First, we hope that everyone is enjoying their Sunday!
Change is not happening fast as legislation and regulation against pharmacy benefit managers (PBMs) that own their own pharmacies that many are forced to such as Optum Rx, CVS Caremark, and Express Scripts is helpful but still missing the mark as there is not enough discussion of the deterioration of safe access as patients are forced to these mostly unregulated mail order pharmacies. Much legislation is only geared towards the below-cost reimbursements to pharmacies and preventing the PBMs from distorting drug costs.
For example, a drug may have a $20 cash price, meaning without using insurance. With insurance, the PBM (Optum RX, CVS Caremark, or Express Scripts) may require a copay such as a $10 copay. The PBM may reimburse competitor pharmacies $4 to purposefully cause our local pharmacies to eventually close. When my family was forced to the CVS Specialty mail order, CVS reimbursed their own mail order pharmacy over 10 times what they reimbursed our local pharmacy, although we had a lower copay.
I share this with our supporters to demonstrate that these legislative issues relating to reimbursements and preventing the distortion of drug costs are important. After all, what good will it do to stop the forcing to mail order pharmacies if all of our locally owned or hospital pharmacies close? The PBMs ability to distort drug prices and pay their own mail order pharmacies 10X the cost of a medication is a true indication of why retail pharmacies such as CVS are making most of their money through CVS Caremark, CVS's PBM, or pharmacy benefit manager.
Yet, the lack of safe access is not being discussed enough in Washington DC or our state capitols. What happens when patients are forced away from their local pharmacies? Some give up. Entire communities lose pharmacy access as pharmacies close. Monopolization of the industry continues and even worsens issues such as drug shortages. How many medications are being stored improperly during shipping as patients are forced to mail order? Most of them. How many have been harmed, some like my son without warning that their lives were at risk in the first place? Too many.
By next weekend, I hope to share an update on my work with State Boards of Pharmacy to regulate the mail order pharmacies. I'm waiting for an update from a couple more State Boards. Sometimes, it takes longer than a week for Boards of Pharmacy to respond. Without finding someone on the inside of State Boards of Pharmacy willing to help us, it is sometimes difficult to stay up to date and know what is happening as sometimes agendas are posted a day prior, and topics can be hidden within the agendas making it difficult for the public to know what is being discussed. We could use volunteers to help us here. I'll post my email below. Please let me know if you're willing.
Currently, temperature issues are being discussed in at least 6 states thanks to advocacy efforts of not only our team but heroic patients, pharmacy students, Board of Pharmacy members, and pharmacists. Most of America doesn't know that meds are currently being stored unsafely in temperatures that reach 120-170 degrees and no protection from freezing in the winter which could render them adulterated and harmful.
Oklahoma was the first state to pass temperature regulation. Currently, ads or social media posts are being displayed in Oklahoma that claim to be for affordable healthcare costs or prescription drug costs. These ads are coming from people directly affiliated with the state's Chamber of Commerce are are claiming that temperature regulation would be too costly. These ads usually include the words "affordable" RX or healthcare in the marketing campaigns. When questioned in the past by legislators if these types of sites were funded by the lobbyists association for PBMs, the lobbyist would only say, "We will defend our industry." The US Chamber of Commerce feels that they have a right to improperly store medications by mail and risk the lives of patients like my son as they wrote letters against regulations to ensure proper temperature storage. The lobbyist association for the PBMs or Express Scripts, Optum RX, and CVS Caremark have increased their lobbying by millions this year.
Only heroic Board of Pharmacy members will be able to stand for safe temperature storage as the conflicts on the Board are massive. Conflicts of interest or pressure blocking the ability to regulate such a common sense issue will be exposed.
Most Board members either are employed by the pharmacy benefit managers or one of their mail order pharmacies, or they receive most of their reimbursements from the pharmacy benefit managers that own these mail order pharmacies that risk lives with delays and improper temperature storage. These board members are also subject to audits. Some pharmacists after speaking to the Board about temperature issues have stated that they believe they were retaliated against in the form of an audit that resulted in punitive financial charges.
We should all be alarmed at the massive and mostly successful repression of pharmacists' voices in the pharmacy industry by corporations and pharmacy benefit managers. Many must speak to reporters anonymously and do not feel safe approaching even their State Boards of Pharmacy on issues. It shouldn't be this way in America.
David in the story of David and Goliath appears large compared to what we are standing against, but we are not giving up!
This is why I'm begging you to please get involved. Your voice is needed. I've not been retaliated against for using my voice. Even if I would get retaliated against, nothing can hurt me more than seeing them already risk the life of my child and the lives of so many others.
We've collected over 300 people now across our nation who have stated that they want to join to become a member and become more active in advocating for change. In the next year, we will begin organizing these individuals. I'm considering organizing these individuals by the National Association of Boards of Pharmacy districts. We will need leaders, but most importantly we need people that are simply willing to show up and speak for the most vulnerable among us.
Thank you for your support,
Loretta Boesing