PBM on the Rocks

Pharmacists United for Truth and Transparency

It's time to break the ice on pharmacy benefit managers' "drink the Kool-Aid" rhetoric! Join Pharmacists United for Truth & Transparency as we host guests from across the healthcare industry to discuss pharmacy news, healthcare issues, & (of course) PBMs... over cocktails.

  1. 1d ago

    Blister Packs and Bad Faith: PBMs and Long-Term Care Pharmacy

    Host Andrew Russell, PUTT Executive Director Monique Whitney, and cocktail crew regulars Chris Hobart and Kendra Korthauer dig into a patient access story that's flown under the radar: a mid-year contract dispute between long-term care PSAO/GPO MHA and PBM giant Optum. Joining them are two long-term care (LTC) pharmacy owners who lived it firsthand - Matt Ansay, PharmD (Streu's Pharmacy, Green Bay, WI) and Philip Hommerding, PharmD (Hunt Silver Lake Drug and Gift, MN). In this episode: How closed-door, long-term care pharmacy differs from community pharmacy - blister packs, after-hours delivery, and PSAO bargaining power The MHA/Optum dispute blow-by-blow: a mid-cycle contract termination, arbitration, patient and facility chaos, and the misinformation pharmacies say they had to fight through Why network adequacy gave MHA more leverage than Optum wanted anyone to know about A troubling "patient choice" workaround: facilities charging residents hundreds of dollars a month to use the pharmacy they actually want A wider look at Optum's banking operations, enforcement gaps in state PBM reform laws, and more Optum "#$@!" A preview of PUTT's September 23rd Virtual Summit on PBM laws enforcement Notable quote: "These patients don't get to walk or make choices with their feet." - Philip Hommerding, PharmD, on what LTC patients face when caught in the middle of a contract dispute Learn more and get involved: TruthRx.org #PBMOTR #podcast Music by JuliusH | Production & Editing by Shannon Wightman-Girard

    Blister Packs and Bad Faith: PBMs and Long-Term Care Pharmacy
  2. Jul 31

    Congressional Hearings & Federal Legislation: Setting the Record Straight

    Fresh off a marathon stretch on Capitol Hill, the PBM on the Rocks crew gathers to unpack two major wins for independent pharmacy: the House Oversight Committee markup of the Pharmacists Fight Back Act (H.R. 6610) and a Senate Armed Services subcommittee hearing on the TRICARE pharmacy program. Greg Reybold walks through what the 6610 markup vote actually means, why the CBO scoring process is the next big hurdle, and what he learned going toe-to-toe with Express Scripts and DHA on the TRICARE data. The crew also traces the bill's journey from its first introduction in 2024 to a coalition letter that pulled in 62+ organizations in under a week - and reflects on how grassroots pressure, persistence, and a few lucky airplane seat assignments made it possible. Host: Andrew Russell Guests: Greg Reybold, Monique Whitney, Lauren Young, Chris Hobart, & Kendra Korthauer In This Episode H.R. 6610 clears markup. The Pharmacists Fight Back Act (Federal Employee Health Benefits version) passed a recorded vote out of House Oversight, with all but two members in favor. A rare showing for a bill at this stage. From 2024 to now. The group looks back at the bill's first introduction, the early fight to land 50 co-sponsors, and how Chairman Comer's decision to co-lead H.R. 6610 with Rep. Auchincloss and hold a markup hearing has moved it further than almost any comparable pharmacy bill in recent memory. A coalition builds fast. Sixty-two-plus organizations - state pharmacy associations, unions, business groups - signed a letter of support in about a week, a sign of how much the conversation around PBM reform has shifted since 2024. TRICARE under the microscope. Sen. Elizabeth Warren used her one hearing as ranking member to focus on the TRICARE pharmacy program. Greg breaks down what the data showed: TRICARE families paying far more in cost-sharing at mandatory mail order than the same drugs cost through Express Scripts' commercial contracts in states like Georgia and West Virginia, where PBM markup reporting is public. Fines with teeth. The 6610 substitute raises penalties for PBM violations from $10,000 to $10 million per violation. What's next for scoring. Greg explains why a CBO score is the next milestone for 6610, why drug pricing bills are notoriously hard to score, and how Chairman Comer entered successful state-level rebate-sharing and NADAC-plus data into the record to counter industry talking points ahead of that process. H.R. 6609: the Medicare/Medicaid companion bill still needs a push. The group discusses why it hasn't seen the same momentum out of Energy and Commerce and what might change that with six months left in this Congress. Members going public. Lawmakers including Rep. Rich McCormick, Rep. Diana Harshbarger, Rep. Nikki Budzinski, and Rep. Raja publicly voiced support following the vote. A sign, the crew argues, that PBM reform has become an easier sell on the Hill than it was even two years ago.

    Congressional Hearings & Federal Legislation: Setting the Record Straight

Ratings & Reviews

4.8
out of 5
10 Ratings

About

It's time to break the ice on pharmacy benefit managers' "drink the Kool-Aid" rhetoric! Join Pharmacists United for Truth & Transparency as we host guests from across the healthcare industry to discuss pharmacy news, healthcare issues, & (of course) PBMs... over cocktails.

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