Welcome to the May 31st edition of Waypoint RX Unscripted. Today's topic is going to be PBM doublespeak. Before I get started I want to just give you one little caveat here. There are plenty of really good people who work for PBMs and I'm not really sure that they truly understand what PBMs actually are doing to pharmacy owners. One of my good friends said recently, PBM employees really drink the PBM Koolaid. This blog is not an indictment on specific people in the PBM industry, this is just an indictment on how PBMs try to position themselves.
We have a saying in the South when someone uses double speak. We say they are "speaking out of both sides of their mouth." Keep this in mind when I share a recent story with a PBM rep. I was at a conference recently and met a PBM rep there. In our conversation, she kept referring to PBMs as friends to pharmacy owners. She actually said, "We can be the best friend to pharmacy owners." I started thinking, "What does being a best friend mean?" My best friends, I have two of them, would drop anything or almost anything to be with me when I'm in need. One of my best friends currently lives in Atlanta. My wife and I were moving out of our house (so she could be closer to her Pharmacy School) and we were forced to move out of our house a little bit earlier than we anticipated. He actually got in his car, drove down from Atlanta to Greenville, about two hour drive, and rented a U-Haul, showed up at my door, knocked on my door and had a U-Haul truck sitting outside. He helped me load up all my stuff, take it. My wife was about eight months pregnant at the time so she wasn't going to be as much help as she would have liked to be, but that's what a best friend does. He didn't ask. He didn't call. He just showed up when I needed him. I wonder sometimes, are PBMs really best friends to pharmacy owners? I wonder why people who work for PBMs think they're friends to pharmacy owners.
I then started asking questions like, "Why would PBMs assess DIR fees and not let pharmacy owners what they are 'til six months down the road? If you truly are friends to pharmacy owners, why wouldn't you try to help them with DIR fees?" She said, "Well, we don't make any money on DIR fees." I responded, "Well, when you collect them what happens to them?" She said, "We give a bunch back to CMS, and then we keep certain amount to put programs together for our customers." I said, "So you technically are making money. You're actually building brand value by using DIR fees." Of course she responded, "Well, no we don't profit from DIR fees. We just break even on that." I'm not really sure that she understood that you can actually profit in other ways than what's on your financial statements.
Then I asked her, "Do you think it's unethical that your PBM owns a mail-order pharmacy?" She said, "Absolutely not." I said, "So do you feel like your PBM is treating that mail-order pharmacy consistently with the way you're treating independents?" She said, "Absolutely." Well, at this point one of my friends decided to come over and I asked him the question. I said, "Do you feel you get treated the same way as this particular mail-order pharmacy?" He said, "Well, I'm not really sure how anybody could actually say that with a straight face." I said, "Well, what's your opinion of the PBM industry?" He politely said, "I wouldn't hose them off if they were on fire." That's the PG version of what he said. I'm not going to get into what he actually said here. I looked over at this representative of the PBM and I said, "That's what independent pharmacy owners think of you." She of course was perplexed and said, "I don't understand why."
We then started talking about a few other issues and one of my other friends from the state of Arkansas came over. He started asking questions about compounding and why PBMs don't reimburse for compounds. Through that process, this particular PBM rep said, "Well, you know, you're in a really good state for independents." He said, "Yeah, we are." He said, "I'm very thankful to be in that state." She said, "Well, you know, we've been trying to work with Blue Cross Blue Shield of Arkansas to get them to move down the continuum of reimbursement." This of course piqued my interest because that is a very intersting statement for her to make. So, I asked her "What the heck does that mean? What is moving down the continuum?" She said, "Well, this particular insurance company overpays pharmacies in Arkansas." I said, "So moving down the continuum ..." She interrupted me and said, "Yeah, that's just trying to get them in line with what market rates are." I said, "So you're actively soliciting this particular insurance company in Arkansas to reimburse community pharmacies less." She said, "Well, no no. No no no." Then I said, "I have witnesses who heard that." I then said, "And how are you the best friend to pharmacy owners again?"
That's PBM doublespeak. That's, "Oh, you need us over here, but on the other hand we're actually going to admit that we're trying to get you lower reimbursements." There's something really seriously wrong when somebody who represents that company actually doesn't understand what is going on.
Finally the last thing we talked about was something really outlanding. She said, "Well, you know, I run this up the chain. I float these ideas by one of the major associations in the independent pharmacy community, and they pretty give us the thumbs up on a lot of the stuff that we do." I looked at her and I said, "So you're telling me one of the leading associations in this industry gives you the thumbs up to basically take advantage of their members?" I said, "I just don't believe that." She said, "Well, I run it by certain people at this association." I said, "I absolutely refuse to believe that this association is rubber stamping these things. I said, "There would be a mutiny worse than The Bounty, if you ever have heard that story.
These are the things that PBMs and PBM reps are telling people. They're saying, "You need me. We're great for you," and then on the back end they're also telling us the things that they're doing to hurt us. Whether that's intentional or unintentional, I'm not sure, but this particular case I believe it was completely unintentional. But the idea is that if we actually dig deep enough, we can actually find out their motives. It all starts with asking the right questions. If we get a chance to meet with PBM reps, we need to do that. As much disdain as we have for them, we need to take the time to learn what they're doing, learn what their people understand about them, because I'm not really sure that we're ever going to change the PBM industry without changing the people who work for the PBMs. We need to help them (the ones who care) understand truly what is going on behind the scenes and how that negatively impacts community pharmacies.
Thank you for your time today, and I hope you have a wonderful rest of the week. Happy Memorial Day out there to all the veterans and we are very thankful for all the people who made the ultimate sacrifice (1.8 million). Finally, I want to give one more shout out to my mom. She is 64 years young today. Happy Birthday.
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