Ohio Leads the Way in Pharmacy Reform, Will Other States Follow?

The United Pharmacy Association (URPhA) is in its infancy and just like any baby, it’s growing daily and finding its way. This baby is lucky to have been born in Ohio, because it is Ohio that’s leading the way in pharmacy reform.

Ohio Attorney General Dave Yost has been taking on pharmacy benefit managers (PBMs) for the past 2 years. Yost has twice sued PBMs for overcharging the state of Ohio by billing state agencies more for prescriptions than was paid to the pharmacies that dispensed them. He has called for legislative reforms and it doesn’t look like he’s ready to stop battling with PBMs any time soon.

At the end of last year, a group of Ohio’s professional associations formed The PBM Accountability Project of Ohio. The project aims to make policymakers and the public aware of the practices of PBMs and hopes to work on policies to address them.

“Lawmakers and administration officials in Ohio have been addressing the role of PBMs and we encourage the incoming General Assembly to continue this work,” Ernie Boyd, executive director of the Ohio Pharmacists Association, said in a statement to an Ohio Capital Journal reporter. “The PBM Accountability Project will provide a platform for more perspectives on how PBM practices impact patients and providers and why reform is necessary.”

At the end of June, a small group of independent pharmacy owners from Mahoning, Trumble, and Columbiana counties met with an Ohio lawmaker to collaborate on a proposal for legislation similar to that which passed in Arkansas. Simply stated, PBMs must reimburse pharmacies fairly and must not give negative reimbursements that result in the pharmacy paying for the patient’s prescription.

If a pharmacy does not agree to this loss, the insurance will refuse to contract with the pharmacy, and thus, insured patients will go to their “preferred pharmacies.”

Currently, the Ohio State Board of Pharmacy is using data from polling pharmacists in the state using a workload survey. Ohio collected more than 150 pages of comments from pharmacists, in addition to the survey responses, and decided to take action. The Ohio State Board of Pharmacy is drafting a proposal to create a Pharmacist Workload Advisory Committee to ensure compliance with companies providing a safe workplace and adequate staffing.

What the Ohio State Board of Pharmacy is doing on a state level is what URPhA is doing on a national level. URPhA uses the data from weekly polls and other sources of input from pharmacists, their technicians, and interns, to identify problems and solutions for improving the profession of pharmacy and the health care industry. URPhA also reaches out to lawmakers on behalf of initiatives created by its members.

This is an important time to be heard and pharmacy professionals continue to be ignored, even during this time of vaccine mania. The COVID Response Team has not had a licensed pharmacist aboard. The media hasn’t focused on the pressure and stress the vaccine rollout has placed on community pharmacists.

Many pharmacists must find a way to vaccinate hundreds of patients in an organized way, while still having to run an understaffed pharmacy. Many ended up with COVID and many went back to work after recovering and worked overtime to inoculate their communities.

Pharmacists and their team members face multiple uphill battles at once.

Understaffing has been one of the biggest issues in the profession. It’s a consistent problem in settings in which industry giants own thousands of pharmacies across the nation and generate billions in profit every year. These corporations can afford to pay for more technician hours, pharmacist overlap, and fair wages. Yet, polling indicates understaffing is a common issue that leads to mistakes within the workflow.

In addition to the understaffing, there are a multitude of other issues, such as no breaks for a pharmacist during a 12-plus-hour shift or being pushed to meet excessive amounts of unrealistic and profit-driven metrics, which do not align with quality patient care, or blatant discrimination.

The sum of these issues is corporate fascism—it has been normalized. It has become commonplace for the governors to appoint district pharmacy managers of giant corporations to their state boards of pharmacy.

There is no national board of pharmacy. Subsequently, there’s no regulator of large corporations and conglomerates whose policies across the nation may be a danger at most, unethical at least, and most certainly seen as an insult to the practice of pharmacy by the standards of state pharmacy laws and those who abide by them. Conglomerates are creating their own laws and there doesn’t seem to be much stopping them.

PBMs, your “pharmacy insurance” managers, are the Wall Street of the health care industry. They’ve gone almost completely unchecked until just recently, as mentioned, where several states have sued PBMs and have gained some ground.

Almost all other states have yet to show interest. Conglomerates easily push out small businesses, and seemingly violate anti-trust laws in numerous ways.

These are national problems because the industry giants are national and communities across the nation have lost the power to choose. Local pharmacies disappear and their preferred pharmacy shows up somewhere within 25 miles of them.

Another issue that consistently shows up in polling/survey data is the same big corporations use retaliation methods to discourage pharmacy associates from stepping up to communicate a problem and, in some cases, a solution. In a recent survey, retaliation was experienced after voicing a complaint about a company policy or person for over 45% of witnesses polled.

URPhA is proud to be born in Ohio and it wants to inspire the same level of pharmacy focus and reform as valued pharmacy associations in Ohio and beyond. URPhA is a national movement.

All pharmacy staff, from anywhere in the United States, should participate in polls and surveys whenever possible. Gathering data can help us achieve a picture of what is needed for the profession to improve and thrive.

The other important arm of URPhA is to give back to the profession by paying it forward to students and newcomers. Membership proceeds go to scholarship funds.

Buying a 1-year membership, annually, keeps the train moving forward and it helps not only the profession as a whole, and potentially your workplace, but it helps students who deserve the chance to shine and potential pharmacy owners who have a vision to manifest.

This is an important time to be heard and it is an important time to support one another. Change can and does happen all the time and there is power in numbers.

For us, the pharmacists, the pharmacy technicians, the pharmacy interns—we are pharmacy. We are 700,000-plus strong and we see the inside view of the health care system.

We are privy to how insurance works, how reimbursement works, how drug purchasing and pricing works, how conglomerates work, how medications work, how the pharmacy industry works, how the FDA works, how the DEA works, and anything else from prescribing patterns of physicians in the community to how much profit is made by giving a flu shot.

It is a wonder you really don’t hear that much about pharmacists in the media. Pharmacy professionals can take their rightful position as insightful members of the health care community. We have valuable information to offer at a time when we have the chance to be heard.

It will take a few hundred thousand of us to participate in regular online activism, which will only take 30 seconds per week. Answer our weekly polls at unitedpharmacistsassociation.org.

You are pharmacy. Together, we are pharmacy.