PUTT SETS RECORD STRAIGHT ON PBM AGREEMENT WITH CLINICALLY INTEGRATED INDEPENDENT PHARMACY NETWORK
May 23rd Announcement Should Have Listed Cigna, Not PBM Express Scripts, in Agreement With CPESN to Cover Non-Prescription Clinical Services
“The agreement is with Cigna, not with its PBM Express Scripts,” said PUTT President Deborah Keaveny, whose pharmacy is part of the CPESN network. “This is an important distinction because the clinical services provided by our pharmacies are not the same as traditional dispensing of medications or counseling patients. Because PUTT and CPESN share an overlapping membership, we felt it was important to set the record straight to avoid further confusion and disruption to patient care.”
Clinically integrated pharmacy networks (CINs) were created in response to years of changes in how PBMs reimburse pharmacies for dispensing prescription medication and counseling patients. . CIN pharmacies provide certain types of healthcare services, such as wellness checks, vaccinations and helping patients with chronic illness monitor their treatment progress. As pharmacists have seen an expansion in their scope of practice to include wellness checks and limited prescribing ability, moving to a clinically-integrated pharmacy model has made better business sense for independent pharmacies. At the same time, PBM business practices have come under public scrutiny in the wake of record pharmacy closures.
“Express Scripts may feel pressure to correct mistakes of the past and overstepped with an announcement that was meant for its health plan parent company,” said Monique Whitney, PUTT’s Executive Director. “Since the PUTT-led protest at Express Scripts headquarters on May 17th and in response to mounting pushback from independent pharmacies and patients across the country, we’ve seen what we hope are meaningful attempts to reverse course toward a more productive relationship.”
ESI is one of six PBMs under investigation by the Federal Trade Commission. In 2023, ESI launched its “IndependentRx Initiative” which it said was intended to expand access to rural healthcare through a partnership with independent pharmacies.In 2023 ESI also formed an “Independent Pharmacy Advisory Council” (IPAC) composed of independent pharmacists who would advise ESI’s IndependentRx program manager on how to better work with independent pharmacies.
Critics of the IndependentRx initiative have pointed to issues including complaints that ESI spends more time promoting its IPAC than meeting with members and offering different, non-negotiable contracting terms to pharmacy services administrative organizations (PSAOs) that contract on behalf of independent pharmacies than to individual pharmacies. These are some of the practices the FTC is studying to better understand the PBM-pharmacy relationship.
ABOUT PHARMACY BENEFIT MANAGERS
PBMs manage patients’ prescription drug benefit, acting as the middlemen between the patient, the pharmacy, and the patient’s employer or health plan sponsor. Since 2019, numerous studies have uncovered evidence of PBMs practices that result in endpayers paying significantly more for patients’ prescription medication than the patient’s pharmacy was reimbursed (a practice called “spread pricing”); and patients “steered” away from their pharmacy of choice to PBM-owned/affiliated pharmacies. Additional studies have shown the drug manufacturer rebates PBMs negotiate increase a drug’s list price year over year, causing patients to pay more out of pocket because of rebate-inflated costs.
To understand how PBM practices affect patient care and affordability of medication for consumers and end payers, visit PUTT’s website at TruthRx.org.
Monique Whitney
Pharmacists United for Truth and Transparency
Monique@TruthRx.org
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