Norman Davis of Phenix City, Alabama’s Medical Park Pharmacy recently gave U.S. Senator Jeff Sessions (R-Ala.) a piece of his mind about a problem not unique to the Yellowhammer State: frustrating and unreasonable pharmacy benefit manager (PBM) audits.
While NCPA works hard at advocacy, local community pharmacists speaking from first-hand experience are quite simply the best advocates for their profession. Mr. Davis’ letter to Senator Sessions, published below with his permission, provides fresh evidence of that. Information about how you can get involved can be found at the end of this post.
Dear Senator Sessions,
Just recently Blue Cross/Blue Shield of Alabama sold their prescription drug benefit plans to a company called Prime Therapeutics, a Pharmacy Benefit Manager (PBM) with which we have had very little experience. Most of the claims for prescriptions are still transmitted in the same manner as before with very little change.
We recently received notice of the Audit policy of Prime. Even though the Doctor’s DEA number, National Provider Identifier (NPI) number, and the origin of the prescription (written, electronic, faxed, phoned-in) and all other pertinent data are readily retrievable from our computers, and are transmitted with each prescription we fill, if all this information is not written on the face of the hard-copy prescription, it is subject to a full recoupment by Prime with no allowance to remedy or appeal. There is no information on whether this affects all New prescriptions after the implementation date (July 1, 2010) or if Refill prescriptions are included which would be a real problem.
This is absolutely harassment and recoups (revenue stream) at whim. If, after a couple of years, with the volume of these Rxs that we do an audit is done with a recoupment, stores could be forced out of business, not for improperly filling a prescription but for filling, in good faith, a prescription for a particular need, for a particular person, for a product which we have paid for with our own money, just to have someone come in and for lack of a written number (which has already been furnished) steal all proceeds which , in reality, have very little profit.
This is, in addition to the well documented breach of the firewall which was supposed to be erected with the idiotic approval of the CVS/Caremark merger. Our patients are continually contacted by CVS concerning the data which we have had to transmit to Caremark. They also have incentivized sponsors into forcing their employees/retirees into using mail-order or only a CVS in our community, even though we have contracts in place.
Additionally EXPRESS SCRIPTS has enticed their sponsors to pre-enroll their employees into mail-order employing passive acceptance whereby in order to continue the trust relationship with the pharmacist of their own choosing, they have to physically take action themselves to dis-enroll from something that they never enrolled in. This is insanity.
We get dinged by all of the PBMs for all kinds of fees: fees to transmit claims over toll-free phone lines, formulary fees, non-formulary fees, maintenance (?) fees, admin (?) fees. These nickels and dimes cost me over $8000.00 last year, and for NOTHING.
We also have SIGIS- where eligible medical purchases have to be made through computer registers so that ineligible purchases won’t be billed. And next year the products which caused the confusion, won’t even be eligible. But we’ll still have our $20 to 30 thousand dollar computers. Oh and by the way, the board of directors of SIGIS is populated by our chain competitors. This is just another example of the type of crap that these oligopolistic monsters are allowed to get away with.
Senator Sessions we need help and we need it soon. We, Independent Pharmacists, need an anti-trust exemption so that we can pool our numbers and collectively negotiate contracts similar to our competitors. We have the numbers, we just need the ability. We can already join together in order to negotiate purchases.
The economic recovery is going to be led by the private sector, small business. By definition, 90% of all business in Alabama is small business, certainly her Independent Retail Pharmacies. We’re afraid to hire additional staff, for quite frankly if these PBMs are going to continue to force our patients out of our stores and into theirs, what’s the point? And in addition, we’ve got severe cuts coming in our Medicaid program, even though more people are being enrolled.
We need to be able to negotiate fair, transparent contracts. We need to be viable in our communities. We need your help. Thanks for your time.
Norman W. Davis
Medical Park Pharmacy
Phenix City, Ala.
Thank you, Mr. Davis, for taking the time to stand up for independent pharmacies across America. Visit the NCPA Legislative Action Center to find your members of Congress and write a letter outlining your challenges and experiences. Congress needs to hear your concerns about the future of community pharmacy from YOU.