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Sun Sentinel: Jay Rittenberg: Pharmacies getting crushed by supposed partners

Tuesday, May 28, 2013

As the owner of a 57-year-old family-run pharmacy in Miami Beach and engaged provider of health care, I want my community to know that our first priority is serving our patients. Our businesses, alongside 1,300 independent retail pharmacies in Florida, are being systematically wiped out by Pharmacy Benefit Managers. Many people have never heard of PBMs and would be surprised to learn of the large role they play in the health care industry.

PBMs were created to help eliminate fraud, waste and abuse in the pharmacy community, which we encourage and welcome. Unfortunately, PBMs have slowly but surely developed abusive tactics when it comes to dealing with legitimate companies.

PBMs are currently not subject to state government oversight in Florida. Being unfettered by any controls, they have created subjective audit procedures allowing them to recoup monies from what should be their partners, pharmacies. For example, PBMs can request reimbursement on a clerical error, such as doctors’ handwriting or if a doctor wrote the numerical date instead of spelling out the entire month. If our pharmacist questions the fairness of the PBM procedures, auditors can proceed to enforce recoupment of all prior refills on any particular prescription clerical error. This arduous process requires time and resources better placed on patient care.

The power of PBMs is concentrated in $3 billion companies. As a result of existing monopolistic control over pharmacy benefits, PBMs have free market realtiies and can set the price for our services and products. PBMs have hired powerful lobbyists who work to convince state lawmakers that current auditing processes can be resolved during the negotiating process, which forces a “take or leave it” contract for community pharmacies and limits patient access to regularly dispensed medications.

Community pharmacies need laws to change in order to see relief by requiring prior notification before an audit, ensure an education level of auditors, prohibit PBMs from making money from clerical errors, allow reasonable timeframes for producing paperwork, require findings be shared so clerical mistakes will not be repeated and give the ability to repeal unfair rulings, while preserving PBMs ability to reduce legitimate fraud, waste and abuse in the system.

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