Understanding Deceptive PBM Practices


In an interview at AAP 2024, Douglas Hoey, CEO of NCPA, talked about changing the pharmacy payment model and deceptive practices being employed by PBMs.

At the American Associated Pharmacies (AAP) Annual Conference, held April 4 to 6 in San Diego, California, Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA), sat down with Drug Topics to talk about different ways to change the current pharmacy payment model, such as cash pricing and clinical services, deceptive practices being employed by PBMs, and why it’s crucial for pharmacies to thoroughly read their contracts.

“NCPA talks about changing the pharmacy payment model, that is our core mission, to facilitate changing the pharmacy payment model,” Hoey said. “Medicaid and Medicare reform are certainly ways to do that. Another way to do it is to really encourage pharmacies to look at their cash pricing. We see more and more patients who choose cash pricing because it’s less expensive than going through their insurance.”

Being fairly paid for clinical services is another important way to change the pharmacy payment model. While more and more pharmacies are having the opportunity to do that, NCPA created the Community Pharmacy Enhanced Services Network (CPESN) to help facilitate it further. Aside from pharmacy payment models, Hoey also discussed deceptive tactics that PBMs are using to get independent pharmacies into their network.

“One thing that we’re keeping an eye on is that [PBMs] may be having difficulty forming those networks because it seems like we’re seeing more, what we would say, are deceptive tactics of creating these pharmacy networks,” Hoey said.

An example Hoey gave was a “phantom fax.” This is where a PBM will tell a pharmacy it faxed them a contract, but the pharmacy never receives it. Since the pharmacy never responded to the alleged fax, the PBM will automatically put them in its network.

“We’re seeing more tactics like that, and that’s just something for pharmacies to be aware of,” Hoey said. “They really need you in that network. Be on the lookout if they’re trying deceptive tactics to get you in the network.”

Click here to see all of our AAP 2024 coverage.

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