LA Times: Battle Over 'Biosimilars'

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Thursday March 21, 2013 · 12:47 PM PDT

2013/03/21 · 12:47

Why are some states standing in the way of cheaper versions of biologic drugs that the FDA deems safe? An editorial appeared in the Los Angeles Times on Sunday which discusses how biosimilars can help reduce some of the costs of an expensive healthcare system.

The Los Angeles Times reports:

The debate over biosimilars is grounded in doubts about their safety; none have yet been approved for use in the United States. Proponents of a bill by California Sen. Jerry Hill (D-San Mateo) to regulate the dispensing of biosimilars include critically ill patients who fear that the new medicines won’t match the biologics they rely on, as well as doctors who prescribe and study biologics. Supporters also include the biotechnology companies whose expensive biologics account for about a quarter of U.S. pharmaceutical revenue — a share that’s expected to reach $100 billion in 2015.
On the other side stand the generic drug companies that want to make biosimilars. They see measures like Hill’s as a thinly veiled attempt by leading biologic manufacturers Amgen and Genentech to hold off competition. They’ve won support from U.S. Food and Drug Administration Commissioner Margaret Hamburg, who warned against reducing the public’s confidence in biosimilars. She recently predicted that competition from biosimilars would “spur innovation, improve consumer choice and drive down medical costs,” just as the generic versions of brand-name pills have done.

Clearly, patient safety has to be policymakers’ top priority. But state lawmakers shouldn’t substitute their own judgment for the FDA’s scientific analysis. And they need to balance the very real needs of the patients taking biologics against the public’s interest in affordable healthcare. That’s why they should be wary of impeding the arrival of biosimilars that the FDA deems interchangeable with their biologic counterparts.

Read more: Battle over ‘biosimilars’

Lawsuit Alleges Blue Cross Keeping HIV/AIDS Patients Out Of Pharmacies

PharmacyAccess

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Thursday January 17, 2013 · 1:50 PM PST

2013/01/17 · 13:50

A new lawsuit filed in California this week alleges that Blue Cross is discriminating against HIV/AIDS patients, among others, forcing patients with certain preexisting conditions to use mail-order only for their pharmacy care.

From the Fox 5 San Diego report:

Under the new program, HIV/AIDS patients’ insurance policies will no longer cover medications at local pharmacies, according to the suit filed Friday by Consumer Watchdog, a nonpartisan consumer advocacy organization with offices in Washington, D.C., and Santa Monica.
HIV/AIDS patients will instead be required to purchase their prescription drugs from a mail order pharmacy, while Blue Cross members who do not suffer from one of the targeted conditions under the same policies will continue to enjoy full access to the pharmacies of their choice, according to the suit.

Health plans and pharmacy benefit managers (PBMs) forcing patients to lose access to their trusted community pharmacist and instead receive medications through the wasteful mail order system deprives these patients of a much needed health care provider.

For patients with chronic illness, their pharmacist is a key player in their ongoing care, and often the provider they speak to the most. For a plan to deny them of that relationship is harmful.

To learn more about how mail-order pharmacies hurt patients, visit Pharmacy Choice and Access Now today!

Video: Mail Order Pharmacy Waste

PharmacyAccess

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Thursday December 06, 2012 · 12:20 PM PST

2012/12/06 · 12:20

This video featuring pharmacist Todd Pendergraft of Broken Arrow Family Drugs gives us an up close and personal look at the incredible about of waste (in both dollars and prescription drugs) that is generated by mail order pharmacies.

All too often, patients are forced into mail-order prescription drug plans either by cuts to public health care services such as Medicaid, or even when enrolled in private insurance plans. Pharmacy benefit managers (PBMs) think mail order is more efficient. Not according to Pendergraft:

“Stop pretending that mail order pharmacy saves the system money. Pharmacy isn’t about who can put pills in a bottle most efficiently or the most cheaply. The professional pharmacy is about a relationship between a pharmacist, who is a healthcare provider, and the patient. A pharmacist, especially an independent pharmacist, would have discovered this problem, recognized it, and put a stop to it. That is something that an automated machine in a far-away state could never do. Until people realize the amount of waste that is inherent in the mail-order pharmacy benefit and until folks understand that waste that’s out there, nothing will change.”

Watch this video to see what he’s talking about:

"Mis-managed" Care

PharmacyAccess

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Wednesday November 07, 2012 · 1:58 PM PST

2012/11/07 · 13:58

Managed care systems for Americans on Medicaid, when executed incorrectly, don’t benefit anyone. And considering the level of mismanagement taking place in some states, others should seriously reconsider implementing managed care for Medicaid patients.

Take what’s happening in Kansas. One managed-care company, Passport, has filed a formal complaint because the state miscalculated the amount of patients the company would receive under the new program, dropping it from 41 percent down to 27 percent. As a result, Passport is formally complaining that the state has violated its own bidding process.

On top of that, Passport claims that if the state were to assign them an even larger share, an astonishing 80 percent of the region’s population, the state would save an estimated $80 million.

Instead of focusing on providing quality health care for patients, Kansas and its managed care companies are fighting each other over who gets assigned the largest patient load. This simply will not work.

We need Medicaid reform that makes sense, and helps patients. Visit Pharmacy Choice and Access Now to find out more.

Flu Season Awareness: Go to a Pharmacy For a Flu Shot

PharmacyAccess

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Wednesday October 24, 2012 · 8:03 AM PDT

2012/10/24 · 08:03

Flu season is in full swing, and many are clamoring for their vaccines to try and keep the dreaded illness at bay. October is also American Pharmacist Month, so this is a great time for a reminder about one of the most convenient ways to access your flu shot: at your local community pharmacy. Unfortunately, in many states pharmacists can only administer flu shots, but not vaccines for whooping cough or pneumonia. Why the disparity? A vaccine is a vaccine is a vaccine, right? Well, not exactly in the eyes of the law.

Slate reports:

The push to turn pharmacists into vaccinators dates back at least to the mid-1990s. Donna Shalala, then secretary of Health and Human Services, saw it as a way to improve the country’s immunization rates and pressed the American Pharmacists’ Association to develop a plan, according to Mitch Rothholz, chief strategy officer for that organization. Some states already had laws on the books that allowed pharmacists to immunize people, even if these provisions were rarely used. The APhA developed a rigorous training program for pharmacists. State pharmacy associations also began to lobby their legislatures. But for years it was slow going.

Traditionally, doctors were the go-to health care professionals when it came to vaccinations, but pharmacies are easily accessible, convenient and affordable. Plus, community pharmacists are highly educated on administering vaccines and are readily available to discuss vaccines and how to keep communities healthy. At a time when many people don’t have health insurance (so they’re not going to doctors), and many healthy people just don’t go to the doctor, then letting pharmacists administer flu, shingles and pneumonia vaccines in all 50 states makes a whole lot of sense.

Click here to read the full coverage at Slate, and visit Pharmacy Choice and Access Now to learn more about how you can support community pharmacies and speak out about enabling pharmacists to administer more vaccines!

Florida's Medicaid Reform Plan Applied Nationwide? Think Again.

PharmacyAccess

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Friday October 12, 2012 · 7:00 AM PDT

2012/10/12 · 07:00

An article in the Bradenton Herald last week posed the question, “Can Florida’s Medicaid reform plan be the model for the nation?” And it’s a very good question. Florida is barely into its managed-care roll out, and many questions have yet to be answered.

“Does the new system cost less because insurers are providing more efficient care or are they simply giving patients less care?” It turns out that the in the state’s pilot, the most successful groups in the HMO networks are being paid on a fee-for-service system, the same system that the state is trying to move away from. Hospitals love the amount of payment they receive in the new system, but physicians find that their reimbursement rates are low. Seriously ill patients are being bounced from provider to provider as HMO’s enter and then leave the program and patients are forced to repeatedly navigate a complicated system to get coverage for their medications and doctors.

Taking the question outside of Florida and looking at its application for the nation as a whole, and it’s more of the same. Other states are trying to implement the same type of managed-care model for their Medicaid programs. We discussed some of the lessons lessons to be learned for Medicaid managed care in a blog post a few weeks ago.

Anyone who thinks this is a good idea should think twice. Texas legislators are learning that both patients and providers alike are struggling in the face of their Medicaid reform. The state of Massachusetts just discovered that its managed care transition wasn’t the bargain it hoped for. Add to this, the data from a Bloomberg study, which showed that in five of the biggest states using managed care, the longer-term costs could eat up any potential savings that could be realized through a managed care program, and you get a system that definitely not a model to be replicated across the nation.

To find out more about how managed care is impacting community pharmacies nationwide, visit Pharmacy Choice and Access Now today.

National Grange: Pharmacists Important To Rural Communities

PharmacyAccess

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Wednesday September 12, 2012 · 8:38 AM PDT

2012/09/12 · 08:38

The National Grange has recently come to the defense of community pharmacists in rural areas, many of whom are in danger of losing their businesses to drastic changes to Medicaid at the state level. In states such as Texas, with large rural populations, many pharmacies have been forced to either close completely or make the difficult choice to turn away their Medicaid patients.

From their recent for Pharmacy Choice and Access Now:

Dealing with the ever-increasing shortage of healthcare professionals has been quite difficult for rural residents in recent years. Currently, there are almost 2,200 Health Professional Shortage Areas (HPSA) in rural areas, in contrast to 910 in urban cities. This stems from the fact that only 10% of all physicians practice in rural areas. Similarly, rural populations average 40 dentists per 100,000 residents. Psychiatrists and psychologists are even harder to come by, with 25% of nonmetropolitan counties lacking mental health services, compared to just 5% in urban counties. Over 470 rural hospitals have closed in the past 25 years, causing many rural Americans to drive over 150 miles to the nearest major hospital. Obtaining care this way, especially infused services such as chemotherapy, can be extremely burdensome.
Facing these limitations, the roles of pharmacies become dramatically important within rural communities. Lacking doctors and hospitals, the local pharmacist is often the only health care specialist available. Rural patients rely on the local pharmacist to help manage their medications and provide basic health care advice. This is especially true for elderly residents who are more likely to have chronic health conditions with multiple prescriptions.

With rural communities already facing the issue of fewer health care providers than in other parts of the country, can we really afford to be losing one of the most important providers in many patients' lives?

The rural community pharmacist plays a role that is too important to ignore: please visit Pharmacy Choice and Access Now and find out what you can do to keep these pharmacies in business!

Texas Managed Care System Causing Pharmacies To Close

PharmacyAccess

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Friday August 10, 2012 · 7:24 AM PDT

2012/08/10 · 07:24

In an interview with KLBJ in Austin, Danny Vela, pharmacy owner in Texas and member of the Rio Grande Valley Independent Pharmacy Association, talks about how the state has taken an efficiently run program (that was once a model for all states), and inserted a layer of bureaucracy in the form of two for-profit companies between the state and the pharmacies.

The result has been a study in what not to do, with 26 independent community pharmacies closing their doors because of the reduced reimbursements in the new programs. Plus, the state has made it difficult for beneficiaries to get their medications at all, much less in a timely manner.

To find out what you can do to protect community pharmacies in your state, visit Pharmacy Choice and Access Now today!

States Limiting Prescription Access for Medicaid Patients

PharmacyAccess

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Friday August 03, 2012 · 6:37 AM PDT

2012/08/03 · 06:37

Federal Medicaid regulations don’t require states to cover prescription drugs, yet most states do have drug coverage under their state Medicaid programs. But that fact is rapidly changing. With many states scrambling to make budget cuts wherever they can, it is often Medicaid patients that are bearing the burden--16 states are limiting the number of prescriptions covered under their Medicaid programs.

At Pharmacy Choice and Access Now, we recognize that health care for most isn't just about trips to the doctor, but is often about managing one's care through vital medications. Often, the community pharmacist is the health care provider patients see most often, particularly those who are disabled or suffering from chronic medical conditions. Providing coverage for a visit to the doctor will not be of much help to these patients if they are not also covered for the necessary prescriptions required to manage their ailment.

OpposingViews.com offers this breakdown of how those 16 states are limiting prescription drugs for their Medicaid patients:

“Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get. Alabama has limited Medicaid patients to one brand-name drug, while HIV and psychiatric drugs are excluded. Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.”

To find out how you can help lend your voice to the fight to preserve access to high quality pharmacy care for patients nationwide, visit Pharmacy Choice and Access Now today.

Pharmacists Group: Pharmacies Need Level Playing Field

PharmacyAccess

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Thursday July 19, 2012 · 9:35 PM PDT

2012/07/19 · 21:35

Pharmacist groups are raising concerns about several issues facing their industry this week, including concerns about state-run Medicaid programs, and the encroaching amount of power held by corporate pharmacy benefit managers.

According to a letter to the editor in The Witchita Eagle this week, the switch to managed care in Kansas could have the same disastrous results that occurred in Texas.

From the letter:

Since Texas transitioned to managed care in March, roughly 30 independent pharmacies have closed or been sold to retail chains. When Kentucky transitioned to a managed-care system in November, independent pharmacists experienced an 80 percent reduction in professional fees and draconian cuts to drug reimbursement.
Under the new system, Kansans who rely on local, rural pharmacies for their medications may be in danger of decreased access to care unless the administration ensures a level playing field for the state’s independent and chain pharmacies.

It seems independent pharmacies just can't catch a break these days. Managed care programs slowly spreading to more states are forcing some community pharmacists out of business, and the ones who still survive also have to worry about pharmacy benefit managers (PBMs). PBMs were created 30 years ago as a mechanism for insurance companies to process claims for prescriptions. They’ve evolved into companies that control what pharmacies are allowed to charge and sometimes even compete with the very companies whose claims they process.

According to the North Jersey Record, these are the four biggest challenges facing your corner drug store:

Pharmacy benefit managers: These large companies hired by insurance plan sponsors to process pharmacy benefit claims also limit the reimbursement a pharmacist can receive and steer patients to their own mail-order services or specific chain stores.
Mandatory mail order: Pharmacists say their customers with continuing conditions that require medicine and supplies all year increasingly are being told they must get prescriptions filled through mail-order companies instead of their local pharmacies.

Specialty drugs: The most expensive drugs, and the most profitable to dispense, increasingly are being classified as specialty drugs, which can only be dispensed by specialty mail-order pharmacies, usually connected to PBMs.

Competition from chains, discount stores and supermarkets: Most local pharmacists feel they can hold their own against competition but say the large chains have an unfair advantage in negotiating prices from drug suppliers and PBMs.

To find out how you can help community pharmacies, please visit Pharmacy Choice and Access Now.

Independent Pharmacies Threatened By States' Shift To Managed Care

PharmacyAccess

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Friday July 13, 2012 · 9:47 AM PDT

2012/07/13 · 09:47

With the Affordable Care Act's recent approval from The Supreme Court, focus in the nation's health care debate has shifted to the state level. In Florida, Gov. Rick Scott has vowed not to expand Medicaid, and several other Republican governors have done the same, including Texas Gov. Rick Perry.

Texas had already been in the process of cutting millions from Medicaid by shifting patients in the program over to managed care, a move that could drastically slash reimbursements and hurt health care providers, including smaller independent pharmacies.

Bruce and Human Drug Co. in Wills Point Texas is the oldest continually family-owned pharmacy in the state. The pharmacy has been in Adele Monning's family an impressive 133 years. Under Texas' dire health care system, which includes a recent switch to managed care for Medicaid patients, this pharmacy and others like it may be in jeopardy.

The Austin-American Statesman reports:

Freda Malone, the store manager, said the mission has always been simple. "Whatever the need is in the community (is what we did)," she said. Of course the basis for the pharmacy is medicine and the history of that is evident throughout the shop. Not just behind the raised platform where the pills are doled out." Pharmacies like these have served their local communities for many years, providing high quality health care to their communities.

Texas implemented managed care on March 1 of this year and community pharmacies like Bruce and Human Drug Co. have been negatively impacted by the change. They have seen dramatic reductions in reimbursements and revenues, unfair poaching of independent pharmacy customers by CVS Caremark, a managed care pharmacy benefit manager (PBM), and computer errors and miscommunications from the Health and Human Services Commission (HHSC). Independent pharmacies under managed care also suffer from a total lack of transparency in dealing with PBMs, making evaluating PBM contracts, a vital step in setting prices and reimbursements, much more difficult.

In the end, Medicaid beneficiaries have been left with limited access to care and pharmacies have been faced with closures and ongoing hardships for those still in business.

The Texas state legislature needs to step up and implement protections for patients and pharmacies to ensure that community pharmacies like the Bruce and Human Drug Co. are able to continue to serve their communities with high quality health care going forward.

Visit Pharmacy Choice and Access Now for more information.

California Medicaid Patients Struggling Under Managed Care

PharmacyAccess

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Friday July 06, 2012 · 10:45 AM PDT

2012/07/06 · 10:45

California approved moving patients enrolled in Medi-Cal, the state's Medicaid program, to a managed care system last year, and the transition has been a rocky one for many California patients, according to an article in the LA Times.

The purpose of the transition is to cut millions from the Medi-Cal budget to help the state's rocky economy. A noble pursuit to be sure, but at what cost? If reforming Medi-Cal causes patients with disabilities, the elderly, and the chronically ill to lose access to the medical care they so desperately need, is it worth it?

According to the article:

But for some of these low-income seniors and disabled patients, the transition has been anything but smooth, forcing severely ill patients to give up their doctors, delay treatment and travel long distances for specialty care.
As of this month, the state has transitioned 333,000 people, many with diseases such as multiple sclerosis, lupus and metastatic cancer. State health officials said managed care oversees all of the patients' treatment and guides them through the healthcare system, helping prevent unnecessary procedures and hospital visits.

Patients could apply for temporary exemptions if they wanted to stay on a fee-for-service plan, where the state pays doctors based on the specific treatment provided instead of a managed care general rate that is usually less. But the patients had to meet a high bar: They had to be in ongoing care for a serious illness and any change could cause their condition to deteriorate.

"The criteria is met by very few people," said Susan McClair, senior medical consultant with the state Medi-Cal Managed Care Division.

One of the biggest issues with managed care continues to be access, as there simply aren't enough providers that service managed care patients. The article goes on to report:

Shifting patients into managed care has been a "disruption" for many, in part because there simply aren't enough specialists who will accept patients on Medi-Cal managed care, said Liz Forer, executive director of Venice Family Clinic. The patients' complicated illnesses overwhelmed family practice providers at Venice Family Clinic, Forer said. They weren't equipped to treat patients with end-stage organ disease, multiple types of cancer or Parkinson's disease.

Managed care is not the solution for California. To find out how you can help fight back against this broken system, please visit Pharmacy Choice and Access Now today!

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