Who should regulate PBM's within a state?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
cycloketocaine

cycloketocaine

Full Member
10+ Year Member
7+ Year Member
15+ Year Member
Joined
Aug 7, 2006
Messages
2,397
Reaction score
10
Members do not see this ad.
Went to an OPhA legislative committee meeting yesterday and it was very enlightening. New legislation will be proposed during the upcoming session that would move the control of PBM's from the state insurance agency to being regulated by the state board of pharmacy. The president of the state board stated that the way that they want it to be written is so that the board can mandate which PBM's can and cannot do business in OK. Those involved think it will pass, as there are some pharmacists within the state house that are great at getting what they want done.

Back story: A few years ago, the state employee PBM, Medco, attempted to mandate required mail order. After much uproar, the state insurance agency decided to not opt in to this requirement. Thus, the state board wants to be able to step in and say hells no.

Should state boards be able to control PBM's and who can operate within a state?

Discuss.
 
Well the role of the BOP is to essentially protect the public. If that is their overall goal through decreasing errors, mandating accountability, or whatever else, then I'd say it's fair game. However, I'm not sure how the BOP would have jurisdiction over a private company outside of public protection. It's a lot for the state to take on IMO. But I come from AZ where the state medicaid is less than ideal.
 
cycloketocaine said:
Went to an OPhA legislative committee meeting yesterday and it was very enlightening. New legislation will be proposed during the upcoming session that would move the control of PBM's from the state insurance agency to being regulated by the state board of pharmacy. The president of the state board stated that the way that they want it to be written is so that the board can mandate which PBM's can and cannot do business in OK. Those involved think it will pass, as there are some pharmacists within the state house that are great at getting what they want done.

Back story: A few years ago, the state employee PBM, Medco, attempted to mandate required mail order. After much uproar, the state insurance agency decided to not opt in to this requirement. Thus, the state board wants to be able to step in and say hells no.

Should state boards be able to control PBM's and who can operate within a state?

Discuss.
Click to expand...

Again everyone's complete and total lack of understanding of how PBM's work is laughable. Medco doesn't mandate ****! Medco doesn't make anyone do anything! The State of Oklahoma decides how the benefit is to be managed when they sign the contract. If the fine residents of Oklahoma were upset then they needed to be upset at the bureaucrats running the State of Oklahoma. You said it yourself "the state insurance agency decided to not opt in to this requirement" except you got one thing wrong. It is not a requirement. It is an option the State can freely CHOOSE to sign up for when they sign the contract with Medco.

A more accurate statement would be

"The State of Oklahoma choose to have mandatory mail order as part of the new pharmacy benefit management contract with Medco. This proven cost saving measure was canceled after the sick, lame and lazy idiots of Oklahoma cried like little babies because they could not breeze into the local retail pharmacy five minutes before closing on Sunday and get their 6 maintaince medications they have been taking for 20 years refilled because they took the last pill the day before and were out."
Click to expand...
 
koolaid.gif
 
cycloketocaine said:
Went to an OPhA legislative committee meeting yesterday and it was very enlightening. New legislation will be proposed during the upcoming session that would move the control of PBM's from the state insurance agency to being regulated by the state board of pharmacy. The president of the state board stated that the way that they want it to be written is so that the board can mandate which PBM's can and cannot do business in OK. Those involved think it will pass, as there are some pharmacists within the state house that are great at getting what they want done.

Back story: A few years ago, the state employee PBM, Medco, attempted to mandate required mail order. After much uproar, the state insurance agency decided to not opt in to this requirement. Thus, the state board wants to be able to step in and say hells no.

Should state boards be able to control PBM's and who can operate within a state?

Discuss.
Click to expand...

You're in Oregon??
 
Crap.....that stupid movie is coming out and I am going to have to take my wife to see it. I have never watched anything as mindless and stupid other the Sponge Bob of course.
 
MountainPharmD said:
Again everyone's complete and total lack of understanding of how PBM's work is laughable. Medco doesn't mandate ****! Medco doesn't make anyone do anything! The State of Oklahoma decides how the benefit is to be managed when they sign the contract. If the fine residents of Oklahoma were upset then they needed to be upset at the bureaucrats running the State of Oklahoma. You said it yourself "the state insurance agency decided to not opt in to this requirement" except you got one thing wrong. It is not a requirement. It is an option the State can freely CHOOSE to sign up for when they sign the contract with Medco.

A more accurate statement would be
Click to expand...

It would be interesting to see the difference in premiums of a mail order only policy and a retail pharmacy inclusive policy. I'm sure the mail order option is MUCH cheaper. So in a way, Medco could force mail order by charging outrageous premiums, but not mandate it.
 
Wheresmyaricept said:
It would be interesting to see the difference in premiums of a mail order only policy and a retail pharmacy inclusive policy. I'm sure the mail order option is MUCH cheaper. So in a way, Medco could force mail order by charging outrageous premiums, but not mandate it.
Click to expand...

Sure the premiums are cheaper. Because they want to incentivize/force people to use THEIR mail order facility. Which isn't anti-competitive at all. :laugh:

PBMs suck. Mountain just loves his job.
 
I hate PBMs for intense audits. We are in the middle of a desktop audit from a certain PBM. They asked for like 50 rx's, sig logs, and 1 year purchasing history for 2011. Then they sent letters to a select number of patients who had received compounds froms us to "make sure" we had rendered services. Althought these audits are necessary, the time and money it takes to gather all this information is costly. We have hired an office manager to do most of this work. I also dislike them for many many other reasons, but it is just business. Mountain is just doing his job. Just as i am biased toward my interests, im sure he is as well.
 
Our state pharmacy association works closely with legislators in the state to do things like this. I believe they helped get legislation through recently to help protect pharmacies from audits that are obviously exploitative.
 
If you can't beat 'em, join 'em. Mail order is becoming a larger part of pharmacy, and they still need pharmacists of course. And I think their working conditions are pretty good. Work at home, desk jobs, lunch breaks, 7-on-7-off.
 
cycloketocaine said:
Went to an OPhA legislative committee meeting yesterday and it was very enlightening. New legislation will be proposed during the upcoming session that would move the control of PBM's from the state insurance agency to being regulated by the state board of pharmacy. The president of the state board stated that the way that they want it to be written is so that the board can mandate which PBM's can and cannot do business in OK. Those involved think it will pass, as there are some pharmacists within the state house that are great at getting what they want done.

Back story: A few years ago, the state employee PBM, Medco, attempted to mandate required mail order. After much uproar, the state insurance agency decided to not opt in to this requirement. Thus, the state board wants to be able to step in and say hells no.

Should state boards be able to control PBM's and who can operate within a state?

Discuss.
Click to expand...

I never even thought about this the first time I read it. PBM's are regulated by the Texas Board of Pharmacy. Texas puts pharmacies into classes based on the type of business they do. For example a Class A pharmacy is a retail pharmacy. There are rules and regulations that apply to all classes. Each class also has rules and regulations that are specific to the class. A PBM in the State of Texas is registered as a pharmacy by the State Board. The Class G pharmacy regulations set out rules for pharmacist to tech staffing ratios as well as defines what activities can be performed only by a pharmacist and what activities can be done by a technician. Think about this...Why would it be advantageous for the Board of Pharmacy to regulate a PBM the way Texas does?

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=15&ch=291&rl=153

RULE §291.153 Central Prescription Drug or Medication Order Processing Pharmacy (Class G)

(a) Purpose.

(1) The purpose of this section is to provide standards for a centralized prescription drug or medication order processing pharmacy.

(2) Any facility established for the primary purpose of processing prescription drug or medication drug orders shall be licensed as a Class G pharmacy under the Act. A Class G pharmacy shall not store bulk drugs, or dispense a prescription drug order. Nothing in this subsection shall prohibit an individual pharmacist employee who is licensed in Texas from remotely accessing the pharmacy's electronic data base from a location other than a licensed pharmacy in order to process prescription or medication drug orders, provided the pharmacy establishes controls to protect the privacy and security of confidential records, and the Texas-licensed pharmacist does not engage in the receiving of written prescription or medication orders or the maintenance of prescription or medication drug orders at the non-licensed remote location.

(b) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise. Any term not defined in this section shall have the definition set out in the Act.

(1) Centralized prescription drug or medication order processing--The processing of a prescription drug or medication orders by a Class G pharmacy on behalf of another pharmacy, a health care provider, or a payor. Centralized prescription drug or medication order processing does not include the dispensing of a prescription drug but includes any of the following:

(A) receiving, interpreting, or clarifying prescription drug or medication drug orders;

(B) data entering and transferring of prescription drug or medication order information;

(C) performing drug regimen review;

(D) obtaining refill and substitution authorizations;

(E) verifying accurate prescription data entry;

(F) interpreting clinical data for prior authorization for dispensing;

(G) performing therapeutic interventions; and

(H) providing drug information concerning a patient's prescription.
Click to expand...
 
rxlea said:
Where is the establishment hating Mountain? I swear there are pod people. First Romney. Now Mountain.
Click to expand...

Oh I am back!!!! The honeymoon is over! There is a reason I know the information I just posted and reason I have had to educate some people on it.

Everything was going so well......was being the operative word.
 
MountainPharmD said:
I never even thought about this the first time I read it. PBM's are regulated by the Texas Board of Pharmacy. Texas puts pharmacies into classes based on the type of business they do. For example a Class A pharmacy is a retail pharmacy. There are rules and regulations that apply to all classes. Each class also has rules and regulations that are specific to the class. A PBM in the State of Texas is registered as a pharmacy by the State Board. The Class G pharmacy regulations set out rules for pharmacist to tech staffing ratios as well as defines what activities can be performed only by a pharmacist and what activities can be done by a technician. Think about this...Why would it be advantageous for the Board of Pharmacy to regulate a PBM the way Texas does?

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=15&ch=291&rl=153
Click to expand...

Awesome....you can run the PBM out of India!
 
MountainPharmD said:
Oh I am back!!!! The honeymoon is over! There is a reason I know the information I just posted and reason I have had to educate some people on it.

Everything was going so well......was being the operative word.
Click to expand...

Wth happened?
 
MountainPharmD said:
Craziness man, craziness. Can't detail the information here obviously. Everything went from really cool to total **** in the span of three weeks.

I guess I should not be surprised considering the company I work for.
Click to expand...

Dood. You've got bad luck. You were so happy too. I'm sorry 🙁
 
You gonna look for a new job?
 
Its Z said:
You gonna look for a new job?
Click to expand...

Yep...See if I can find a place where intelligence, motivation and hard work are encouraged instead of discouraged.

I have learned alot in a short period of time so I will see if I can take that and move on to something bigger and better.
 
rxlea said:
Dood. You've got bad luck. You were so happy too. I'm sorry 🙁
Click to expand...

No, I am one of the luckiest people you will ever meet. I have had a lot of lucky things happen to me in my life. I've got nothing to complain about because things could darn sure be worse. Small dissapointments happen to everyone, no big deal.
 
You must log in or register to reply here.

Similar threads

F
Career Growth Opportunities in PBM/Industry as a PBM Pharmacist
Replies
12
Views
2K
projektreverb
P
owlegrad
Who knew?
Replies
20
Views
3K
DH1987
D
Mr.Smile12
[AJPE] An Investigation of College and School of Pharmacy Support for Graduates who Fail the NAPLEX
Replies
0
Views
653
Mr.Smile12
Mr.Smile12
Lexington2012
FTC sues PBMs for artificially increasing insulin prices.
Replies
2
Views
953
clarkbar
C
C
PBM Jobs--What is the deal?
Replies
6
Views
3K
DoctorRx1986
D
Top