Jessica Montanez, MHA, CSSGB’s Post

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

It’s critical that leaders like @repciscomani and his colleagues fight for patients and independent pharmacists by supporting #PBM reform. There is so much momentum on this issue, and being able to lower drug costs while supporting independent pharmacies is a win/win: 

#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

In light of the recent Federal Trade Commission (FTC) report targeting deceptive practices in the PBM industry, we are proud to reaffirm the values that drive our mission – making medications more affordable for the people who need them, so they can live their lives more fully. David W. Fields, CEO at Navitus, said Tuesday, “We applaud the FTC for shining a spotlight on this issue and stand in opposition to the backroom negotiations between drug companies and the Big Three, where high prices result in large rebates that the PBMs use to satisfy their profit machines.” David went on to share, “Our 8th annual Drug Trend Report, which launches publicly Monday, July 15, includes real, auditable data that shows what we pay for medications on behalf of our clients.” Plan sponsors and health plans are increasingly seeking alternative PBM models that promote transparency and align with their goals of delivering cost savings to members. That's just one of the reasons UCare moved to Navitus in 2024. Patrick Mitsch, Vice President of Pharmacy at UCare recently said, "We don’t want to get mixed in or muddied up with any of those other practices that may be associated with some of the other PBMs" in an article by Modern Healthcare. Read the FTC report: https://lnkd.in/grcNSQqK Read David Fields’ full statement: https://lnkd.in/epGgrqFb Read the Modern Healthcare article: https://lnkd.in/enRrVF-e

Legacy PBMs are inflating your prescription drug costs. It's time to fight back. 💪 Everything you need to decode confusing contracts, spot hidden fees, ensure transparency, and align PBM goals with yours is right here! Our in-depth blog will equip you with the proper knowledge to evaluate your PBM accurately. Click here for insider tips on choosing a PBM that truly serves your needs: https://lnkd.in/ggvtAYPf #healthcare #prescriptiondrugs #employeebenefits #PBM #smithrx

Are you a healthcare professional looking to stay informed about the latest Medicare updates? The Medicare Prescription Payment Plan, a new program under the Inflation Reduction Act, is set to begin on January 1, 2025. This program requires Part D plan sponsors to offer enrollees the option to pay out of pocket prescription drug costs through monthly payments over the course of the plan year. Participants will pay $0 to the pharmacy for covered Part D drugs, with plan sponsors billing monthly for any cost sharing incurred while in the program. If you have questions about how this new guidance might impact your products, please don't hesitate to reach out. #fortrea #marketaccess #PartD #IRA #reimbursement #medicare

The Reality of Prescription Drug Costs in the U.S. While the new out-of-pocket cap for Medicare prescription drug plans starting in January 2025 may seem like a victory, it’s a stark reminder of how broken the U.S. healthcare system is compared to many other countries. What’s routine healthcare abroad is often a financial burden here, leaving many Americans struggling to afford essential medications, treatments, and even nutritious food. Even with this new cap, we must ask: Do most Americans truly have the financial ability to access the care and medications they need for a healthy life, regardless of their age? Equitable access to healthcare should not be a luxury. It’s time for meaningful reforms that go beyond temporary fixes. https://lnkd.in/edEp5Gra #HealthcareReform #Medicare #PrescriptionCosts #HealthEquity #CalleoHealth

In his new Forefront article, Tomas Bednar from Healthsperien LLC discusses how a combination of government policies and market trends is causing significant turmoil in the Prescription Drug Plan market, especially for plans that serve beneficiaries who receive the Medicare low-income subsidy. "In combination, these issues jeopardize the quality and quantity of Part D coverage available to LIS beneficiaries. If left unaddressed, these trends could have significant negative consequences for many of the lowest-income Medicare beneficiaries, including a cycle of annual reassignment of beneficiaries across lower star rating plans, a dearth of plan options, and a persistently low quality of service delivery. Effective solutions to these problems will require hard looks at the Part D program and how its structural elements are tuned for plans that serve high numbers of LIS beneficiaries." Read the full article here: https://bit.ly/3YKAy6D

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

Americans pay nearly three times what those in other countries do for prescriptions. And according to a new study, patients' prescription costs have risen twice as much as payers'. This structure is counter-productive. Patients who can't afford their medication may go without or try to ration doses. This can lead to costly complications and even death. Let's stop treating pharmacy like a volume business based on the number of prescriptions we fill. Let's make patients the priority and cut costs for both your plan and your members. With this approach, and thanks to Group Synchronization, our covered patients maintain a PDC (percentage days covered) greater than 80% – the industry's standard measure for excellent prescription adherence (and the point at which a patient is getting the maximum benefit from their medications). Can we help your plan members? #pharmacy #prescriptioncosts #prescriptionprices #prescriptions #healthcare #selffunded #healthcoverage