Amir Emamifar, PharmD, MBA

Great piece by ed silverman in #Stat+. Remember, if you’re an expensive drug and you are not preferred on the formulary, no one will take your drug unless it is given away for free. PBMs and manufacturers know this. So are the rebates/fees a manufacturer gives to the PBM to get placement on the formulary a “bribe”? Or are the manufacturers “blackmailed” into paying the highest rebate, which is a percentage of the list price? It’s whoever has the power… I would submit that the PBMs have the power as they are the constructor of the formulary. Are manufacturers innocent? No - but since we as a country have not been able to SHUT DOWN the rebate system of formulary construction, the most expensive drugs continue to get preferred placement. As I wrote 5 years ago in #Healio “ Formulary Construction in America: Perfectly Legal and Perfectly Wrong”

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This vertically integrated and concentrated market structure has allowed PBMs to profit at the expense of patients and independent pharmacists The interim report highlights several key insights gathered from documents and data obtained from the FTC’s orders, as well as from publicly available information: Concentration and vertical integration: The market for pharmacy benefit management services has become highly concentrated, and the largest PBMs are now also vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies. The top three PBMs processed nearly 80 percent of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six PBMs processed more than 90 percent. Pharmacies affiliated with the three largest PBMs now account for nearly 70 percent of all specialty drug revenue. Significant power and influence: As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ ability to access and afford their prescription drugs. The largest PBMs often exercise significant control over what drugs are available and at what price, and which pharmacies patients can use to access their prescribed medications. PBMs oversee these critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public. Self-preferencing: Vertically integrated PBMs appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs. PBMs may be steering patients to their affiliated pharmacies and away from smaller, independent pharmacies. These practices have allowed pharmacies affiliated with the three largest PBMs to retain high levels of dispensing revenue in excess of their estimated drug acquisition costs, including nearly $1.6 billion in excess revenue on just two cancer drugs in under three years. Unfair contract terms: Evidence suggests that increased concentration gives the leading PBMs leverage to enter contractual relationships that disadvantage smaller, unaffiliated pharmacies. The rates in PBM contracts with independent pharmacies often do not clearly reflect the ultimate total payment amounts, making it difficult or impossible for pharmacists to ascertain how much they will be compensated. Efforts to limit access to low-cost competitors: PBMs and brand drug manufacturers negotiate prescription drug rebates some of which are expressly conditioned on limiting access to potentially lower-cost generic and biosimilar competitors. So it goes n8 #PMB #valuebasedcare #hospitals #healthsystems https://lnkd.in/g2qEaWPk

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The dominance of major PBMs in #340B space raises questions about how revenue from the 340B program that is meant to benefit uninsured and underinsured patients in need is instead being retained by some of the nation’s largest for-profit corporate middlemen with little transparency, oversight, or accountability. "43% of 340B mail-order contract pharmacies are vertically integrated with a PBM. The results indicate significant control by the seven major PBM and mail-order entities over #340B arrangements and diversion of program dollars from patients to for-profit middlemen." "Previous estimates have found that for-profit PBM contract pharmacies retain 25% to 35% of the total 340B discount and have an average gross margin of 72%. This significant retention of profits is concerning, particularly as the 340B program is designed to support non-profit health care."

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With looming Medicare drug cost changes, LTC pharmacies are facing a potential crisis. Eight of the ten drugs currently under negotiation are heavily prescribed to LTC patients. This could potentially lower the cost for the consumer but also be costly for LTC pharmacies. LTC pharmacies already rely on thin margins, and with these potential changes, many are bracing for the impact. To help navigate these challenges, consider the numerous benefits of automating processes within your pharmacy. This can save time and money, lower operational costs, and offset the impact of drug price changes on your margins. Contact us today to streamline and automate your pharmacy before the drug prices take effect. #LTCPharmacy #Automation #CustomSoftware #Pharmacy

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The Pharmacists Fight Back Act (HR 9096) is critical to reining in #PBMs & their GPO counterparts greed-based business practices. If you care about the future of #pharmacy & #patientaccess to care, Contact Your Congressperson & ask them to sign on to this important legislation today! #PBMreform #BreakTheWheel #independentpharmacy Benjamin Jolley Matt Stoller

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AMCP 2024 Highlights from First Report Managed Care: Guest expert and AMCP 2024 presenter Meron Gartner, PharmD, elaborates on how pharmacists play a crucial role in addressing social determinants of health (SDOH) by engaging with patients, identifying barriers, and connecting them to resources for improved outcomes. Learn more about how pharmacists can play a crucial role in addressing SDOH in this interview. #FirstReportManagedCare #AMCP2024 #Payers #SocialDeterminantsofHealth

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By restricting 340B, we can do real harm to patients, especially low-income and uninsured patients. 340B allows stronger communication between pharmacist and patient, and therefore enhanced patient education. When we take away 340B, we even potentially take away patients' ability to access medication at pharmacies most convenient to them, which can create even further access barriers. #340B #Pharma #PatientAccess

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A very interesting analysis on 340B and the impact on that program from PBMs from Avalere. The analysis details how PBMs have a hand in exploiting the 340B program through their business practices. https://lnkd.in/gEQAKczY

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The SUSTAIN 340B Act can resolve this issue if structured correctly. All stakeholders have a responsibility to keep this vital program alive. Cutting corners by one entity, to the detriment of others, will undermine the entire system. #340B #Healthcare #Collaboration #SUSTAIN340B

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ASHP Midyear: Pharmacists Must Proactively Consider and Implement AI Tools: Although challenges and obstacles persist, artificial intelligence could help rural and smaller pharmacies close gaps in care. #finance #pharmacy #lifesciences

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New research found about 1 in 3 U.S. retail pharmacies closed since 2010 with independent pharmacies at over 2x higher risk of closure than chain pharmacies. The data showed disproportionate impacts on Black, Latino, and low-income neighborhoods, where independent pharmacies often serve as the only local option. These closures widen gaps in access to prescriptions, vaccines, and essential care—deepening existing health disparities. In our pursuit of #HealthEquity, we must address systemic issues like pharmacy benefit manager practices that limit services for independent pharmacies. We must work to safeguard community access and prioritize care for underserved populations. https://lnkd.in/gue9vj6s

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📅 Another week, time for some more reasons to team up with us, community and retail #pharmacy! 🙌 We're counting down the top 12 reasons why all retail open-door, walk-in #pharmacies in the US should join our pharmacy network and the #TeamCubanCard at www.teamcubancard.com with Mark Cuban Cost Plus Drug Company, PBC: Last week: Reason #12: https://lnkd.in/gy-cftKe Reason #11: https://lnkd.in/gJDdfCVa Reason #10: https://lnkd.in/geck9PHy Reason #9 today - below. 💊 If you're a patient, head on over to www.teamcubancard.com and grab your own Team Cuban Card and join, just in time for 1/1/25 plan changes - it's free! 💊 If you're a #pharmacy and you haven't joined our network but want to learn more - just complete this form and we will be in touch: https://lnkd.in/gnruGTkH

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Creon 10000 and 25000 gastroresistant capsules are in limited supply until 2026 and Nutrizym 22 capsules are out of stock until mid-August 2024. How will this impact your prescribing practice?

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Pharmacists can make a positive impact in the care of CKD patients and reduce the gap in current patient care. This review shines a light on how pharmacists can help optimize prescribing of finerenone in people with diabtes and CKD. https://lnkd.in/eiBYtGTe

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The recent #FDA update on compounded #GLP-1 drugs signals a shift in how pharmacies will manage both inventory and patient relationships. As compounding must now stop for many of these drugs, thousands of patients may lose access to affordable medications. For pharmacy leaders, these regulatory shifts present new challenges in balancing compliance with providing vital care. Has your pharmacy had to adjust its procurement strategies? #Pharmacy #SupplyChain #Patient

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