Under Assault: teaching in NYC: Pharmacy Benefit Mgrs

Congress should (excerpted from a BipartisanPolicy.org post):

Require PBMs to provide cost disclosures and report on negotiations with drug manufacturers and profits from spread pricing and pharmacy fees to plan sponsors

Report annually to the FTC on spread pricing, pharmacy payments, changes to formulary tiers, and differences in reimbursements to different pharmacies [so] policymakers and employers could better determine whether and by how much PBMs are impacting the cost of drugs and thus design evidence-based solutions

[With] transparency requirements ... employers could negotiate fairer contracts with PBMs to mandate transparency, limit spread pricing, and require pass-throughs.

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BILLS

Cantwell and Grassley (for the Committee on Commerce, Science, and Transportation), bill of May 24, 2022 (S.4293) “Pharmacy Benefit Manager Transparency Act of 2022”

Prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.

Prohibits PBMs from arbitrarily, unfairly, or deceptively (1) clawing back reimbursement payments, or (2) increasing fees or lowering reimbursements to pharmacies to offset changes to federally funded health plans. PBMs are not subject to these prohibitions if they (1) pass along 100% of any price concession or discount to the health plan, and (2) disclose specified costs, prices, reimbursements, fees, markups, discounts, and aggregate payments received with respect to their PBM services.

Must report annually to the Federal Trade Commission (FTC) certain information about payments received from health plans and fees charged to pharmacies.

FTC and state attorneys general are authorized to enforce the provisions of the bill

https://www.congress.gov/bill/117th-congress/senate-bill/4293

Cantwell and Grassley (for the Committee on Commerce, Science, and Transportation), bill of Jan 26, 2023 (S.127) “Pharmacy Benefit Manager Transparency Act of 2023"

Reintroduction of 2022 bill as above

https://www.congress.gov/118/bills/s127/BILLS-118s127is.xml

The author of this blog

UA retired from teaching after 24 years, having built more than a couple of dozen school choruses and conducted them in well over 100 concerts. Her absences have been infrequent, her ratings satisfactory, and she teaches with enthusiasm. In some years, up to 450 students have passed through her classroom each school year.

UA was a musicologist before she became a teacher and held the position of senior staff editor on the world's largest and most comprehensive encyclopedia of music (The New Grove Dictionary of Music, 29 vols.). She is known for her scholarly work on some of the longest (and most tedious) bibliographical articles in the main work and the subsequent offshoot reference books. She also trained as a coloratura in New York, London and Italy, and has a working knowledge of several other languages.

After a flirtation with rumba and tango, UA wrote a play on ballroom partner dancing called Real Changes, which makes side trips into Zen, intellectualism/eroticism, tragedy/comedy, a parody of Shakespeare's Love's Labours Lost, Nietzsche's early works, and nirvana. (She is still not clear which of these should dominate the psyche, but is happy to have spent four years trying to find out.

Before her recent retirement, UA thought she could pass the remaining years of her career in relative calm. But this was not to be. She was excessed for the second time in her career and was for a year and a half a sub, or in the vernacular, an ATR. A successful grievance restored her to a position, but a principal has many ways to keep someone squirming. Teaching fully out of license was one of them, during which time she lost her desire to teach at all.

It is very hard to tell whether she was excessed in that period because her subject is music (which is not particularly respected in this school system), or because she was becoming too old, too expensive, or too ... "vocal."

Under Assault: teaching in NYC

RESOURCES

Pharmacy Benefit Mgrs

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