Usually I write about only one story or issue at a time, but today there were so many to choose from, I decided to post a grouping of several developments. Many of you have likely already heard about the upcoming decision that will be issued by the SCOTUS this spring on Rutledge v. PCMA, which will have far-reaching effects across our country and impact the ability of states to regulate the operations of PBMs within their borders. This decision will be of utmost importance - it could make or break the future viability of pharmacy practice for many.
But that's not the only place we can look for pharmacy updates today. There are four other happenings I'd like to share and comment on, and hopefully hear what those of you in the affected states think about them.
Rather than regulate PBMs, Senator Max Wise has proposed an outright ban on PBM involvement in the state's Medicaid program. He wants the state to directly pay pharmacies for the products provided. Opponents say this decision would have unintended consequences and negatively impact much of Kentucky's Medicaid population. Contention exists over the accuracy of an analysis from 2019 which claims the state could save nearly $240 million by eliminating the prescription drug middlemen.
In further reporting from the Columbus Dispatch, lawmakers have accused PBMs of "targeting 340B providers with 'discriminatory contracts that absorb all or part of the 340B savings by reducing reimbursements or adding fees,' essentially diverting the savings to their own pockets." Furthermore, in complaints similar to those often heard across the country from independent pharmacy operators, 340b health clinics are being cornered into "take it or leave it" contract situations - essentially eliminating any form of negotiation. According to a quotation in the article, many vulnerable patients could be left with no healthcare options if these 340b health centers disappear, and "'The intent (of the 340B program) was to extend patient care to the most vulnerable among us, not to increase the profits of large corporations.'"
In an "effort to expand access to pharmacy services and improve health outcomes in rural and underserved areas", Michigan Governor Gretchen Whitmer signed a bill authorizing the remote supervision of pharmacies in certain areas by a pharmacist linked to the location only by real-time audio-video link, with no requirement for an on-site supervising pharmacist. There are some limitations to the law, including a minimum radius of distance from another pharmacy at which the remote sites may be set up, a maximum number of pharmacies that any one particular "Pharmacist-in-Charge" may supervise, and a maximum average number of daily prescriptions that may be dispensed from the remote location. The measure is said to be supported by Cardinal Health, the Michigan Pharmacists Association, and other organizations.
In an effort to increase access and anonymity for Oregon patients seeking PEP and/or PrEP, new legislation has been proposed to allow pharmacists to provide both types of antiviral therapies following a patient consultation and HIV test. The law includes provisions that may require insurances to cover the cost of this consultation, even if the pharmacy provider is outside the insurance network. This legislation will be considered as House Bill 4116 during the 2020 legislative session of Oregon lawmakers.
I would love to hear comments from pharmacists in these states about the expected ramifications of these decisions, and the climate of opinion surrounding them.