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Why You Should Support HB 5254!
Pharmacy providers should not be terminated without cause! |
| 1, November 1, 2005 |
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When a Pharmacy Benefit Manager (PBM) offers a pharmacy provider a network or panel contract, they are indicating that they value the participation of that provider. Without cause, such as substandard performance or fraud, a PBM should not be able to arbitrarily drop a provider.
When a pharmacy provider signs a PBM contract, they should not give up their right to free speech or to speak freely to legislators, even if the topic is PBMs and their business practices. Pharmacy providers should not fear retaliation for activities other than performance. When a PBM takes action against a Pharmacy Provider, the public health and welfare suffers. The consumers in Michigan are penalized when they are forced to choose a new pharmacist. For patients with significant health issues, or the elderly, this can be quite upsetting. A Pharmacy Provider must be able to advocate on behalf of their patient without fear of retribution. A pharmacist occasionally has to contact the PBM, on behalf of their patient, to ensure that a drug that they know is covered is approved for processing. When a pharmacist is representing their patient, they must be protected to ensure the quality of care. When a PBM wants to form a new network, they simply send out contracts to the providers they want to include in that new network. Since PBMs operate several different networks at a time, pharmacy providers can have 15-20 different network contracts with any given PBM. A pharmacy provider must make a business decision on any new network agreements they are offered from a PBM, based on its business and profit potential. Therefore, a pharmacy provider should not be coerced to join a new network because they hold other contracts with the same PBM. HB 5254 will not increase costs! As always, the PBM selects which providers they want or don't want in any new network.Therefore, the PBM's negotiating position doesn't change. Claims that costs will go up and employers will drop coverage are worn-out scare tactics. Some opponents of HB 5254 want you to believe that this is going to tie the hands of the PBM and drive up costs. The truth is that Blue Cross and many PBMs report performance to their providers regularly. This legislation does not protect poor performers; it simply states that PBMs should base their decisions on their own data, not on politics or public relations! This is not Any Willing Provider legislation. PBMs can select the pharmacy providers that they want when creating a new panel or network. This legislation simply ensures that a provider can only be terminated from an existing network for reasonable cause, with notice of this action, and the right to appeal the decision. Some have suggested that pharmacy providers should form their own PBMs to compete with the PBM/Mail Order companies. This bill provides protection that a pharmacy organization won't be thrown out of a given PBM network, without reasonable cause, just because their new PBM took some business away from their larger competitor. A growing list of states have requirements in place to ensure providers maintain basic rights. These include New York, New Jersey, Massachusetts, Georgia, North Carolina, and Texas. |
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