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Tennessee PBM Reform Win | PBM Reform · Pharmacy Podcast Network

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Speaker 1: You are listening to the global network of podcasters dedicated
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Speaker 1: to the pharmacy profession.
0:10
Speaker 2: Welcome to the Pharmacy podcast Network.
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Speaker 3: Welcome to the PBM Reform Podcast, where we dive deep
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Speaker 3: into the world of pharmaceutical benefit management, cutting through the
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Speaker 3: noise to uncover the truth. Since twenty nineteen, we've been
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Speaker 3: your go to source for the latest on how PBMs
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Speaker 3: impact patient care, drug pricing, and the very future of pharmacy.
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Speaker 3: Here we champion the role of pharmacists.
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Speaker 4: The most knowledgeable advocates for medication safety and expertise. Join
1:02
Speaker 4: us as we expose and generate discussions that are reshaping
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Speaker 4: healthcare and explore how we build a better payment system
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Speaker 4: which focuses on advancing pharmacy care.
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Speaker 5: This is a special episode of the PBM Reform Podcast
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Speaker 5: with Anthony Pudlow, Executive director CEO of the Tennessee Pharmacist Association.
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Speaker 1: I'm so excited about this.
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Speaker 5: I get to tag along with Greg Ribold, who's our
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Speaker 5: host of the PBM Reform Podcast. Greg, what a timely
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Speaker 5: episode to have on the PBM Reform Podcast.
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Speaker 2: Yeah, amazing, Todd, thank thank you for the introduction, and
1:48
Speaker 2: thank you Anthony for coming on. You know it's been
1:52
Speaker 2: a while, Frank, it's to have a PBM reform podcast episode,
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Speaker 2: and I don't know that there's a one one that
1:58
Speaker 2: could be more relevant or bigger. So really appreciate Anthony
2:02
Speaker 2: coming on as a guest. Quiet week for you, Anthony, Right,
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Speaker 2: you want to just let's let's let's jump.
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Speaker 1: Right on your thumbs over here in Tennessee.
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Speaker 2: I don't think I can go on social media, whether
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Speaker 2: it's LinkedIn, whether it's Facebook, whether whether it's X and
2:18
Speaker 2: you know, everywhere I go, right, there's so much excitement,
2:22
Speaker 2: there's so much optimism, and there's so much admiration and
2:25
Speaker 2: admiration for the work that's going on in Tennessee. So,
2:29
Speaker 2: you know, if you could let our viewers know sort
2:30
Speaker 2: of where you're at, you know, you get a just
2:33
Speaker 2: a teeny little bill.
2:34
Speaker 1: You've been working on and over you. Yeah, yeah, it's
2:39
Speaker 1: been kind of a quiet time in the last few
2:40
Speaker 1: months here in Tennessee. Yeah, we're latest and greatest. I
2:46
Speaker 1: think we're fresh off of a major victory in terms
2:51
Speaker 1: of how our States General Assembly voted and approved and
2:55
Speaker 1: passed Center Bill twenty forty, House Build nineteen fifty nine
3:00
Speaker 1: just this week on Monday, the Senate in the evening
3:03
Speaker 1: voted a not quite unanimously, but it was a twenty
3:06
Speaker 1: four to nine vote on the House side. I'd say
3:09
Speaker 1: even the majority was even stronger with a eighty six
3:13
Speaker 1: to seven vote on the House side. So we currently
3:18
Speaker 1: are awaiting. This bill is now in the process of
3:21
Speaker 1: being transmit over to the Governor's desk, and we really
3:26
Speaker 1: hope to see a positive supporting process from the governor
3:30
Speaker 1: to see the law take effect. So hopefully by time
3:34
Speaker 1: you all listen, you'll see even more news about where
3:37
Speaker 1: and how this law will take effect for the state Tennessee.
3:42
Speaker 2: Very good and for the listeners, if you would do
3:45
Speaker 2: I just kind of breaking down exactly what this you know,
3:47
Speaker 2: what this bill looks to do.
3:50
Speaker 1: Yeah, I want to make sure I call all attention.
3:55
Speaker 1: I think it's been formally dubbed the Freedom Access and
3:58
Speaker 1: Integrity and Registered PHARMACE SEE Act or fair RX Act
4:03
Speaker 1: that the primary bill sponsor, Senator Bobby Harshbarger out of
4:08
Speaker 1: the Kingsport area, kind of dubbed it that way, and
4:12
Speaker 1: so really supportive and appreciative of his strong leadership and
4:17
Speaker 1: bringing this forward as well as our House sponsor, which
4:20
Speaker 1: was Representative Rick Scarborough from the Tennessee region as well.
4:25
Speaker 1: But what this bill is very similar to what our
4:28
Speaker 1: colleagues in Arkansas passed. There's a few minor things that
4:32
Speaker 1: were a little different given just how our state's laws
4:36
Speaker 1: are brought forward, but ultimately the same process and the
4:39
Speaker 1: fact that it empowers our Board of Pharmacy to deny
4:43
Speaker 1: a license to a pharmacy if that ownership structure includes
4:48
Speaker 1: a PBM and a health insurance issuer, at least in
4:53
Speaker 1: terms of the terminology that you use. So more or
4:56
Speaker 1: less breaking up that vertical integration model in saying that
5:00
Speaker 1: the boarder farment, we cannot see a license to a
5:03
Speaker 1: pharmacy if that ownership structure is a health plan or
5:07
Speaker 1: a PDM.
5:10
Speaker 2: Amazing, right, And this this follows on the heels of Arkansas,
5:14
Speaker 2: and so Arkansas and now Tennessee both just long leaders
5:18
Speaker 2: on the front lines of PPM reform. And so you're
5:22
Speaker 2: now two states in the country to get this through
5:24
Speaker 2: the General Assembly, which is amazing. And you know, I
5:28
Speaker 2: think you know, a lot of the concept was born
5:31
Speaker 2: out of federal right the you know, there was federal
5:34
Speaker 2: legislation introduced in twenty twenty four in the House and
5:38
Speaker 2: in the Senate, and my god, right, I think that
5:42
Speaker 2: when that was first introduced, a lot of people thought, oh,
5:44
Speaker 2: that's a messaging bill or oh that's not realistic. And
5:47
Speaker 2: now you've got two states that have have always led
5:51
Speaker 2: that have done this. You know to me the import
5:54
Speaker 2: and obviously right you're you know, in your position CEO
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Speaker 2: for the Pharmacy Association, but you know, vertical integration acts
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Speaker 2: in such an anti competitive way, certainly against pharmacies, right,
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Speaker 2: any pharmacy that's not affiliated with a PBM. But you
6:13
Speaker 2: talk to us a little bit about vertical integration, and
6:15
Speaker 2: you know the cost to the consumer, the cost to
6:17
Speaker 2: the patient, and the impact there because I think that
6:20
Speaker 2: the best news here is for the patients.
6:22
Speaker 1: Yeah, you know, And I think for us what really
6:25
Speaker 1: helped in our effort. And I still took my cap
6:29
Speaker 1: to my colleagues on Arkansas and what John Vincent and
6:32
Speaker 1: his team was able to do. But in conversations we've had,
6:35
Speaker 1: as we've obviously been in close communication as we've been
6:39
Speaker 1: going forward, I think what Tennessee has had over Arkansas
6:43
Speaker 1: on this effort is the data, the data from our
6:48
Speaker 1: state and back in twenty twenty two, we did pass
6:51
Speaker 1: the law that granted authority to our state's insurance commissioner
6:55
Speaker 1: and his team to audit PBMs on a regular basis,
6:59
Speaker 1: and we're we are known that it's known that the
7:04
Speaker 1: division audits about five PBMs a year, and not just
7:09
Speaker 1: for what we've seen recently, but when at first, when
7:13
Speaker 1: the results first came out on express Scripts last year
7:15
Speaker 1: and the audit results, we were seeing upwards of three
7:19
Speaker 1: thousand percent difference in terms of the payments that an
7:23
Speaker 1: Express Script's affiliated pharmacy was receiving versus a non affiliated
7:27
Speaker 1: pharmacy still in the same network. And then our state
7:30
Speaker 1: this year came out with results on CDs care Mark
7:35
Speaker 1: even more detrimental impact of sixteen percent in some cases.
7:41
Speaker 1: But even back to the Express Scripts audit, they were
7:45
Speaker 1: in clear violation of some of our prohibitions around spread pricing.
7:48
Speaker 1: And even what that audit showed was that Express Groups
7:53
Speaker 1: was with holding close to thirty million dollars from employers
7:58
Speaker 1: and taxpayers and others for what they were seeing. So
8:02
Speaker 1: you know, we had a very easy, clear message to say,
8:05
Speaker 1: look at what our state, our own state, not even
8:09
Speaker 1: with the FTC and others, OEG and others that have
8:11
Speaker 1: been investigators look at the data straight from our own
8:15
Speaker 1: state that is showing that these PBMs are withholding this
8:21
Speaker 1: money or keeping for themselves, whether it's from pharmacies, other providers,
8:26
Speaker 1: the patients themselves, I mean everybody. And it has been
8:29
Speaker 1: I think the harder message still or the harder nut
8:33
Speaker 1: to crack. And I think you all, I know, I've
8:35
Speaker 1: heard a few of your previous sessions about how do
8:39
Speaker 1: we break through to employers and help them understand where
8:43
Speaker 1: they don't see their own data, they don't get that
8:46
Speaker 1: information from their PBM, but it's there. It's it's very
8:50
Speaker 1: clear and what our state's been able to do, so
8:52
Speaker 1: I know for us, you know ultimately this bill it's
8:56
Speaker 1: it's a patient safety bill, it's a hence why the
9:00
Speaker 1: of pharmacies involved in this, it's an access bill. We've
9:04
Speaker 1: seen too many pharmacies close in our state since we've
9:08
Speaker 1: really some of the data that we've gotten from our
9:10
Speaker 1: colleagues at NCPA and their their efforts with Southern Calm
9:15
Speaker 1: and the Pharmacy Desert's information. We saw since twenty seventeen,
9:20
Speaker 1: six hundred and twenty pharmacies close, not just independent but
9:23
Speaker 1: other chain pharmacies too. I mean that's we guestimated about
9:27
Speaker 1: a third of pharmacies closed in that last what is
9:30
Speaker 1: that in nine years? So it's applications to that, it's
9:35
Speaker 1: access to care.
9:35
Speaker 6: Yeah, absolutely.
9:37
Speaker 1: You know.
9:37
Speaker 2: The other thing, you know, I look at this very
9:40
Speaker 2: much as is I think I think it's also a
9:41
Speaker 2: free market bill, right, Like you talk about the pricing
9:44
Speaker 2: disparities uncovered in the audits, right, one of the elements
9:47
Speaker 2: and of the free market is like price signals, right,
9:49
Speaker 2: you've got and what you've got as PBMs acting as
9:52
Speaker 2: price makers and also price takers. And so the free
9:56
Speaker 2: market isn't setting those prices PBMs even sometimes government contractors
10:01
Speaker 2: or setting prices picking winners and losers, and of course
10:05
Speaker 2: oftentimes reversing themselves with massive, massive.
10:07
Speaker 6: Markups that have no bearing to the market price.
10:11
Speaker 2: And then the other thing I want to touch on
10:13
Speaker 2: and ask you about is on top of these massive markups,
10:16
Speaker 2: so often the patient doesn't necessarily have the choice to
10:19
Speaker 2: not fill it at those pharmacies that are PBM owned.
10:22
Speaker 1: True. Yeah, and you know for us too, it's you know,
10:25
Speaker 1: this bill it gets more beyond some of the administrative
10:29
Speaker 1: things that we've been able to try to pass right.
10:31
Speaker 1: This is getting at the structural integrity of the system.
10:35
Speaker 1: That is a very different approach on addressing these issues
10:39
Speaker 1: in the PBM space. But don't get me wrong, Like
10:42
Speaker 1: we've been successful in Tennessee and allowing pharmacies to be
10:45
Speaker 1: paid at cost, making sure pharmacies get proper dispensing fees
10:49
Speaker 1: at least for lower volume pharmacies based on our ten
10:53
Speaker 1: Care program standards. But ultimately, yeah, I mean, it's patients
10:59
Speaker 1: that are being coerced and moved to pharmacies that they
11:03
Speaker 1: don't want to go to or to mail order, where
11:06
Speaker 1: we also see excessive amounts of fraud and waste in
11:10
Speaker 1: the system. So you know, I do think. I mean,
11:13
Speaker 1: I think for all the listeners out there, the amount
11:15
Speaker 1: I mean, it feels like we've been preaching this for
11:18
Speaker 1: so long, but I think every case scenario now has
11:22
Speaker 1: led up to this, Like the pot is full in
11:26
Speaker 1: terms of how much we can tell this story. And
11:29
Speaker 1: I think whether you're a state legislator, whether you're a
11:32
Speaker 1: member of Congress or any other policy maker, there's more
11:36
Speaker 1: than enough data to move move the needle, whether it's
11:40
Speaker 1: at the state or at a federal level. Yeah.
11:43
Speaker 2: Absolutely, I need it so often when you see, you know,
11:46
Speaker 2: something massive like like what you all have pulled off
11:49
Speaker 2: in Tennessee. You know, of course you know other states
11:52
Speaker 2: and you know patient groups and pharmacy groups or you
11:54
Speaker 2: know are going to look look to your state. And
11:57
Speaker 2: I don't know that there is a secret sauce, but
12:00
Speaker 2: do you know, right like you guys have you have
12:01
Speaker 2: a culture of winning. I talked about that a lot,
12:03
Speaker 2: right when you look like Arkansas, the work you do Kentucky,
12:07
Speaker 2: right there is there's a culture of winning and passing
12:11
Speaker 2: legislation that you know improves patient care, improves access to care,
12:16
Speaker 2: lowers prices, protects from anti competitive PBM practices. But a
12:21
Speaker 2: lot of the work that you did this year was
12:23
Speaker 2: built on the year's pass right, This didn't magically happen
12:26
Speaker 2: in one year. And you talked a little bit about
12:29
Speaker 2: the you know, the insurance commissioner and doing the audits,
12:32
Speaker 2: and that was a result of state legislation as well,
12:35
Speaker 2: right in power Yeah, Yeah, And I don't even greg
12:38
Speaker 2: out even go as farther and saying I've told a
12:41
Speaker 2: lot of members that have already reached out, you know,
12:43
Speaker 2: expressing their gratitude for what we've done.
12:46
Speaker 1: You know, it's it's not just the level of the
12:48
Speaker 1: legislation that we passed over the years. This is a
12:51
Speaker 1: prime case example of what grassroots advocacy means, and not
12:56
Speaker 1: just certainly here and now, but the longevity to making
13:00
Speaker 1: meaningful relationships with your legislators. That's not easy, no matter
13:05
Speaker 1: if you agree with their politics or they're not or
13:07
Speaker 1: you're not. You have an elected leader that represents you
13:12
Speaker 1: in your district that you need to form a relationship
13:14
Speaker 1: with in showcase this issue when sometimes it's speaking a
13:18
Speaker 1: completely different language, right, I mean very rarely do we
13:21
Speaker 1: have as many pharmacists run around our state houses to
13:24
Speaker 1: see we've been a little fortunate in that area. But
13:27
Speaker 1: like that relationship is hard and to have somebody, an
13:32
Speaker 1: elected leader that listens to you when the time is
13:36
Speaker 1: right and builds that And I think Tennessee has had
13:39
Speaker 1: a long history of developing meaningful relationships that have been
13:44
Speaker 1: obviously on full display here this year or.
13:47
Speaker 2: So, yeah, absolutely so for some of a lot of
13:50
Speaker 2: our listeners or policy or are I have spent time
13:52
Speaker 2: in capitals, but not all of them, And so.
13:56
Speaker 6: Would love to talk a little bit just about.
13:58
Speaker 2: Like the under you know, under the Dome on the
14:01
Speaker 2: marble floor politics, and like just just to give the
14:04
Speaker 2: listeners an idea.
14:05
Speaker 6: Of like what you were up against.
14:07
Speaker 2: And so I'm going to ask you a ballparket because
14:09
Speaker 2: you probably don't have a number, right, but that this legislation,
14:12
Speaker 2: you know, represented an existential threat to a pipeline to
14:16
Speaker 2: profits for PBMs that have affiliated pharmacies, and obviously they've
14:21
Speaker 2: got diverse interests. There's multiple companies. How many lobbyists do
14:24
Speaker 2: you think we're working against you?
14:27
Speaker 1: Yeah, you know, I think in any normal year, the opposition,
14:31
Speaker 1: and I've had a few meetings where they want to
14:33
Speaker 1: just sit down directly with me, there's probably fifteen to
14:37
Speaker 1: twenty lobbyists that are regularly here for the opposition this
14:42
Speaker 1: year alone, This year alone, we counted an additional sixty
14:47
Speaker 1: two higher lobbyists on top of their normal ones, on
14:52
Speaker 1: top of their normal lobbyists. Plus you have a group
14:56
Speaker 1: like CBS, and it's been reported that between CD and
15:00
Speaker 1: a few other stakeholders, they've invested over seven million dollars
15:04
Speaker 1: in ad campaigns against this. Our Speaker of the House
15:09
Speaker 1: tweeted out once we saw data about some social media
15:13
Speaker 1: influencers being paid thirteen thousand dollars just to put out,
15:17
Speaker 1: you know, a one reel to make their mess. So
15:20
Speaker 1: I mean the money and the people were there. So
15:24
Speaker 1: I think for everybody to realize, there'd be moments where
15:27
Speaker 1: myself and our lobby is so we're just two plus
15:30
Speaker 1: our grassroots network. The two of us would be waiting
15:33
Speaker 1: to go in with the key leader, say of a
15:36
Speaker 1: finance committee member or the chair of the committee, and
15:40
Speaker 1: who would be walking out would be one PBM group
15:44
Speaker 1: who'd be waiting when we came in or when we
15:46
Speaker 1: came out, there'd be a whole other line of them.
15:49
Speaker 1: I mean, it was they were there. They were there
15:52
Speaker 1: every day. You know, some of you may have seen
15:56
Speaker 1: images where CBS representatives were in these committee hearings, which
16:04
Speaker 1: now in Tennessee there's summer rules about what you can
16:06
Speaker 1: do and not do as you want to display your
16:09
Speaker 1: support or opposition on a build that they were in
16:11
Speaker 1: full scarves that look like where's Waldo scarves? Red and
16:15
Speaker 1: white scarves everywhere, And so we even had this question
16:19
Speaker 1: of you know, many associations might have one hill day
16:23
Speaker 1: right where we get everybody down to the capital make
16:26
Speaker 1: our pitch. We were almost thinking like do we need
16:29
Speaker 1: to start doing many hill days. And now on our effort,
16:32
Speaker 1: we kind of did it. In some regard, we had
16:35
Speaker 1: a lot of support from some of our other chain
16:37
Speaker 1: partners that were not directly influenced. So yes, we had
16:41
Speaker 1: one chain working with us one week and then the
16:44
Speaker 1: next chain would come the next week. So we kind
16:46
Speaker 1: of had a cascade approach in that regard outside of
16:49
Speaker 1: what we were regularly doing and what our members were doing.
16:53
Speaker 1: So you had it was a team approach for sure,
16:58
Speaker 1: but the opposite, the oppositeosian. They were in full force
17:02
Speaker 1: as an army that they had.
17:04
Speaker 2: I mean massively. I say this all the time. You know,
17:06
Speaker 2: my kids loved your mind you that I say the
17:08
Speaker 2: same thing over and over again. Right, but it's it's
17:11
Speaker 2: hard to pass any bill, right, Like you know, to
17:14
Speaker 2: take the most innocuous bill and it's hard to pass it.
17:16
Speaker 6: And you guys move some you know, move something.
17:19
Speaker 2: Through with that much opposition, I think, obviously testament to
17:23
Speaker 2: the work you've done, the strategy you've done. But it also, boy,
17:28
Speaker 2: it makes it makes it makes me feel optimistic, that
17:31
Speaker 2: sort of winds of change, right.
17:32
Speaker 6: Like eyes are opening.
17:34
Speaker 2: And when you go back to twenty eighteen, and you know,
17:36
Speaker 2: you had these you know, these giant insures and ppms,
17:41
Speaker 2: and you know they were merging and you know, they
17:43
Speaker 2: were getting more vertically integrated. And then obviously you've got
17:46
Speaker 2: the work of the FTC and you know Arkansas. Now
17:49
Speaker 2: now you guys, and I'm optimistic that we're going to
17:51
Speaker 2: see you know, patients before monopolies reintroduced at the federal
17:55
Speaker 2: level as well. You know, and you may not have
17:58
Speaker 2: had a chance to really reflect on this, you're just
18:00
Speaker 2: coming off a big fight. But do you think this
18:02
Speaker 2: touches you know, do you think this this builds momentum
18:05
Speaker 2: for federal and other states?
18:07
Speaker 1: And yeah, you know, I think probably some of your
18:10
Speaker 1: listeners were just out in d C for the NCPA
18:14
Speaker 1: congressional fly in or another fly in, and we had
18:18
Speaker 1: a pretty good contingency once again from Tennessee and and
18:21
Speaker 1: met with almost all of our congressional delegation. And not
18:25
Speaker 1: only were we hearing it from our congressional delegation about
18:29
Speaker 1: there what they're hearing, and they were hearing they were
18:32
Speaker 1: well informed on this. I think I also heard that
18:35
Speaker 1: the opposition was pushing on them to try to get
18:40
Speaker 1: involved in the state politics. Of what was going on.
18:42
Speaker 1: But we definitely heard from other contingencies, other areas of
18:46
Speaker 1: the country that their legislators, their members of Congress were
18:49
Speaker 1: well aware of what's going on in Tennessee. You know,
18:52
Speaker 1: I do think there'll there'll be a few more states
18:55
Speaker 1: that will likely look to pass something in the next year.
18:59
Speaker 1: And then the question is like, what's that threshold, you know,
19:02
Speaker 1: how many more dominoes need to fall before before Congress
19:05
Speaker 1: acts or the FTC for that matter. But I might
19:10
Speaker 1: actually put more hope in Congress acting before we see
19:14
Speaker 1: really some honest movement out of the FTC. But you
19:19
Speaker 1: can probably speak more of that issue. But but yeah,
19:22
Speaker 1: I do think there is a lot of momentum. I
19:26
Speaker 1: definitely have kept my counterparts in other states well informed.
19:30
Speaker 1: I know John in Arkansas, and I work quite diligently
19:35
Speaker 1: to assist and help inform our colleagues to say, what's worked, Well,
19:39
Speaker 1: how do you plant these seeds right that we've talked about,
19:42
Speaker 1: Because it doesn't just happen overnight, you guys, and I'm
19:45
Speaker 1: saying this to all the listeners, It does not happen overnight.
19:49
Speaker 1: This this has definitely been years in the making, So
19:52
Speaker 1: you've got to make sure the right seeds are planted.
19:55
Speaker 1: Sometimes you need a little luck, you need some stars
19:57
Speaker 1: to align. But very very fortunate for the amount of
20:02
Speaker 1: support that we've had from our legislators to make this happen.
20:06
Speaker 2: And now it's just what's next, you know, Yeah, And
20:10
Speaker 2: you know, you know, it's so interesting to me. I'm
20:12
Speaker 2: starting to get calls and have conversations with folks who
20:14
Speaker 2: are in the healthcare sphere, right, but not necessarily in
20:17
Speaker 2: the pharmacy sphere. And you know, we're in a world
20:19
Speaker 2: now where the insures or some of the largest employer
20:22
Speaker 2: of physicians and they owned clinics, and you know, obviously
20:26
Speaker 2: PBMs and insures are vertically integrated. And so I just
20:31
Speaker 2: think it's an exciting time. You know, back I remember
20:34
Speaker 2: opposing mergers at like the state level, back when it
20:37
Speaker 2: was you know, back when like folks like opened the
20:39
Speaker 2: door and felt like, oh my god, vertical integration. It's
20:42
Speaker 2: going to save money and it's going to reduce costs.
20:44
Speaker 2: And it feels to me with what Arkansas now Tennessee
20:49
Speaker 2: has done is like it feels sort of like a
20:51
Speaker 2: paradigm shift moment now, right, And it's like the jury
20:54
Speaker 2: is out all of these, you know, everything that pharmacy
20:58
Speaker 2: and healthcare providers have been kind of warning about. Right
21:01
Speaker 2: eyes are being opening, and I think I'm optimistic. I
21:04
Speaker 2: think this is going to build momentum for you know,
21:07
Speaker 2: similar to legislation at the federal level. And I also
21:10
Speaker 2: think that this could be a catalyst for tackling vertical
21:13
Speaker 2: integration and healthcare beyond just the pharmacy PBM.
21:16
Speaker 6: Relationship and started looking at the.
21:18
Speaker 2: Insure and the PBM, or the insure and the physician
21:23
Speaker 2: groups or the clinics or the whole healthcare.
21:26
Speaker 1: So yeah, yeah, I mean we saw a fair amount
21:29
Speaker 1: of I would probably call retaliation bills that you know,
21:33
Speaker 1: I think if I was the other side. One of
21:36
Speaker 1: the things given we were talking about the amount of
21:38
Speaker 1: lack of people we have and compared to what they have.
21:41
Speaker 1: You know, one strategy we talked about like, if I
21:43
Speaker 1: was the other side, I'd be throwing a ton of
21:46
Speaker 1: other bills out there that made us play defense on
21:49
Speaker 1: and that kind of happened. There was a few that
21:52
Speaker 1: we had to also say at the same time, as
21:54
Speaker 1: we're pushing this, we strongly oppose these or we like
21:57
Speaker 1: some components here, but we want to talk in flesh
21:59
Speaker 1: thas out there, but yeah, I mean we I think
22:02
Speaker 1: any state also deals with that as well, and I
22:05
Speaker 1: think that's probably more likely going to happen, not just
22:09
Speaker 1: for us in Tennessee moving forward, but I'm sure a
22:11
Speaker 1: lot of other states is like, you're going to see
22:13
Speaker 1: the bombardment of more retaliation type bills that may almost
22:17
Speaker 1: play defense until you can see some of this newment.
22:21
Speaker 1: I mean, it's it's a whole other strategy. I'm sure
22:23
Speaker 1: the opposition is working through.
22:25
Speaker 2: Yeah, absolutely, I think that's a good point. I want
22:28
Speaker 2: to digress a little bit too. This may be not
22:30
Speaker 2: not as exciting, but you know, obviously everybody's everybody's looking
22:35
Speaker 2: at like what you've done with this massive piece of legislation.
22:37
Speaker 2: But on any given year, state associations are engaged in
22:42
Speaker 2: so many what may be seemingly mundane bills, right, but
22:45
Speaker 2: it can impact the practice of pharmacy or can impact
22:49
Speaker 2: patient care. And you know, through while you're fighting this
22:52
Speaker 2: big fight, right you're still having to do that work.
22:56
Speaker 2: And without a strong association, so many of those those
22:59
Speaker 2: bills go un answered.
23:01
Speaker 1: Right now, it's very well well brought. We're well brought
23:06
Speaker 1: on point Greg, I mean I think we, gosh, not
23:09
Speaker 1: any given year, at least Tennessee, we're probably monitoring eighty
23:12
Speaker 1: to ninety bills right some and just kind of given
23:15
Speaker 1: our political process, some of these are filed is what's
23:17
Speaker 1: called caption bills. They're like placeholder bills, and you don't
23:20
Speaker 1: even know the language until the language officially dropped in
23:24
Speaker 1: the committee and you're like, holy cow, what do we do?
23:27
Speaker 1: What does this mean? What's the implications? Not every state
23:30
Speaker 1: does that, but the opposition is doing those kind of
23:34
Speaker 1: things right, and so we have to play defense at
23:36
Speaker 1: the same time be ready to play offense. But gosh,
23:41
Speaker 1: I last year alone, I remember having a whole lot
23:43
Speaker 1: of bills like that that were like what is going on?
23:46
Speaker 1: Like there's bills around trust and public health messaging that
23:50
Speaker 1: potentially could have prevented pharmacists from even having a basic
23:53
Speaker 1: conversation with a patient about AWFU labeled use of medicines
23:57
Speaker 1: that would have been detrimental to how we work can
24:00
Speaker 1: communicate with providers and patients about awful able use and dosing.
24:04
Speaker 1: It's it's wild some of the things that you've got
24:07
Speaker 1: to be ready for.
24:08
Speaker 2: Well, you know, I suspect We're going to have a
24:10
Speaker 2: lot of listeners you know here who are already engaged
24:13
Speaker 2: with their state association. But I suspect, you know, because
24:17
Speaker 2: this is such so big, so significant, we're gonna have
24:19
Speaker 2: a lot of a lot of pharmacists and probably other
24:21
Speaker 2: healthcare providers who may not be engaged with their associations.
24:24
Speaker 2: I think this is a you know, while we have
24:26
Speaker 2: their attention, it's a great opportunity to remind them of
24:29
Speaker 2: the work that you do, you know, all year around,
24:33
Speaker 2: in every session, even when you're not you know, fighting
24:36
Speaker 2: just a monster bill or pushing a monster bill, and
24:40
Speaker 2: so you know, there can be all sorts of implications.
24:43
Speaker 2: So great opportunity to remind folks to be engaged with
24:46
Speaker 2: their state association because that that is the best way
24:49
Speaker 2: to shape, you know, their practice and shape their profession.
24:54
Speaker 6: I want to be respectful of your time.
24:55
Speaker 1: I know you're probably doing one hundred of these right now,
24:57
Speaker 1: just but I.
24:58
Speaker 2: Think folks would be interesting just to hear us sort
25:00
Speaker 2: of what is so we talked about what, you know,
25:02
Speaker 2: what your opposition was like, what is your what does
25:05
Speaker 2: the association's team look like?
25:07
Speaker 3: Right?
25:08
Speaker 2: You know, associations are obviously do not have the money
25:11
Speaker 2: of the you know, of the PBMs and the insurers,
25:15
Speaker 2: and they're affiliated pharmacies.
25:19
Speaker 1: About just your structure, Yeah, I mean once you've seen
25:21
Speaker 1: one state pharmacy association and kind of seeing one, and
25:25
Speaker 1: I think we all have some great ways of how
25:27
Speaker 1: we operate and engage. But we're a small but mighty
25:30
Speaker 1: team here in Tennessee. We're a staff of five full
25:34
Speaker 1: time staff. One is kind of a full grant funded position,
25:38
Speaker 1: and we have three part timers. So we're we're a
25:42
Speaker 1: small but mighty team. And you know, we myself as
25:46
Speaker 1: one of our lobbyists, and then we contract out with
25:50
Speaker 1: a part time contract a multi client contract lobbyist. But yeah,
25:55
Speaker 1: it's kind of who we are. We're probably a little
25:57
Speaker 1: bigger than some, but not as big as others as well.
26:01
Speaker 1: But yeah, I think for us, we're we're very strong
26:04
Speaker 1: in the fact that we are a big group that
26:06
Speaker 1: brings all pharmacy practitioners together across the spectrum of care.
26:10
Speaker 1: Not every state is organized like that. So we have
26:12
Speaker 1: members in your large large, large health systems to small
26:16
Speaker 1: critical access hospitals, national chains, grocery chains, independently owned long
26:21
Speaker 1: term care, home infusion, nuclear pharmacy, managed care. We've got
26:25
Speaker 1: them all and we build a bus to bring them
26:28
Speaker 1: all together. Yeah, I mean you're I said.
26:31
Speaker 2: One of the things I've always noticed admired about your
26:33
Speaker 2: style is is you know, like you're very deliberate in
26:36
Speaker 2: what you do. When you build a big tent, right,
26:38
Speaker 2: like you're very inclusive and you collaborate.
26:42
Speaker 1: You have to know, it's a really impressive way. One
26:45
Speaker 1: of the things I think that really helps serve us well.
26:47
Speaker 1: And Greg, I think you're you're well aware of this.
26:49
Speaker 1: And some of the calls we have is I call
26:52
Speaker 1: it our team Tennessee Pharmacy calls. Once a month we
26:55
Speaker 1: bring together all the government affairs folks from the different
26:59
Speaker 1: stakeholder groups just to say, hey, we're all limited in
27:03
Speaker 1: our capacity. So here's what the association is doing, how
27:07
Speaker 1: we can get the job done. But here's where we
27:09
Speaker 1: need help from these different organizations. That I think helped
27:13
Speaker 1: us dramatically. We built these relationships with the right parties
27:17
Speaker 1: coming into this, and it really helped us say Okay,
27:20
Speaker 1: now here's where I need you to help with this.
27:23
Speaker 1: Here we go, let's just get with direct the traffic
27:26
Speaker 1: and get the job done. In the end, so very
27:29
Speaker 1: very important.
27:30
Speaker 6: Yeah, first, the way you did that.
27:33
Speaker 5: I have a question for either of you, and I'm
27:35
Speaker 5: just curious. CBS Health keeps publicizing that if they can't
27:44
Speaker 5: be the insurance company, then they're going to have to
27:47
Speaker 5: close pharmacies. However, independence and regional chains and grocery store
27:53
Speaker 5: pharmacies that are out there are in operation without owning
27:57
Speaker 5: an insurance company. So can someone tell me what they
28:01
Speaker 5: tell legislators is the true reason that if they're not
28:05
Speaker 5: ensure that they're not going to be able to practice pharmacy.
28:09
Speaker 5: Because everybody on this podcast episode knows that that's a
28:15
Speaker 5: bunch of malarkey. But what are they peddling or positioning
28:20
Speaker 5: to try to get people to believe that?
28:22
Speaker 1: Oh god, So there's been a few talking points that
28:24
Speaker 1: I've seen todd from what they were using. I mean,
28:28
Speaker 1: one approach that they were taking is just top to bottom,
28:31
Speaker 1: like the entire location, the four walls of the CBS
28:35
Speaker 1: location will close, which you know, this bill, like we've said,
28:40
Speaker 1: targets the board of Pharmacies process and licensing the pharmacy.
28:43
Speaker 1: So they basically are admitting that the pharmacy if the
28:47
Speaker 1: pharmacy in the back corner closes or changes ownership structure,
28:51
Speaker 1: the rest of the building can't function. So like they
28:53
Speaker 1: had members of their minic clinic staff coming in testifying
28:57
Speaker 1: they're going to lose their positions, front end staff, warehouses
29:01
Speaker 1: that they operate in the state are all going to
29:04
Speaker 1: close doors. So it's been very interesting kind of their
29:08
Speaker 1: scare tactics that they were using this year. But you know,
29:14
Speaker 1: it is it is interesting too because we saw some
29:16
Speaker 1: of their testimony from some of their pharmacy team members
29:21
Speaker 1: almost I guess, in ignorance to understanding that CBS itself
29:26
Speaker 1: deals with other PBMs too, Like their their pharmacy staff
29:30
Speaker 1: was like oblivious that PBMs exist and that the company
29:34
Speaker 1: needs to even do business with other PBMs. It was
29:37
Speaker 1: really alarming that that was the type of strategy that
29:41
Speaker 1: they used in their messaging, acting like PBMs just don't
29:45
Speaker 1: exist and they're not a problem. So it was it
29:48
Speaker 1: was interesting.
29:49
Speaker 2: Yeah, you know, Todd, in the legal world, there's a
29:53
Speaker 2: there's an expression called parade of horribles, right and you
29:56
Speaker 2: know in state capitals, I would just liken it to
29:59
Speaker 2: the sky is falling right like, and that plays out
30:03
Speaker 2: in every state capital. On PBM reform, you know to
30:06
Speaker 2: some varying degree, right, you know, if if patients get
30:10
Speaker 2: the benefit of the rebate, they claim premiums are going
30:12
Speaker 2: to go up. If you know they're not ability, they
30:15
Speaker 2: don't have the ability to set prices or they don't
30:17
Speaker 2: have the ability to steer, they claim costs are going
30:19
Speaker 2: to go up, and over and over and over again.
30:21
Speaker 2: The data tells a very very different story. I think,
30:25
Speaker 2: you know, the legislation that Anthony and Tennessee ran this
30:28
Speaker 2: year again for them as an existential threat to just massive,
30:31
Speaker 2: massive profits. And so I think a lot of the
30:34
Speaker 2: talking points you know that I heard was very much
30:37
Speaker 2: the sky is falling parade of horribles and just kind
30:40
Speaker 2: of trying to scare legislators into inaction.
30:46
Speaker 1: Well I love that review.
30:49
Speaker 5: Once again, Anthony, congratulations on such a massive win. And
30:56
Speaker 5: you know, when you have somebody like the State of
30:59
Speaker 5: Arkansas painting that you can't be an insurer and owned pharmacies,
31:04
Speaker 5: and now Tennessee does it, it's almost the buddy system
31:08
Speaker 5: where other organizations and other states and other legislators are
31:11
Speaker 5: going to start looking a lot deeper into this when
31:14
Speaker 5: you have more than just one that are doing it.
31:17
Speaker 5: And I cannot wait to interview the next state Pharmacy
31:21
Speaker 5: Association executive, the CEOs out there of my own state,
31:25
Speaker 5: Pennsylvania or Ohio or New Mexico or something that we
31:30
Speaker 5: can celebrate again to say, Hey, an insurance company that
31:35
Speaker 5: does steering and does pricing, favoritism and does everything that
31:40
Speaker 5: we know that they're doing that, they're just not going
31:42
Speaker 5: to be able to do that anymore because you can't
31:44
Speaker 5: own a pharmacy and be the insurance company. I think
31:48
Speaker 5: this is wonderful.
31:51
Speaker 1: Well, thank you guys. I really appreciate you helped amplifying
31:54
Speaker 1: the news and for all the support for both of you,
31:58
Speaker 1: I know and those listening. Like I've said, it's been
32:01
Speaker 1: a team effort. All boats are going to rise because
32:05
Speaker 1: of this, and that's what we hope. So we're here
32:08
Speaker 1: to be a resource. If there's those listening that need
32:11
Speaker 1: better connections with your local state association, please let me know,
32:15
Speaker 1: happy to make those connections, and.
32:18
Speaker 2: He means that, which I think is neat Well, Anthony, again,
32:22
Speaker 2: thank you for doing this and you just have a
32:25
Speaker 2: lot to be proud of. I do hope you get
32:27
Speaker 2: some rest. I know you're overdue, but you know you
32:31
Speaker 2: did something special here, and I think healthcare and the
32:33
Speaker 2: structure of healthcare moving forward.
32:35
Speaker 6: Is going to be better for it. So you've done
32:36
Speaker 6: amazing work.
32:38
Speaker 1: Thank you both. Thank you.
32:40
Speaker 5: Hey, you were listening to the latest episode of the
32:42
Speaker 5: PBM Reform podcast. Do us a favor and share this
32:46
Speaker 5: episode with the state legislator, Share this with a fellow
32:51
Speaker 5: health and human services professional. Share this with another pharmacist
32:55
Speaker 5: out there that may not understand the intricacies and the
32:58
Speaker 5: impact the PBM reform is going to have on our
33:01
Speaker 5: national healthcare system. Thank you so much for listening. Greg,
33:05
Speaker 5: Thanks for letting me be on your show.
33:07
Speaker 1: Are you kidding?
33:09
Speaker 6: Thank you, Thank you for all you do. Todd appreciate
33:11
Speaker 6: you so much.
33:12
Speaker 5: All right, Anthony, we will talk to you soon. Hope
33:14
Speaker 5: to see you at a conference coming up.
33:17
Speaker 1: Sounds great.
33:17
Speaker 2: Thanks to Take a break, man, Go take a break.