PBM Reform Podcast

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...

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,...

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 gues...

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....

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....

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 phar...

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...

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 Fede...

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...

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 i...

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 therape...

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...

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...

Special interview w/  award-winning ProPublica reporter Marshall Allen, a primer for anyone who wants to fight the predatory health care system--and win. We welcome back two patriots in PBM Reform on the interview w/ Marshall.  Monique Whitney - CEO of Pharmacists United for Truth & Transparency and PUTT President and Pharmacy Owner Scott Newman.   Every year, millions of Americans are overcharged...

Capital Rx and 3 Axis Advisors Study Finds Potential for Billions in Prescription Drug Savings With Transparent Pricing Practices Mandatory NADAC responses by pharmacies for 1,600 unique oral solid products could create additional savings of $1.5 billion over 10 years Comparing generic drug costs with NADAC and Alabama actual acquisition cost, study finds $937 million in potential annual savings a...

LIPA v ESI: Fight for the Right to Be Paid  What happens when a state implements provider fee statutes that are officially approved by CMS but one of the big 3 PBMs still claims exemption? Join guest host Monique Whitney with special guests Randal Johnson, JR Whaley, and MJ Terrebonne as they discuss Louisiana's legal battle with ESI over 10 cents per claim, and the ramifications this could have o...

Tennessee Gov. Bill Lee signed HB 786, a comprehensive PBM reform bill that strengthens existing fair pharmacy audit laws, limits PBM adjudication fees, and prohibits a PBM from reimbursing a pharmacy less than it reimburses a PBM-affiliated pharmacy. May 30, 2019 Tennessee SB650 Present law defines "pharmacy benefits manager" (PBM) to mean a person, business, or other entity and any wholly or par...

What's the expected outcomes of a transparent PBM? How does a fiduciary driven pharmacy benefit management company compare to the 3 largest PBMs in the country processing more than 76% of all the prescriptions per year in the United States.  The PBM market is dominated by three major players, who together handled about 76 percent of all prescription claims in 2018, according to Drug Channels Insti...

We talk with Community Pharmacy owner Dr. Steve Moore, PharmD about the Implications of the Rutledge versus PCMA Supreme Court decision on Independent Pharmacy.  About Condo Pharmacy:  Condo Pharmacy is an independently owned and operated pharmacy dedicated to meeting the unique healthcare needs of each individual patient. In addition to providing both traditional and specialty pharmacy services,...

Georgia House of Representatives Earl L. “Buddy” Carter joins CEO of RxSafe Bill Holmes to summarize the The Supreme Court of The United States (SCOTUS) has rescheduled the Rutledge v. The Pharmaceutical Care Management Association (PCMA) hearing for October 6, 2020.1 The initial April hearing date had been postponed due to the coronavirus disease 2019 pandemic (COVID-19) Rutledge v. PCMA revolves...

Director of Government and Public Affairs for Independent Pharmacy Alliance (IPA) Anthony Reznik joins us on the PBM Reform Podcast Series to discuss strategies Pharmacy can implement to fight the PBMs while we wait for legal reform at the state & federal levels.  Independent Pharmacy Alliance, est. 1988, is a trade group and retail pharmacy buying cooperative representing over 3,100 independent p...

Georgia Gov. Brian Kemp (R) has signed three innovative PBM reform bills into law. HB 946 and SB 313 require the reporting of drugs paid 10 percent above and 10 percent below National Average Drug Acquisition Cost every four months, prohibit PBMs from tying a pharmacy’s drug reimbursement to a patient’s health outcomes, and require PBMs to offer drug coverage plans that do not include spread prici...

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...

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...

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 giv...