Since Thursday, March 7th, I have been flooded with emails encouraging my support on legislation for independent pharmacies such as Mahaska Drug. I would like to share with my newsletter readers my response to anyone who reached out to me about this:
1. To begin with, as of this past Thursday morning, I have received almost 100 emails from Mahaska County residents, and I am so thankful for that. By far, this is the greatest number of emails that I have received from my own county since being sworn into office in January 2023.
2. I want to emphasis to you that lifelong Mahaska County residents and owners of Mahaska Drug, John and Jean Nicholson, were awarded the Good Neighbor Pharmacy of the Year in June 2023. Please understand this was not a state award, it was a national award, and they were recognized from among 3,500 other pharmacies. Truly, an impressive award that demonstrates their decades long commitment to their patients, costumers, and the community.
3. Your support of Mahaska Drug and other independent Iowa pharmacies is critical right now. I want you to know that I fully support them and I am working hard to move real PBM reform that will allow them to continue to meet the needs of their customers with the high quality of service they have always provided. I am in frequent communication with the Nicholsons and am doing everything I can to fight for them and all independent Iowa pharmacies in the Iowa House.
4. I ask that you continue to be vocal about your support and that it be concentrated to also include the House and Senate leadership, whose direction and decision making is crucial regarding this bill. You can find their information at the link below. Also, the two senators who share in representing Mahaska County would benefit from hearing from you. They are Senators Ken Rozenboom and Adrian Dickey. Even if you have reached out to them via an email, I would encourage you to call the switchboard and leave a voice mail directed to them. It will then be sent to their email inbox, and they can listen to it from there. Switchboard numbers are listed below. If I may ask, please attempt to connect with them no later than next Wednesday. Here is why:
5. The House is likely scheduled to discuss and debate the BPM bill that you reference in your email at the start of this coming week, March 8. Once passed out of the House, it will be sent directly to the Senate. I am encouraging my colleagues in the House and Senate to strengthen this bill so that it can live up to the “comprehensive” perception that is being portrayed. This is where things can get complicated but it all boils down to the fact that independent pharmacies should be able to get a fair reimbursement from the PBM company for the cost of the drug; they should at least break even when they fill your prescription – and right now, they do not many times. Nor does this bill ensure that. Here is how the process works:
There are THREE players in this situation:
1. The insurance company. They provide the health insurance to a business, county, or other entity. Blue Cross/Blue Shield is an example of one of the largest health insurance companies in Iowa and the company that state employees, like myself, are insured under.
2. The pharmacy. Iowa has only about 250 independently owned pharmacies left. Many independent pharmacies have been bought up or replaced by large, chain stores such as CVC and Hy-Vee over the last decade.
3. The pharmacy benefit manager (PBM). They are a third-party company that functions as a middleman between the insurance company and the pharmacy. They exist to manage the cost of prescription drugs for the insurance company, employee and health care plans.
The bill that we are likely to debate Monday does not go far enough in fair practices for our independent pharmacies. We are being told that to require PBM’s to pay what is known as the “NADAC reimbursement cost,” will force insurance companies to raise their premiums. This argument is addressed in a video I am attaching below. If you are compelled to further understand this issue, please watch the roundtable discussion. You can go directly to comments made about PBMs at around the 20-minute mark or so.
6. Since before I was elected to the Iowa House last year, legislation was introduced but it has never gone far enough or been strong enough to be fair towards independent pharmacies. Thankfully, Mahaska Drug has been able to hold on to their business during this time, but things must change. Your pressure directed in the right place will help.
7. My apologies if this is a bit too much but I am striving to keep those that I represent informed. So please go through the information below as much as you are able and do more than just reach out to me. Now that I have your email address though, I will send you further updates on the PBM bill as I am able. Also, I put out a weekly newsletter via email and I intend to add your email address to it so that you can receive my weekly updates and stayed informed. If you wish to not receive them, please just unsubscribe.
Thank you all for supporting Mahaska Drug and Iowa’s other independent pharmacies. Please let me know if you have any other questions.
Here is the link to the House and Senate Leadership. The top three names are of key importance.
Switchboard Phone numbers. A quick voicemail is helpful. Be sure to mention your name, where you are from, return contact information, and who should receive your voicemail when you leave the message:
House: (515)281-3221
Senate: (515)725-4122
Video of Mark Cuban on Independent Pharmacies and PBMs. Of all the information I have sent to you this is a must watch video and is ONLY two minutes long.
Video of Roundtable on Lowering Healthcare Costs and Bringing Transparency to Prescription Drug Middlemen. BPM discussion starts around the 20:00 mark:
https://www.youtube.com/watch?v=DiA6hAslOFg
John and Jane’s National Award:
http://oskynews.org/local-pharmacy-honored/
Watch John Nicholsons WHO news cast here:
https://who13.com/news/oskaloosa-pharmacy-foresees-closure-unless-drug-reimbursement-policies-change/
Read the PBM bill (HF2401) here:
https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=HF%202401
This is who has lobbied against this legislation:
https://www.legis.iowa.gov/lobbyist/reports/declarations?ga=90&ba=HF2401
This is what the bill (HF2401) does in a nutshell:
-Help pharmacies get reimbursed for services (like test and treat) they perform within their scope of practice.
-Disallows a PBM to charge an employer group or third-party payor more for prescription drugs than the amount the pharmacy benefits manager reimburses the pharmacy for dispensing the prescription. This is called “spread pricing.” If the employer group decides they want the PBM to utilize spread pricing, the spread goes back to the employer group.
-Strengthens the appeals language so when pharmacies believe they get reimbursed below the cost to purchase a drug, there is a process by which a pharmacy can appeal to have the chance to break even. Today, no formal process exists. According to the Insurance Commissioner, pharmacies made 72,000 complaints about PBMs over the past year. 99% of those complaints were directly related to being reimbursed below cost.
This bill does bring improvements to pharmacies, but I would like emphasis that real reform begins when PBM’s reimburse the pharmacy at least the NADAC reimbursement (National Drug Average Acquisition Cost) or at least the AAC (Average Acquisition Cost). If the PBM’s would give them the full and fair reimbursement amount of the cost of the drug, then the pharmacy could at least break even when they fill the prescription. This is not asking too much. It is only asking to be treated fair.
Reform should also include reimbursement from the PBM for dispensing the drug. On average, it costs the pharmacy a minimum of $12.00 to fill a prescription. This cost occurs when the pharmacy fills the prescription, advises the patient and processes the transaction.
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