The Georgia Pharmacy Association

The Georgia Pharmacy Association is the organization for Georgia pharmacy professionals who care about their pharmacy practice, the health of their patients, and their own careers.

GPhA provides legislative and political advocacy, information services and professional development to more than 10,000 Georgia pharmacists. We’re the collective voice for pharmacy in Georgia, and our voice is louder with you as a member.

GPhA Buzz by Andrew Kantor

The August/September issue of Georgia Pharmacy is here

The new issue of Georgia Pharmacy magazine will be hitting mailboxes soon, but if you like pixels over atoms, check it out on Issuu:

Prefer a PDF? Click here to view or download that instead.

Andrew Kantor • July 22, 2016

The right way to treat someone who’s addicted to painkillers

Rule number 1: Ignore shows and “counselors” that give bad advice, such as “Celebrity Rehab with Dr. Drew.”(More than 13 percent of participants died after treatment).

You want to find treatment that’s based on evidence, not anecdote and not “…what I’ve seen work on my patients.”

Addiction expert Maia Szalavitz at FiveThirtyEight has an article about what you should be doing: “What Science Says To Do If Your Loved One Has An Opioid Addiction.”

Andrew Kantor • July 22, 2016

US drug shortage has FDA reluctantly turning to banned Chinese plant

A Chinese factory had a history of poor quality control, plus it was found to have manipulated data. In September, the FDA issued a ban on import from the facility.

But — faced with a shortage of some cancer drugs in the U.S. — the FDA is now allowing the plant to continue to export drug ingredients to America. The factory owners say they are taking quality seriously.

Andrew Kantor • July 22, 2016

Update on the Aetna-Humana and Anthem-Cigna mergers

There was supposed to be a hearing by the Department of Insurance about the Aetna-Humana merger, but it’s been postponed because the feds have filed a suit to block the proposed deal over anti-competitive concerns. Georgia is part of that lawsuit.

As for the Anthem-Cigna deal, Georgia is one one of 11 states to oppose it because of the potential harm it would do to patients and consumers. There’s also a federal lawsuit pending to stop that merger.

Read it all in Georgia Health News.

Andrew Kantor • July 22, 2016

Help Georgians quit tobacco with DPH initiative

The DPH’s Georgia Tobacco Use Prevention Program has a program for the healthcare community called Georgia cAARds — it stands for “Ask, Advise, and Refer with Follow up.” It’s based on the well-known 5As model for treating tobacco use.

You can get free online training in implementing the cAARds system, which includes 1 CME, by signing up at GAtobaccointervention.org.

So what is cAARds?

The idea is for healthcare providers to spend just a few minutes with each patient: You ask them about tobacco use, advise them on the benefits of quitting, and then refer them to a tobacco cessation counseling program such as the Georgia Tobacco Quit Line.

After you handle two of those “5 As,” the GTQL handles the other three (assessing, assisting, and arranging follow ups).

Help your patients who still smoke and get free online training and CME — sign up at GAtobaccointervention.org.

For more information on the training, Georgia cAARds, or the Georgia Tobacco Quit Line, drop a note to  Kayla Lloyd, GDPH’s tobacco cessation coordinator at Kayla.Lloyd@dph.ga.gov.

Andrew Kantor • July 22, 2016

HHS has new nondiscrimination rules for pharmacists

From our friends at the National Alliance of State Pharmacy Associations:

Federal Nondiscrimination Regulation Imposes Key Requirements on Pharmacies

The U.S. Department of Health & Human Services released the Nondiscrimination in Health Programs and Activities Final Rule in May of this year. Most of the provisions of this rule go into effect next Monday, July 18, 2016.

For more information and tips on how to comply, please see this resource from the American Pharmacists Association: https://www.pharmacist.com/federal-nondiscrimination-regulation-imposes-key-requirements-pharmacies.

Andrew Kantor • July 22, 2016

GPhA to insurance commissioner: Oppose Humana-Aetna merger

In a public-comment letter to State Insurance Commissioner Ralph Hudgens today, GPhA urged the commissioner to oppose the proposed merger of health insurance titans Humana and Aetna.

This is the final day to submit written comments to the Insurance Commissioner. A public hearing on the proposed merger is scheduled for this coming Tuesday, July 26 at the State Insurance Commission in downtown Atlanta. There, among other groups, the Medical Association of Georgia is expected to testify in opposition to the merger.

The entire text of GPhA’s letter to Commissioner Hudgens follows here.

 

July 21, 2016
 

Commissioner Ralph T. Hudgens
Office of Insurance and Safety Fire Commissioner
Two Martin Luther King, Jr. Drive
West Tower, Suite 704
Atlanta, Georgia 30334

 
Re:  Aetna, Inc./Humana, Inc. proposed merger

Dear Commissioner Hudgens,

Thank you for the opportunity to be heard on this important issue. The Georgia Pharmacy Association (“GPhA”), which represents the interests of Georgia pharmacists in all practice settings, is extremely concerned that this proposed merger will have a negative impact on Georgia patients as well as Georgia healthcare providers.

Specifically, based upon the information submitted, there appears to be strong evidence that “the effect of the acquisition may be substantially to lessen competition” with regard to individual, small group, large group, and Medicare insurance. These concerns have been raised in Medical Association of Georgia CEO Donald Palmisano’s March 1, 2016, written correspondence to your office.  GPhA shares the concerns raised in that letter and urges its consideration prior to any decision regarding the proposed merger.

Consolidation in the insurance industry, including health insurers and pharmacy benefit managers with whom health insurers contract (PBMs), leaves Georgia patients and Georgia pharmacies particularly vulnerable.  As a result of little to no bargaining power, pharmacies find themselves in the position of entering into take-it-or-leave-it provider agreements which often, among other things:

  • Force participating pharmacies to charge patients more than a drug actually costs and pass along the excess to the PBMs;
  • Prevent participating pharmacies from informing patients of lower-cost alternatives;
  • Force participating pharmacies to accept negative reimbursements on prescriptions;
  • Force participating pharmacies to offer pharmacy services beyond the filling of prescriptions without reimbursement;
  • Withhold money from pharmacies in connection with unattainable metrics;
  • Charge pharmacies different types of fees, including direct and indirect remuneration fees, often undisclosed at the time of claim processing (these can amount to thousands and thousands of dollars per year);
  • Prevent participating pharmacies from being reimbursed for compounded products; and
  • Prevent participating pharmacies from being reimbursed for refills or prescriptions beyond a thirty (30) day fill.

These contracts typically contain arbitration clauses, confidentiality clauses, and the ability of the health insurer/PBM to terminate pharmacies from networks without cause. These provisions have a silencing effect, as pharmacies often fear retaliation and network termination.

Interestingly, Humana Pharmacy Solutions recently promulgated a proposed contract amendment that has garnered the attention and concern of U.S. Congressmen Doug Collins and Buddy Carter. In a press release on the issue, Rep. Collins stated:

Humana, one of the largest insurance providers in the country, currently has a proposal th[at] would require these small pharmacies to lose $5.00 per prescription, up front, with the hope that they will be reimbursed if they meet certain metrics. However, meeting all of the criteria is not a guarantee that the pharmacy will get reimbursed because there are only spots in the top rankings for a few pharmacies. Under this proposal, a pharmacy could meet most of the CMS benchmarks, provide quality customer care, and still not be reimbursed by Humana. Humana’s criteria has little to do with patient care, and everything to do increasing their profit and driving community pharmacies out of the market. Some of these metrics, including “patient adherence” are beyond the control of the pharmacists. Pharmacies already compete for customers and business, let’s not set a precedent to make them compete for reimbursement by insurance companies as well.”

While Humana Pharmacy Solutions does not appear to be actively registered with your office as a pharmacy benefit manager, the company appears to operate in that capacity within the state. The notice addressed by Congressman Collins was sent to participating Georgia pharmacies. In light of actions such as the one described by Rep. Collins, there is real concern amongst Georgia pharmacists that further consolidation will result in even more onerous contractual practices.

Contractual provisions aside, industry consolidation in the health insurance industry has resulted in health care providers being excluded from networks and patients being divested of their choice in healthcare providers.   With regard to pharmacy in particular, pharmacies are often excluded from networks, and patients are often forced to use mail-order pharmacies or steered to mail-order pharmacies via incentives such as reduced copays.  Indeed, on a daily basis, Georgia pharmacies are unable to fill certain prescriptions for patients with insurance coverage because when they attempt to process the claim, they get a reject code specifying mail-order is required. This, despite the fact that Georgia has an anti-mandatory mail-order statute which provides, among other things, that insurers cannot force insureds to use mail-order; and that “[i]nsureds who do not utilize a mail-order pharmaceutical distributor shall not be required to pay a different copayment fee . . .”  See O.C.G.A 33-30-4.3.

The foregoing problems are a result of an already highly concentrated market. GPhA believes this proposed merger, should it move forward, will exacerbate these problems. Unequal bargaining power is a bad thing for Georgia providers and consequently, a bad thing for Georgia patients.  Moreover, lack of patient choice does not improve healthcare, it undermines it.  As such, GPhA encourages you to exercise your authority under the law and issue an order blocking the proposed merger on the grounds that “the effect of the acquisition may be substantially to lessen competition.”

Sincerely,

Greg Reybold

Vice President of Public Policy & Association Counsel

 

cc:  GPhA Board of Directors

GPhA CEO Scott Brunner, CAE

Scott Brunner • July 21, 2016

Coming soon: Your 2016-17 GPhA dues invoice

"...and if you pay your GPhA dues on time, we promise to stop pestering you to pay your GPhA dues on time."

“…and if you pay your GPhA dues on time, we promise to stop pestering you to pay your GPhA dues on time.”

It’s (almost) that time again: Time to renew your GPhA membership for 2016-17.  We’ll be mailing your dues invoice to you in early August, and you’ll have a variety of options for remitting payment, including monthly via credit card charge. We want you back as a member, so PLEASE RENEW YOUR MEMBERSHIP BY SEPTEMBER 1…and help us continue to provide essential support and protection for your profession.

[ Cartoon credit: Originally appeared in The New Yorker, but we fiddled a bit with the caption for our purposes.  Can you tell? ]

Scott Brunner • July 20, 2016

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Opportunities to Engage by Phil Ratliff

GRITS sidebars: where the action is and how you can get in on it

GRITS got you in fits? We’ve got something for that, ya know…

[Read it!]

July 19, 2016 • Phil Ratliff

Communication expert Allison Linney’s convention session rescheduled

Allison Linney has gotten some sleep and is ready to deliver Critical Conversations: Coaching Patients to Adherence via our Go To Training platform. Read more….

[Read it!]

July 19, 2016 • Phil Ratliff

Explore How Specialty Pharmacy Can Transform Your Practice

Ever curious about how specialty pharmacy could become your specialty? Find out more with our August CPEasy series.

[Read it!]

July 19, 2016 • Phil Ratliff

• Announcing: Specialty Pharmacy series – registration now open

• Registration for LeadershipGPhA is now open

• Online training for pharmacists and techs on Georgia’s PDMP revisions

• Learn to expand your immunization practice using GRITS in this new webinar

» Click here for more ways to engage with GPhA....