St. Paul Corner Drug

Fellow Minnesotans (and midwesterners willing to travel 💃), we need you!

One month from today we’ll be joining our friends from Pharmacists United for Truth and Transparency (PUTT) for a peaceful protest outside of Optum in nearby Eden Prairie, MN. We’re excited to continue participating in this form of activism after a similar and successful protest was hosted earlier this year at Express Scripts Pharmacy HQ in St. Louis, MO. We need every person who is able to show up, get loud, and make a statement with us! ✊

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For details about the protest, visit our Events page at https://buff.ly/43Bne4W. Registration is greatly appreciated!

“Vertical integration” refers to any effort by a company to take ownership of two or more steps in the supply chain, thereby “integrating” them, and is the primary route through which Pharmacy Benefit Managers (PBMs) have become nearly untouchable in recent decades.

After decades of the federal government allowing them, through mergers and acquisitions, to purchase a wide range of healthcare, technology, financial, and many other types of companies, these mostly-Fortune 15 companies* have found themselves occupying every aspect of the pharmacy supply chain. Take CVS, for example:

”People recognize the three-letter ‘CVS’ as the pharmacy, Caremark is the PBM. That same company owns Aetna, which is one of the largest health insurance companies in the United States. They own CVS specialty pharmacy and mail order pharmacy. They have their own wholesaling line of business where they partnered with Cardinal Health [Red Oak Sourcing] and actually act as the largest purchaser of generic drugs as a wholesaler… [and] now, CVS launched a new subsidiary called ‘Cordavis’ where they’re actually taking inventory of drugs and slapping labels on them, essentially becoming quasi-drug manufacturers.” —Antonio Ciaccia, co-ounder of 46brooklyn Research

This kind of monopolization eliminates competition, allows them to skimp on transparency (because only “big” purchases relative to their overall net worth have to be reported), and is a threat to national security (think: Change Healthcare ransomware attack in February of this year, which is still ongoing).

*It’s worth noting that the 3 biggest drug wholesalers (Cardinal Health, McKesson, and Cencora (formerly AmerisourceBergen)) as well as 3 other huge players in the pharmaceutical industry (Amazon, Costco, and Walmart) are also Fortune-15 companies, meaning that 9 of our nation’s top 15 companies are primarily or peripherally involved in the prescription drug market… 😱

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To watch the full video—which we think is an *excellent* intro to PBM abuse, albeit with a bit of (we think, well-deserved) fruity language—visit the PBMafia playlist on our YouTube channel: https://buff.ly/3WhZP59

Last week, the Governor of Pennsylvania signed into law a new bill that addresses 3 key elements of (swipe left to see!). For a state that’s already lost 😱 140 😱 local pharmacies since the start of the year (70% of which were indies), it’s a huge step in the right direction and an example to other state governments about what can be done at the state level to combat PBM abuse.

Last month, the Green Mountain State also passed legislation that prohibited spread pricing, gag clauses, and making classifications of drugs beyond what is established by state and federal governments and Vermont’s Board of Pharmacy; created broader authority for enforcement and rulemaking for their Department of Financial Regulation (DFR), the cost of whose examinations of PBMs will be charged to the PBMs; and appropriated $405,000 to hire three individuals to oversee PBM regulation, including one enforcement attorney and two investigators.

Minnesota lawmakers: this is what we need. And this is what us and fellow pharmacy advocates will be working our butts off toward in next year’s legislative session 💃 Minnesota Senate ✨ Minnesota House of Representatives Public Information Services ✨ Representative Kaohly Vang Her ✨

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To read the article about Pennsylvania’s new PBM legislation, click here: https://buff.ly/4caXzTz

For as long as we can remember, we’ve heard people hypothesize that us “little guys” (i.e., independent pharmacies) simply haven’t been able to withstand market competition from chain pharmacies. However, they’re closing in large numbers across the country now, too, and it’s becoming clear that Pharmacy Benefit Manager (PBM) abuse isn’t just affecting us little guys—it’s causing the big guys that don’t own their own PBM* to lose money filling prescriptions, too. Amidst an ever-more-complicated pharmacy market affected by civil unrest, rising inflation, and subsequent changes to consumer behavior, we’re seeing more and more communities across the US lose not just their dwindling independent pharmacy options, but all of their local pharmacies.

*like in the case of CVS retail pharmacies, whose parent company CVS Health also owns CVS Caremark, one of the nation’s 3 largest PBM (and CVS pharmacy locations are still closing!)

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To read the full article, click here: https://buff.ly/4cT2JV8

🌲 Do you call Minnesota “home?” We need YOU! 🌲

The Minnesota Department of Commerce (DOC) just announced that they will be collecting feedback from Minnesotans about their health insurance coverage: what’s working, what isn’t, and what residents would want to see from a publicly funded, universal health insurance option if it were to become available (an expansion of the current MinnesotaCare program and ). Let’s help our state become the FIRST to ensure that EVERY human living within our borders has access to affordable, effective health insurance! Feedback will be collected through the end of August in the form of online small-group discussions of 8-10 individuals. The completed report of their findings from these discussions will be available on the DOC website.

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To learn more and express your interest in participating, visit MN DOC’s Public Health Insurance Option Group Discussion Interest Form by clicking here: https://forms.office.com/pages/responsepage.aspx?id=RrAU68QkGUWPJricIVmCjL4O-S1fJzNGjMU7SzkCVJhUOFBSVDJYNVFOUklHN1o5OE5RSUY3QjkzMi4u&emci=0152b89f-2645-ef11-86c3-6045bdd9e096&emdi=126f8c6f-2745-ef11-86c3-6045bdd9e096&ceid=12539241

🗨️ The form is also now linked on our website’s “Share Your Story” page! (stpaulcornerdrug.com/share)

Our nurse has been working behind the scenes on a new site that houses her growing knowledge of mail order pharmacy. Now it’s ready to share with you and others!

Mail Order UNCOVERED is exactly what it sounds like: a hub of information about mail order pharmacies—what they are, how they work, why we use them—along with Hildie’s honest thoughts about working with them (including information that mail order pharmacies would definitely rather you didn’t know). It also includes comprehensive instructions for enrolling with and using several different mail order pharmacies (currently, Costco, CVS Caremark, Express Scripts, OptumRx, and WellDyne), as well as tips for working with each one based on everything she's learned over the last few years.

Additionally, similar to the options listed on our own site's "Share Your Story" page (https://buff.ly/45z4La0), the new site offers a place for patients to share their stories related specifically to mail order. With permission, Hildie will share this data with legislators and other key stakeholders to help raise awareness about the difficulties (and sometimes dangerous consequences) of working with mail order pharmacies.

The many problems common to “traditional” mail order pharmacies (those owned and operated by a pharmacy benefit manager (PBM)), are prime examples of PBM abuse in their own right, but are still something that many people know little to nothing about. Commonly, patients think their negative experiences with mail order pharmacy are their own fault or just a fluke, but this couldn’t be further from the truth. In reality, the mail order pharmacy experience is rife with technology glitches, inane hoop-jumping, and hit-or-miss customer service.

Hildie has seen it all over the past few years. She’ll continue to update the site as she gains more experience, and soon she’ll be adding a blog-like section where she’ll share specific mail order-related stories from her own work.

After taking a look, she asks that you share the link to the site far and wide—mail order pharmacies are national, not state-specific, so we expect this will be a helpful resource for patients all across the country.

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To check out the new site, click here: https://buff.ly/3SkjEYq

Tomorrow morning at 9am CT, the House of Representatives Committee on Oversight and Accountability will be holding its third hearing as part of an ongoing investigation into and its role in rising healthcare costs (funny how Pharmacy Benefit Managers (PBMs) claim on the daily that they “decrease healthcare costs” 😆).

The hearing will feature testimony from executives of the nation’s three biggest PBMs—CVS Caremark, Express Scripts, and OptumRx—which together now account for nearly 90% of prescription claims processed in the US. Let the grilling begin…

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To watch the livestream directly on the Committee's website, click here: https://buff.ly/3LCW59H

You can also find the stream on the PBMafia playlist of our YouTube channel at https://buff.ly/4cRggN4

A recently unearthed Star Tribune article from 1995 was a stark reminder of just how long the issue of has been going on in our industry (and how long we’ve been sounding the alarm… unanswered).

Nearly 30 years later (we’re sorry to say), it’s never been truer…

Earlier this week, the Federal Trade Commission (FTC) released a damning interim report detailing how prescription drug middlemen (i.e., PBMs) “profit at the expense of patients by inflating drug costs and squeezing ‘Main Street pharmacies’” (i.e., local indies like us). The Commission opted to release an interim report at this time in order to urge lawmakers and regulators to act NOW to (see the top of our Federal Initiatives page for a super quick and easy way to send a message off to your legislator). Notably, this has been an ongoing investigation since 2022, but “several of the PBMs that were issued orders have not been forthcoming and timely in their responses, and they still have not completed their required submissions, which has hindered the Commission’s ability to perform its statutory mission,” according to the report.

Our friends at Pharmacists United for Truth and Transparency have been doing a lot of work behind the scenes and are confident that Chairwoman Lina Khan's FTC *actually* gets what is happening in our industry—a huge win for those of us who for many years have been trying to sound the alarm about every single bulleted key highlight noted in the article.

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To read the FTC’s article about the release and access the full interim report, visit the link in our bio ⬆️ and tap on today’s image // click here: https://buff.ly/3YbknPG

Want a layman’s terms take on the report and what it means for PBMs? Check out this article from the NYT: https://buff.ly/3S9UTyk

PBMs regularly claim that employers “choose” to work with them in order to save healthcare costs (swipe left for an example we recently found on Twitter). That’s . In reality, there is no choice (and, of the PBMs they can choose from, very few, since the 3 biggest currently occupy ~90% of the market).

Plans with drug coverage MUST contract with a PBM in order for pharmacies like us to bill them when filling prescriptions for patients. That’s like telling a Swiftie “sure, you can go to the Taylor Swift concert without using Ticketmaster!” No, they can’t, and their prescriptions can’t be billed to insurance without a PBM in the mix, either.

P.S. For those who aren’t Swifties (it’s ok, we know she’s not everyone’s cup of tea!), Taylor’s recent Eras Tour has been at the heart of the discussion surrounding Ticketmaster’s harmful monopolization of the entertainment industry, similar to what PBMs have done in our own industry. Notably, our hometown Senator Amy Klobuchar (D—MN), as Chairwoman of the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights, has been leading the charge calling for accountability of Ticketmaster’s anticompetitive practices (her bill proposed earlier this year, Preventing Algorithmic Collusion Act of 2024 (S.3686), addresses concerns specifically about price fixing, which is currently rampant amongst PBMs).

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To read the full article, click here: https://buff.ly/3VCWMED

To learn more about Senator Klobuchar's proposed price fixing legislation, check out our Federal Initiatives page: https://buff.ly/3VcE46A

On June 26th, a group of Congresspeople led by Senator Elizabeth Warren (D—MA) and Representative Buddy Carter (R—GA) sent a letter to the Assistant Secretary of Defense for Health Affairs and the Director of the Defense Health Agency regarding concerns about Express Scripts Pharmacy and how it’s running the TRICARE pharmacy program. Their letter expressed (pun intended 🤑) bipartisan concern about the PBM’s anti-competitive practices and overcharging of taxpayers whose dollars help fund the program, as well as the program’s steering of patients away from local independent and retail pharmacies to Express Scripts’ mail order and specialty pharmacies (named “Accredo”). Additionally, they requested answers to pointed questions about the Department of Defense’s contract with Express Scripts by Tuesday, July 2nd.

TRICARE is the uniformed services health care program for active duty service members, active duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide. Previous to August 2022, St. Paul Corner Drug had proudly served a number of TRICARE patients at our pharmacy; however, after receiving a proposed Express Scripts contract (remember: we need contracts with PBMs in order to bill prescriptions to insurance) that would have been financially disastrous for us to accept, we became one of nearly 15,000 community pharmacies across the US that left the TRICARE network, forcing, according to the legislator’s letter, “400,000 active-duty and retired military families to decide between searching for a new in-network pharmacy or simply opting into [Express Scripts’] mail order option.” When concerns were raised almost immediately about the harmful effects this would have on our uniformed service members, veterans, and their loved ones, Express Scripts followed up—in their usual fashion—with an even worse contract. Unsurprisingly, we and those other pharmacies (through no desire of our own) haven’t been a part of the TRICARE network since.

Accountability is KEY 🔑 We’re thrilled to see legislators taking this to heart with a focus on preserving patient access to pharmacy care, especially in the wake of AlignRx’s recent termination of their commercial contract with Express Scripts (see last week’s post for info about that!).

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To read the article and access the full letter, click here: https://buff.ly/3LjFuHR

Early last month PSAO (Pharmacy Services Administrative Organization) AlignRx officially announced they would be terminating their commercial agreement with Express Scripts, one of our nation’s 3 largest Pharmacy Benefit Managers (PBMs), on August 29th, 2024.

As our PSAO, AlignRx is responsible for advocating for us and other indie pharmacies they represent in contract negotiations with PBMs. Their data analysis showed that Express Scripts’ final proposed reimbursement rates to pharmacies would lead to a crippling financial loss on EVERY prescription filled and billed to the insurance plans for whom they serve as the PBM (among our patients, this includes Medica, Cigna, and some BCBS plans). After lengthy negotiations and several workable solutions proposed by AlignRx that would have brought reimbursements above water for pharmacies, it became clear that Express Scripts wasn’t interested in paying us a “living wage.” Is this new, you ask? No—they’ve been doing it for years; this is just the first time we and our fellow independents are saying “no” on a broad scale.

The termination of an agreement like this represents one of the costs of allowing private insurance companies and PBMs to underpay healthcare providers in the name of profit: we simply can’t afford to accept patients’ insurance, so we don’t. We say “no” to their proposed contract, forcing our patients to either pay cash for their care or go elsewhere.

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To read the full article, click here: https://buff.ly/3xGAytc

A gentle reminder that we’ll be CLOSED this week on Thursday, July 4th in observance of Independence Day. If you need a refill before then, please reach out to us ASAP! We’ll be back in the store on Friday (but hope many of you will already be away enjoying your long weekends! 🛶😎🎊).

Funded by the US Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC), the Bridge Access Program makes free COVID vaccination and tests available to eligible underinsured and uninsured adults 18 years and older. This program will only be available through the end of August 2024, so if you’re under- or uninsured and aren’t up to date on your COVID vaccination, now is the time!

Financiado por el Departamento de Salud y Servicios Humanos de EE. UU. (HHS) y los Centros para el Control y la Prevención de Enfermedades (CDC), el Programa Puente de Acceso proporciona vacunas contra el COVID actualizadas gratuitas a adultos de 18 años o más sin seguro médico o cuyo plan no cubre el costo total de las vacunas contra el COVID de un proveedor en su red. El programa finalizará el agosto de 2024, por lo que si no tiene seguro o cobertura para esta vacuna y no está al día con su vacuna contra el COVID, ¡ahora es el momento!

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Visit covidaccess.com to see if you’re eligible and stpaulcornerdrug.com/appointments to book your 💉 appointment at our store!

Visite covidaccess.com para ver si es elegible y stpaulcornerdrug.com/appointments para reservar su cita de 💉 en nuestra tienda. Para ayuda en español, envíe un ✉️ a nuestra enfermera a [email protected].

Back in January, The New York Times put out a call for stories to aid their investigation into pharmacy benefit managers (PBMs). We’re thrilled to share that the first in a series of articles from that investigation has been published! It’s the most comprehensive, high-profile investigation of PBM abuse we’ve ever seen, with stories from patients across the country to illustrate the sinister, profit-over-patient tactics used by the PBMs. Scroll through the images above to see some ✨ from the article.

The National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS) are seizing this moment of media visibility to launch a grassroots activism campaign, and it needs support from patients like YOU. Help us build momentum by taking a few minutes to contact your congresspeople!

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Click here to read the article: https://www.nytimes.com/2024/06/21/business/prescription-drug-costs-pbm.html?unlocked_article_code=1.1U0.KH8J.-s72DAcsTTcN&smid=em-share

Click here to access the grassroots advocacy tool to tell your federal representatives that we need PBM reform NOW! https://www.votervoice.net/mobile/NCPANET/1/Campaigns/112249/Respond

🚨 Heads up patients! 🚨

Just yesterday we became aware that patients now appear to be receiving scam calls from their “insurance company” or “mail order pharmacy” (e.g., to “help schedule a primary care appointment that you’re eligible for” or “because we need permission to fill a new prescription that was sent in for you”).

Thus far, we’ve only heard of this happening specifically to OptumRx mail order (the pharmacy benefit manager (PBM) owned by UnitedHealth Group, or UHG) patients, but given the breadth of the data leak that occurred in the wake of the February Change Healthcare ransomware attack—which included thousands of patients from across the country’s private health information—it’s not impossible that this could happen to patients with other kinds of insurance. We suspect scammers have realized that patients’ interactions with their insurance company and/or the PBM that owns and operates their mail order pharmacy are ripe for scamming potential, given these interactions are often confusing and happen over the phone.

UHG is offering free credit monitoring and identity theft protections for two years to anyone impacted by the attack (which, as mentioned above, could be most people living in the US). To contact Change Healthcare Cyberattack Support, call 1-866-262-5342 or visit https://www.unitedhealthgroup.com/ns/health-data-breach.html.

Whether or not you’re a UHG/OptumRx patient, we strongly suggest educating yourself about the current scamming landscape and how to deal with things like robocalls. If you receive an unexpected call from your insurance company or mail order pharmacy, be cautious about offering any personal information (or even answering “yes” or “no” questions); if you suspect or determine the call to be a scam, feel free to share the details with our Nurse, who is actively logging incidents like this. She can be reached at [email protected].

Visit the FCC website for tips and tricks for handling robocalls, robotexts, and more: https://www.fcc.gov/consumers/guides/stop-unwanted-robocalls-and-texts