Enforcement of new pharmacy law begins, but challenges remain
BY JOHN BRICE
THE LAFAYETTE SUN
ALABAMA — Enforcement provisions of Senate Bill 252 — also known as the Community Pharmacy Relief Act — went into effect last month after the legislation was signed into law this spring at the State House in Montgomery. Valley Pharmacy owner and Alabama Independent Pharmacy Alliance (AIPA) President Craig Moore has been closely monitoring the rollout as Pharmacy Benefit Managers, or PBMs, come under enhanced regulatory oversight by the state.
The law is being enforced by the newly formed PBM Division within the Alabama Department of Insurance (DOI). Moore said the division faces an enormous task.
“I think they have an enormous task in front of them,” Moore said. “Speaking solely from my store’s experience, I have filed around 600 complaints for underpayment violations. The department is quick to respond that they have forwarded the complaints to the PBMs for a response. I got my first resolution last week on two claims. As far as our store, I don't think they have taken any steps beyond sending complaints to PBMs. These 600 complaints have occurred since Oct. 1.”
A recent AIPA press release highlighted differences in how smaller PBMs have responded to the new law compared to larger PBMs. Moore said those distinctions are hard to see from the ground level.
“Most of the PBMs, if not all that we deal with, are the big boys,” Moore said. “I think that is a direct result of most of our commercial claims processing through larger PBMs. Remember, the big three — Caremark, Optum and Express Scripts — control greater than 80% of the entire market.”
Moore said compliance among the major PBMs has been inconsistent.
“It's definitely a mixed bag. Some have made adjustments, and some continue to totally disregard the law,” he said. “Express Scripts is not complying at all. Some are using the excuse that they are not physically located in Alabama, so they don't have to comply. One company is stating that it will take about six months to get their software compliant to pay the adjusted rate, yet they have cut reimbursements immediately. So they do what is beneficial for them, and they stall on what is beneficial for the pharmacy.”
Moore said the new law is a starting point rather than a final solution for independent pharmacies in Chambers County and across the state.
“The path forward is the attorney general is going to have to take them to court and make an example out of one of them,” Moore said. “Otherwise, they will continue to initiate a death-by-a-thousand-cuts strategy of stalling or just flat-out not complying because they know there is no consequence.”
Moore said he is encouraged by the DOI’s recent hire of Kelli Littlejohn to lead the PBM compliance branch.
“Kelli is a seasoned veteran with plenty of experience with pharmacy matters,” he said. “She has worked in high-level positions at Alabama Medicaid, and she understands the landscape and she understands what we are dealing with.”
