COA Executive Director: COA Conference is ‘Reinvigorating Pharmacists to Stop PBM Abuses’

Pharmacy Times interviewedTed Okon, MBA, executive director of the Community Oncology Alliance (COA), on the experience of the first in-person COA conference in 2 years.

Alana Hippensteele: Hi, I'm Alana Hippensteele with Pharmacy Times. Joining me is Ted Okon, MBA, executive director of the Community Oncology Alliance (COA), to discuss key highlights from the COA 2022 conference.

So, Ted, how was the COA conference this year and what were some moments of note?

Ted Okon: Yeah, the conference was great. As you can see, I'm just coming off that sort of post-conference high, if you will, and trying to get back into the swing of things.

Alana, I think what was interesting is that the conference was a combination of a couple things. Number one, it was getting people together. So, we had over 1500, I guess close to 1600 people live—that's a fair amount of people to get together. So, I think they enjoyed not only hearing what I think were some great sessions on several different timely topics, but the fact that they were all together, and you could network, you could talk, you could share ideas.

It's one thing to be able to do that on Zoom, it's another thing to be able to do that in person. So, I think it was really that combination of some great speakers, great panels, and great presentations, combined with the fact that people just wanted to get back together again.

Alana Hippensteele: In terms of both networking and the opportunity to gather new information in the field. How do you think the experience of meeting in person this year affected that in relation to in person versus virtual attendance for those who attended?

Ted Okon: Yeah, I mean, virtual is great. Of course, the [COA] conference was held virtually the last 2 years—you can hear panels, you can hear presentations—but there's nothing like a substitute for this spontaneous exchange of information.

I can't even tell you how many meetings that I had that were spontaneous—going over to a corner, talking about things like pharmacy benefit managers (PBMs) or the 340B program, or the impact of COVID on cancer care. So, it was really one of those things where it really showcased the spontaneity of being able to exchange ideas and talk as opposed to on a structured Zoom. Of course, when you're viewing the presentation, virtually, you can’t interact—you can in terms of you can ask questions, but it's not the same interaction as you get in person.

Alana Hippensteele: Absolutely. You moderated a session at the COA conference on legal and legislative actions to curb abuses relating to pharmacy benefit managers. Do you have any key takeaways to share from this discussion?

Ted Okon: Well, first, although I moderated something on PBMs and we also had a panel on state PBM issues—those 3 little letters, PBM, came up in so many panels. It was amazing.

In fact, I was asked the other day in a radio interview what was the highlight, and I said the 3 little letters PBM. We had 2 great panelists, Jeff Mortier, who heads our outside lobbying group, former staffer on the Energy and Commerce Committee, really understands the PBM issues and sort of has the pulse of where it is. Jeff talked about the fact that not only has there been a hearing on PBMs in November, where I testified, but there is more bipartisan activity related to PBMs than we've ever seen before, and that was interesting.

On a legal perspective, Jonathan E. Levitt, Esq, from the law firm Frier Levitt who we retained, Levitt talked about where the legal issues are heading and the fact that the PBMs are running into several legal issues. John's a believer that there are things like the any willing provider law and some other laws that really go against what PBMs are currently doing, and we kept that at a federal level.

Alana, what was interesting is we had a panel later and literally at the end of the conference, that was a great panel talking about all the state activity. In fact, this morning, I tweeted out activity in Missouri, activity in Vermont, new activity in Ohio. So, you see more of the states, and that's one of the reasons why COA has created a state function, literally to look at all these state laws that are coming up, and even take some of those and bring those to the federal level.

Alana Hippensteele: Do you think that there might be a trickle-down effect in terms of federal legislation impacting on the state level? Or would you say potentially the opposite, or is that hard to tell?

Ted Okon: I'd say trickle up, frankly, I say trickle up. In terms of what you see happening at the state level, and the opportunity to basically introduce some of those concepts into federal legislation. For example, Texas has passed this gold card that basically says that if you're adhering to established pathways, you shouldn't have to get a prior authorization on every cancer patient or any patient in general. So, we're thinking about getting that gold card concept at the federal level. So, I think you see more trickling up.

I think the other thing, one of its interesting is that you have members of Congress who now realize what's going on in their state, and are coming back to Washington, DC, and say, we have to do more on PBMs. As I said, currently, there is so much that is partisan. It's like everything is partisan—but this is actually a bipartisan area.

I just recently saw Senator [Chuck] Grassley push the FDC to do a study on PBMs—Senator Grassley, of course, being a Republican—and Senator [Ron] Wyden, the top Democrat, the chair of the Senate Finance Committee, literally doing a lot on PBMs. He even gave an interview on NPR, about how the pharmacists in his state are going out of business because of PBM abuses.

Alana Hippensteele: You also moderated a session on cancer politics and policy in Washington, DC. Do you have any highlights to share from this discussion that may be of interest to an audience of oncology pharmacists, or would you say this conversation around PBMs was similar in this discussion as well?

Ted Okon: It was PBMs—it's amazing. The reason why we have this panel is it gives a chance for some of the other cancer organizations, as well as the distributors, to basically give their view of the world of policy in DC.

When I got onto the question of PBMs, it was uniform in terms of the PBM abuses that came out all during the conference. Adam Fein, CEO of Drug Channels Institute, gave an interesting presentation that hit on PBMs and the consolidation that was happening there.

It was very interesting to see these other oncology groups basically say the same thing that we're seeing on the PBM front.

Alana Hippensteele: Yeah, absolutely. I can imagine. How might insights gleaned from this conference impact oncology pharmacy practice this year?

Ted Okon: Well, I think it's got everybody revved up. Whether you're talking about PBMs, trolling for patients, mandating that patients get their prescriptions, not at their pharmacy of choice or their provider of choice, but literally through the mail-order pharmacy, or things like [direct and indirect remuneration (DIR)] fees—these were a hot topic.

So, these [DIR] after sale fees are just literally obliterating and creating pharmacy deserts and putting so much pressure on pharmacy providers that the talk around the conference, I think from several different perspectives, presentations, and panels have invigorated the pharmacy community to say, ‘Hey, we are making a difference with laws, we can make more of a difference, and let's get engaged.’

So, we really are trying to empower pharmacy providers, whether they be associated with oncology practices or urology practices, or even independent pharmacists out there. I have a great rapport with the independent pharmacists out there and empowering them to basically talk back and talk to their legislators, whether it's at the local level, the state level, or the federal level. So, I think one thing if I can sort of say came out of this is that it was a reinvigoration, especially, as I said, being live to say, ‘In the pharmacy community, we can make a difference.’

Alana Hippensteele: Absolutely, absolutely. Beautifully said. Any closing thoughts?

Ted Okon: I think that really the closing thought here is that when you look at some of this PBM bad behavior, it seriously does impact patients. I tell the story about right before the pandemic of being in Senator [Bill] Cassidy's office, who's also a physician, and having a brother and a sister from Louisiana, tell the story of it taking their mother 2 months to get her medication. Unfortunately, the week before she got her medication, she was admitted to hospice, and the week after she got her medication, she died.

That daughter said, ‘I'm not saying Senator, that basically getting that medication would have saved my mother's life or even expanded her life, but it took away her hope. The fact that she couldn't get it took away her hope.’ I think that we see that, unfortunately, too much across the country. I think if one thing came out of this conference, it’s this reinvigoration, if you will, to really stop these PBM abuses.