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1/8
Re: Rutledge v. @pcmanet decision by @scotus https://drugch.nl/3mnpDJv
My $0.02: A huge win for independent retail #pharmacy against #PBMs. Congrats!
For your consideration: Some unintended consequences as #PBMs and payers react
Re: Rutledge v. @pcmanet decision by @scotus https://drugch.nl/3mnpDJv
My $0.02: A huge win for independent retail #pharmacy against #PBMs. Congrats!
For your consideration: Some unintended consequences as #PBMs and payers react
2/8
Multistate employers will look for #pharmacy networks with more nat’l chains and fewer independents (consistency of benefits)
#PBMs will also negotiate rates and prefer #PSAO networks with stable, consistent rates for large employers #justsayin
Multistate employers will look for #pharmacy networks with more nat’l chains and fewer independents (consistency of benefits)
#PBMs will also negotiate rates and prefer #PSAO networks with stable, consistent rates for large employers #justsayin
3/8
Even greater incentives to manipulate “invoice prices” used to compute pharmacies’ “acquisition cost”
Recall that acq. cost surveys ( #NADAC #AAC) exclude off-invoice discounts, rebates, and price concessions
These surveys deserve (and will get) greater scrutiny.
Even greater incentives to manipulate “invoice prices” used to compute pharmacies’ “acquisition cost”
Recall that acq. cost surveys ( #NADAC #AAC) exclude off-invoice discounts, rebates, and price concessions
These surveys deserve (and will get) greater scrutiny.
4/8
Pharmacy win ≠ #PBM loss
Many studies have shown excessive #PBM profiteering from network spreads in Medicaid, i.e., state officials did a horrible job of protecting taxpayers
But comm’l spreads are lower (or $0), b/c PBM profit models differ
Pharmacy win ≠ #PBM loss
Many studies have shown excessive #PBM profiteering from network spreads in Medicaid, i.e., state officials did a horrible job of protecting taxpayers
But comm’l spreads are lower (or $0), b/c PBM profit models differ
5/8
Local pharmacies will lobby for more state laws to protect their business & boost profits, a.k.a. Public Choice theory https://drugch.nl/2Km8AKa
Ironically, more “protection” may hasten their demise by making independents into a less competitive channel
Local pharmacies will lobby for more state laws to protect their business & boost profits, a.k.a. Public Choice theory https://drugch.nl/2Km8AKa
Ironically, more “protection” may hasten their demise by making independents into a less competitive channel
6/8
Example: State anti-mandatory mail laws that block plan sponsors from favoring mail pharmacies
These laws kept scripts in the retail channel, but ironically also reduced retail profits by forcing retail pharmacies to accept mail reimbursement and fill more 90 day scripts
Example: State anti-mandatory mail laws that block plan sponsors from favoring mail pharmacies
These laws kept scripts in the retail channel, but ironically also reduced retail profits by forcing retail pharmacies to accept mail reimbursement and fill more 90 day scripts
7/8
And how (if at all) will Rutledge v. @pcmanet lower prescription costs for patients or payers?
Did I miss those analyses? Do they even exist?
This should be a warning to everyone who is celebrating right now…
And how (if at all) will Rutledge v. @pcmanet lower prescription costs for patients or payers?
Did I miss those analyses? Do they even exist?
This should be a warning to everyone who is celebrating right now…
8/8
Please don’t misunderstand me: Rutledge v. @pcmanet a major short-term victory for @Commpharmacy & #pharmacy owners.
But #PBMs and payers will react in logical ways--and pointing this out doesn't make me pro-PBM / anti-pharmacy
More on Friday: https://drugch.nl/outlook2021
Please don’t misunderstand me: Rutledge v. @pcmanet a major short-term victory for @Commpharmacy & #pharmacy owners.
But #PBMs and payers will react in logical ways--and pointing this out doesn't make me pro-PBM / anti-pharmacy
More on Friday: https://drugch.nl/outlook2021
