislation: ent fees (e.g., DIR fees) to pharmacists or pharmacies at • Senate Bill 650 [bit.ly/2MrKgVw] by Reeves, Haile, Swann, the state level. Yager • Prohibits PBMs from using contractual language to re- • House Bill 786 [bit.ly/2HEm8yg] by Sexton C, Terry, Powers, quire a pharmacist to dispense a drug or product to a pa- Sparks, Dixie tient contrary to the pharmacist’s professional judgement. • Establishes notiȴ cation requirements for PBMs regarding Current Legislation as Amended: a pharmacy’s network status. HB 786 / SB 650 [bit.ly/2FWTnL3] • Requires PBMs to disclose any material change to con- Summary: As amended, makes various changes to law con- tracts to a pharmacy or pharmacist in its network at least cerning pharmacy beneȴ ts managers. thirty (30) days before the e΍ ective date of the change. • Establishes certain contract standards and prohibitions Here's how this legislation would a΍ ect the pharmacy between PBMs and pharmacies. profession: • Establishes that PBMs shall not engage in a pattern or • Strengthens audit protections regarding pharmacy’s right practice of reimbursing a pharmacy or pharmacist less to amend claims prior to recoupments, including recoup- than it would reimburse itself or an aɝ liate for providing ments due to clerical and record-keeping errors. the same drug or dispensed product. THE INDEPENDENT LINK IS PUBLISHED BY THE TENNESSEE PHARMACISTS ASSOCIATION AND SPONSORED BY PHARMACY PLUS Resources to support Independent Pharmacy $SULO ,QGHSHQGHQW/LQN 3DJH 7HQQHVVHH3KDUPDFLVWV$VVRFLDWLRQZZZWQSKDUPRUJWSD#WQSKDUPRUJ ACTION NEEDED NOW! • Email YOUR State Representative and State Senator: Send an email to your elected oɝ cials to share your per- sonal story and request their support for House Bill 786 and Senate Bill 650. • Call YOUR State Representative and State Senator: Make calls to the oɝ ces of your elected oɝ cials to voice your support for House Bill 786 and Senate Bill 650. • Meet with Your Elected Oɝ cials: Invite your elected oɝ cials to meet with you at your pharmacy to educate them on the importance of House Bill 786 and Senate Bill 650. • Make Your Emails and Calls Personal! Go to capitol. 1. Utilize the attached Quick Guide to Advocating for Comprehensive Pharmacy tn.gov/legislators Beneȴ ts Manager Reform. to ȴ nd the contact 2. Share your experience and explain why comprehensive PBM reform is needed. 3. Provide de-identiȴ ed examples of negative patient outcomes caused by PBMs. information for 4. Share examples of egregious pharmacy audits and contracting issues. your State 5. Discuss the negative impact of retroactive fees (such as DIR fees) on your practice. Representative 6. Ask legislators to support pharmacists and patients by supporting and voting for and State Senator. HB 786 and SB 650. House Finance, Ways, and Means Committee (Sponsor and Supporters) capitol.tn.gov/house/committees/ȴ nance.html Susan Lynn (Chair) Mount Juliet [email protected] (615) 741-7462 Patsy Hazlewood (Vice-Chair) Signal Mountain [email protected] (615) 741-2746 Charlie Baum Murfreesboro [email protected] (615) 741-6849 Karen Camper Memphis [email protected] (615) 741-1898 John Crawford Kingsport [email protected] (615) 741-7623 John DeBerry, Jr. Memphis [email protected] (615) 741-2239 Ron Gant Rossville [email protected] (615) 741-6890 Gary Hicks Rogersville [email protected] (615) 741-7480 Matthew Hill Jonesborough [email protected] (615) 741-2251 Andrew Holt Dresden [email protected] (615) 741-7847 Sabi Kumar Springȴ eld [email protected] (615) 741-2860 William Lamberth Gallatin [email protected] (615) 741-1980 Brandon Ogles Franklin [email protected] (615) 741-6808 Jay Reedy Erin [email protected] (615) 741-7098 Cameron Sexton Crossville [email protected] (615) 741-2343 Johnny Shaw Bolivar [email protected] (615) 741-4538 Rick Staples Knoxville [email protected] (615) 741-0768 Rick Tillis Lewisburg [email protected] (615) 741-4170 John Mark Windle Livingston [email protected] (615) 741-1260 Jason Zachary Knoxville [email protected] (615) 741-2264 Senate Finance, Ways, and Means Committee (Sponsors and Supporters) capitol.tn.gov/senate/committees/ȴ nance.html Bo Watson (Chair) Hixson [email protected] (615) 741-3227 John Stevens (1st Vice-Chair) Huntingdon [email protected] (615) 741-4576 Joey Hensley (2nd Vice-Chair) Hohenwald [email protected] (615) 741-3100 Richard Briggs Knoxville [email protected] (615) 741-1766 Todd Gardenhire Chattanooga [email protected] (615) 741-6682 Brenda Gilmore Nashville [email protected] (615) 741-2453 Ferrell Haile Gallatin [email protected] (615) 741-1999 Jack Johnson Franklin [email protected] (615) 741-2495 Brian Kelsey Germantown [email protected] (615) 741-3036 Ken Yager Kingston [email protected] (615) 741-1449 Je΍ Yarbro Nashville sen.je΍ [email protected] (615) 741-3291 HB 786 and SB 650: A Quick Guide To Advocating For Comprehensive Pharmacy Benefits Manager Reform Explain Who Pharmacy Benefits Managers Are And What They Role They Play: • Pharmacy Benefit Managers (PBMs) are companies that contract with health plans to assist them with processing prescription drug claims, managing a plan’s prescription drug benefit programs, and also offer additional consultative services. • The three biggest PBMs are Express Scripts (now a part of Cigna), CVS Health (now a part of Aetna), and OptumRx (now a part of UnitedHealthcare). • PBMs administer drug plans to more than 266 million Americans. • They act as a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicaid, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. Discuss Why PBMs Are Facing Increased Scrutiny: • Historically, PBMs have operated in the shadows of the pharmaceutical supply chain. • However, due to the rising costs of drug prices, the public, media, and lawmakers both at the State and Federal level are finally looking more closely at the role that PBMs play in the prescription drug market and their business practices. • “FDA Commissioner, Scott Gottlieb, recently told CNBC the reason drug prices remain high is due to the “wacky” rebate system. Rebates are the discounts paid by manufacturers to the PBMs in exchange for a spot on their formulary or approved drug list. These rebates are not passed on to patients, but shared with insurers and employers who lower premiums across the board. Sick people subsidize the healthy people.” https://www.beckershospitalreview.com/pharmacy/wacky-rebate-system-to-blame-for-high-patient-drug-prices-fda-chief- says.html Explain the Primary Issue: • PBMs by and large have gone unregulated and been able to gain enormous market share through unfair and anti- competitive business practices • This lack of oversight has caused them to have control and influence over the prescription marketplace which has been detrimental to the patients we serve and our own pharmacy businesses. Provide Examples of Unfair PBM Practices Which Affect Your Pharmacy and Your Patients: • Rebates: PBMs often favor higher-cost drugs on a formulary because the PBM can negotiate a higher rebate, which they retain as profit.