Navitus Health Solutions’ Post

I recommend reading the recent FTC report on PBMs, along with David Fields' call to action for policymakers, as industry-wide reform is now more important as ever. I'm privileged to be a part of the Navitus team, where we've stayed true to our transparent, pass-through model since our inception. If you're interested in what our model achieves for plan sponsors and members, stay tuned for our 8th annual Drug Trend Report, releasing this Monday, July 15. #PuttingPeopleFirst

🌟 Advocating for Pharmacists: A Call for Transparent and Fair Reimbursements 🌟 Yesterday, I was deeply impressed by the two inspiring pharmacy owners who took a stand at a special White House roundtable discussion on lowering healthcare costs. Dr. Dared Price from Winfield, Kansas, and Dr. Chichi Ilonzo Momah from Delaware County, Pennsylvania, highlighted the pressing issues faced by pharmacists in dealing with Pharmacy Benefit Managers (PBMs). Dr. Price, highlighted the harmful impact of patient steering and called for an end to rigid PBM contracts, citing an example where his pharmacy was reimbursed $12,000 below cost for essential medications. This resonates with the broader struggle faced by many pharmacies, particularly in dealing with inadequate reimbursements, especially in specialty areas. Dr. Ilonzo Momah, owner of Springfield Pharmacy, echoed Dr. Price's concerns, emphasizing the shrinking prescription reimbursements from PBMs amid escalating drug costs. She urged the Centers for Medicare & Medicaid Services (CMS) to adopt a transparent cost-plus reimbursement model, advocating for fairness and sustainability across Medicaid fee-for-service, Medicaid managed care programs, and Medicare Part D. The unexpected support from billionaire Mark Cuban underscored the challenges faced by independent pharmacies. Mark criticized how Pharmacy Benefit Managers (PBMs) are slowly destroying independent pharmacies and prioritizing profits over health. In response, Cost Plus Drugs, an online retailer backed by Cuban, aims to provide transparency by selling medications directly to consumers at affordable prices. The company commits to openly disclosing manufacturing costs, differing from PBM practices that often control a significant portion of drug purchasing in the U.S. Cost Plus Drugs seeks profitability and sustainability without resorting to exploitative pricing. I strongly urge you to watch this video. 💊🌐 #PharmacyAdvocacy #HealthcareReform #FairReimbursements Mark Cuban Chichi Ilonzo Momah, PharmD, CPGx Dared Price

A significant change is on the horizon for pharmacy benefit managers (PBMs) under Medicare's drug program. Starting January 1, "performance fees" must be taken when the prescription is filled, addressing the substantial clawbacks that reached $12.6 billion in 2021. But independent pharmacists say this new policy is backfiring. https://bit.ly/3sOoQdx HealthLeaders #HealthPlans #payments

Forbes: "The current drug pricing market is malfunctioning, an obvious conclusion to anyone who is paying attention. But why? Like much of the healthcare sector, the current government driven, third party payer system misaligns the interests of patients and the companies that manage patients’ drug benefits (called pharmacy benefit managers, or #PBMs). These misaligned interests inflate #patients’ out-of-pocket costs and often encourages the use of expensive drugs when more affordable alternatives exist.” Read the article: https://ow.ly/6rU750Q9uM5

Insurers and pharmacy managers might be making these changes but the majority of plan sponsors are not! Simply said, protocols around mandatory generic/biosimilar drugs and prior authorization are more than sufficient to help manage drug costs right now. These formularies are more about locking you into a specific carrier and limiting choice for employees in light of the marginal savings provided. As well, plan sponsors can always use creative plan design changes to manage costs on their own. Just my 2 cents so let me know what you think. #employeebenefits #benefits #groupbenefits #betterbenefits

Lowering the cost of insulin is a no-brainer. The patient wins 👏 Medicare wins 👏 But what about the independent pharmacy that dispenses it? ✋ Last week, I had multiple claims for negative reimbursement on insulin. This puts our pharmacy in a bad situation. I want to serve my community, but we can't serve if we are not being paid the cost of the drug plus a dispensing fee. This is not a business model for success. The President and The White House MUST make sure that independent pharmacies are being included in this legislation otherwise, access to medications will become a problem as more pharmacies close their doors. It's time for the PODUS to fight the PBMs especially the ones the government pays to administer the Medicare programs. The legislation must include proper reimbursement to independent pharmacies as we are the most accessible pharmacy provider. Has your pharmacy seen negative reimbursement on Medicare claims? Comment below with what you have seen and the name of your pharmacy. Pharmacists and owners must start telling our side of the story. #independentpharmacy #podus #whitehouse #medicare #fightpbms #pharmacist https://lnkd.in/egahyhya

And the news around medications keeps coming! 🔹 Humira is the highest grossing medication in history, dwarfing the sales of all other drugs. In the past 20 years, Humira has brought in $208 billion worldwide 🔹 After a prolonged 7 year fight, in 2023, Abbvie's Humira finally lost patent exclusivity - and the biosimilars are entering the market (biosimilars are generics for biologic drugs like Humira) 🔹 CVS has cut Humira from its formulary !! Which means the CVS Caremark Pharmacy Benefits Manager will only be listing Humira Biosimilars 🔹 CVS Caremark is one of the 3 largest Pharmacy Benefit Managers 🔹 If you're curious, check out the comments for a great NYT article on how Humira kept exclusivity going, earning them an extra $114 billion in the past 7 years via Healthcare Brew by Maia Lura Anderson #medications #drugs #payors #PBM #humira #IBD #RA #autoimmunedisease #biologics https://lnkd.in/gBvuR_dR

#PharmacyBenefits aren't just crucial for patients and consumers but businesses as well. As Rick Van Warner explains in this piece, the costs of prescription drugs are skyrocketing across the nation. Because of this, effective pharmacy benefit management can be an enormous advantage to companies that value their team's health and well-being. While this article was written with Florida specifically in mind, it could easily be applied to any other state. As with most things in healthcare, collaboration is crucial. #Healthcare #EmployeeWellness

“Our legislation takes aim at a wide range of problematic PBM practices, from inappropriate patient steering to opaque and unreasonable network contracts,” [US Senator Mike Crapo] told the assembled health care professionals. “With respect to steering, PBM-owned specialty pharmacies have come to dominate that market, enabling pharmacy benefit managers to game and distort dispensing rules to divert a growing portion of prescriptions from independent pharmacies and toward their business affiliates. Our bill helps to curb this practice by establishing clear criteria for drugs that PBMs can subject to these narrow and ever-changing dispensing restrictions, as well as by boosting oversight through reporting requirements and ensuring that any pharmacy can access a Part D plan or a PBM’s special dispensing rules at any time.” https://lnkd.in/e5vmCF-r

Sharing a little disruption for pharmacy benefit managers (PBMs) who can make it difficult for pharmacies to remain profitable and consumers to afford medications. https://lnkd.in/gTNMHTTa *** #pbm #pharmacy #communitypharmacy #payers #consumerhealth #patientcare #patientadvocacy