Is California Finally Ready for PBM Reform?
California is a leader in many things, especially consumer protection and healthcare. However, when it comes to protecting patients from the interference of Pharmacy Benefit Managers (PBM), our state is falling behind.
For the last decade, CPhA has attempted to address the unfair business practices of some PBMs with little success, primarily due to the overwhelming power and resources of PBMs and some health plans that are owned by PBMs.
We have spent the years educating legislators and legislative staff on PBMs illustrating how they are harming community pharmacy and patients. CPhA members have participated in our efforts through outreach to legislators and hosting pharmacy visits to better understand the negative impacts of these unregulated practices.
After years of fighting this battle alone, CPhA, now has a growing and dynamic coalition of support. Due to the aggressive practices of a few bad players in the PBM business, corporate-owned chains, physicians, and patient advocates are all supporting CPhA co-sponsored bill SB 966 (Wiener) due to the harm that is being caused to patients. SB 966 will require PBMs to be licensed by the Department of Insurance, providing transparency and accountability into hidden manipulations of this important health benefit and prohibit many unfair business practices that are harming patients.
PBMs play an important role in the drug supply chain, but they must function to the benefit of patients and the entire health system. Reducing patient access to their pharmacists and driving hundreds of pharmacies out of business annually to increase PBM profits, only weakens patient health outcomes and raises costs throughout the health system. There are smaller PBMs functioning as they were originally intended and it is possible that with oversight and transparency, the three large PBMs will reform their practices.
Our bill continues to have a significant amount of opposition, PCMA (the PBM trade association) health plans and the California Chamber of Commerce continue to oppose our bill. Despite this opposition, SB 966 cleared the Senate Business & Professions and Health and Appropriations Committees as well as the full Senate with bipartisan and unanimous votes.
As is the case with any legislation that faces opposition, we have made a number of amendments to address the concerns of the legislature and opposition. None of the amendments have “watered down” the bill and many of the suggested changes have made it a stronger bill.
Hundreds of communications were sent by CPhA members to their legislators over the last month and your elected representatives are listening to you. Thank you for responding to our calls to action.
The bill will now go to the Assembly where it will be heard in the Assembly Health and Appropriations Committees before going to the full floor of the Assembly.
While the votes thus far are strong, we cannot become complacent. The PBMs are not going down without a fight so there are no guarantees that we will enjoy the same success in the Assembly that we had in the Senate.
Please continue to respond to RxAlerts, it's not over until the Governor signs this vital bill into law.
— Michelle Rivas
Just as summer brings growth and constant change, this issue is all about transitions.
Those start with our theme for this issue, transitions of care. As Guest Editor Laressa Bethishou, PharmD, APh, BCPS, of Chapman University, details in her editorial on page 12, our focus is on how pharmacists in a variety of care settings are working to reduce readmissions, medication errors, and the cost of care while improving health outcomes and patient satisfaction.
In addition to the transitions of care feature articles starting on pages 13 and 17, we are proud to present a continuing pharmacy education article written by Dr. Bethishou for the PowerPak website. Be sure to use the QR code on page 23 to obtain a 25% discount for pharmacist or technician CPE credits for your study of this article.
Our Peer-to-Peer section also includes an article on using brief consultations to help Californians of Middle Eastern descent safely use acetaminophen. A second peer-reviewed article is available online, one that looks at the impact of COVID-19 vaccination status and complication risk scores on hospitalizations and mortality among veterans in Southern California.
Our incoming CPhA President, Melissa Kimura, PharmD, outlines her aspirations for the 2024–2025 year in this summer issue. As she notes in the feature article that begins on page 20, CPhA is creating a new strategic plan, continuing its governance reboot, and continuing to advocate for our ability to care for patients.
California Pharmacist is also making a big transition with this issue. Like most periodicals, we are moving from print to online-only publication. In addition to reducing our carbon footprint and reducing costs, this contemporary publication channel allows us to get important material to CPhA members and other readers more quickly and to include more material than we have been able to fit into print publications. We are also able to track your interactions with the material we publish, giving us monthly reports on what material enticed you to click. We look forward to this feedback. CPhA will send new-issue alerts to all members, content reminders each Friday as part of the CEO Message, and social media posts that reach members as well as broader audiences throughout the state and beyond.
Thank you for reading California Pharmacist and to our contributors for sharing their ideas, experiences, and research with CPhA members in all parts of the profession in the Golden State.
— L. Michael Posey, BSPharm, MA, Editor-in-Chief, California Pharmacist
