Helina, Mont. – Montana’s small and independent pharmacies say that it is increasingly pressure on the payment of managers by pharmacy allocations – and they pay an ambitious bill to curb what they say are unfair practices by strong industry negotiators known as PBMS.
“Who in their right mind will subject themselves to this type of treatment in a commercial relationship?” Mike Mcofich, a portion of eight pharmacies in a small town in Montana, said. “It is a monopoly. We can be the best pharmacy in the world, and they can still get us away from work.”
DraftWhich sailed through Montana’s house 98-1 in early March, and is now in front of the Senate in the state, that would determine a price of the price that PBMS must pay pharmacies for each prescription. At the present time, there is no minimum amended contract with pharmacies, and an independent pharmacy said that the rates are often less than what they paid for medicines.
This measure includes half -scale restrictions on other PBM practices called smaller pharmacies.
Pharmaceutical benefits, who work in health insurance companies, are powerful brokers in the chain of medicines. They determine the drugs covered by health plans, arrange discounts from drug makers, and fill the payments that pharmacies receive when selling covered drugs.
The largest six PBMS runs more than 90 % of the country’s drug sales. Most are owned or affiliated with health insurance giants such as UNITEDHELHELH GROUP, Cigna, Humana and Aetna.
About 90 Montannan -owned pharmacies are not affiliated with national companies or PBMS, and closed 10 last year, according to Josh Morris, who owns many small pharmacies in the state. Morris said that his pharmacists lost $ 30,000 for drug claims last year and that it loses its money on 90 % of the branded drugs they raise.
The representatives of independent pharmacies in Montana says that without the changes made by the legislation, more of their ranks will be closed, because they cannot cover their expenses on the rates of drug payment that they are imposed by what they say are “taking or disturbing” from PBMS.
“We fill more prescriptions more than ever, but employees have not got an increase in three years,” Morris said. “Our payment has decreased 60 % since 2019.”
PBMS is escalating with a concerted effort in the Senate in Montana to kill the Parliament’s Bill 740, on the pretext that it can cast a large key to drug prices in Montana that would increase the costs of consumer.
“It will not only cost people, but will basically change how to pay the prescribed medications in the state,” said Tonia Sorrell-New, of the Pharmaceutical Care Association, a commercial group representing PBMS. “He takes the options of employers who pay for these health plans” to maintain low drug prices.
She said that the draft law restricts the application options via the mail for drugs, and the borders when PBMS can check the claims, and imposes excessive payment.
This battle between PBMS and independent pharmacies are not at Montana – it has wandered around the country, has caught the attention of Congress, and may end before the United States Supreme Court.
Last summer, federalism Committee for Control and Accountability at home and Federal Trade Committee Very critical reports have been issued that PBMS uses pricing tactics that keep the costs of medicines high, help PBM profits, and damage independent pharmacies.
New federal regulations PBMS was included in the post -election budget bill for the year 2024 before Congress, but was stripped at the last minute after pressing the managers of the pharmacy advantages.
At least 20 states They approved the laws regulating PBM payments for pharmacies and many other states, including California, studying legislation this year.
Oklahoma approved one of the most expanded laws in 2019. But PBMS filed a lawsuit and won Federal Court ruling However, the law does not apply to self -funded health plans, thus removing about two thirds of the insured population from the jurisdiction of the law.
Last year, the Insurance Commissioner in Oklahoma asked the US Supreme Court to cancel the decision, but the court did not decide whether to take the case. General lawyers From 31 states and provinces of Colombia, I asked the Supreme Court to rule in favor of Oklahoma; Montana’s Ag is not one of them.
In Montana, HB 740 regulations apply to the PBMS management of self -funded plans.
The main component of HB 740 is to put requirements for what PBMS must compensate for pharmacies for each prescription filling it, when this prescription is covered with a health plan using PBM.
She says the payment can be at least 106 % of the average cost of national drug acquisition, or NADAC – which is determined by a survey of wholesale prices paid by pharmacies – in addition to “dispensation fees” for each prescription.
The dispensation fee will be the same as what the Montana Medicaid Pharmacy program – from 12 to 18 dollars per prescription, will pay, depending on the volume of the pharmacy. Medicaid government program also pays a minimum of 106 %.
Montana pharmacies say that dispensing fees cover their basic costs and enable them to make profit in most sales. Under contracts with most PBMS, pharmacies say they do not get dispensing fees.
The draft law also requires other changes in PBM commercial practices that pharmacies say to benefit from PBMS and make it difficult for independent pharmacies to stay in business.
For example, HB 740 says that PBMS cannot offer better prices for the diamonds they possess, cannot impose fees after the situation on the basis that low payment rates cannot be slow to contract contracts, and cannot reduce payments for drugs that are sold after the date of sale “imposed by PBMS.
The pressure groups in PBM and Plan Health attacked the bill because of its breadth and details, saying it is very wide so that no one really knows how it might affect the markets of medicines and prices in Montana.
“This bill has a lot,” Bruce SpencerA lawyer for the mountainous health cooperative told the Council of Labor and Labor in the House of Representatives at the first hearing of the draft law in February. “It has severe unintended consequences in the financial world.”
Laura Shirif, a spokeswoman for the government account auditor, said that the provisions of the bill should be narrowed to target smaller pharmacies.
PBM pressure groups require the killing of HB 740 and instead pass a draft law to study a prescription market in Montana, while considering possible solutions to help rural pharmacies.
“I would like to say that there are many elements and factors that affect the work of rural pharmacies,” said Suril Neil of the PBM Trade Group.
However, supporters said that HB 740 needs to determine what is happening in this field closely, between PBMS and pharmacies, so that these practices can be organized.
As for waiting for two years to study? Pharmacy owners say this is too late, and that the time to fix the problem is now.
“He will never be able to damage within two years of its recovery, in these societies,” said Matovic. “Ten years ago, we may have lost money on five recipes per month. Now, it’s thousands of medical prescriptions per month.”