Medicare-D Plan Ready To Roll In October
March 15, 2020 The Dominion Post
Who better to design a patient-centered, pharmacy-friendly pharmacy benefit plan than a pharmacist?
That’s the premise behind a new Medicare-D plan making its debut this fall thanks to a group of independent pharmacists who got sick of being pushed around by the largest pharmacy benefit managers (PBMs) and decided to take matters into their own hands.
The result is Indy Health Insurance Co., a newly licensed insurance company on track to roll out its first Medicare-D plan offering in West Virginia this October when Medicare open enrollment begins.
“It was important to us to protect patient access,” said Eric Belldina, owner of Belldina’s Pharmacy in Masonton and managing partner for Indy Health Solutions LLC, the parent company. “Community pharmacies are uniquely positioned to care for patients, meeting the same demands as the big-box retail pharmacies but with quality and attention to detail you’d expect from a community pharmacy.” Independent pharmacies also can provide mail service if needed, which is often restricted under other plans, he added.
“Pharmacy access for patients within West Virginia has increasingly become an issue. With Indy Health, patients are once again empowered with the choice where they fill their prescriptions,” said Matt Walker, executive director of the West Virginia Independent Pharmacy Association.
DIR Fee Relief: Reducing Costs, Improving Health
Feb 14, 2020 National Association of Chain Drug Stores
Direct and indirect remuneration (DIR) fees are loopholes used by payers to claw back reimbursement paid to pharmacies for prescriptions. DIR fees result in higher cost-sharing for patients. This negatively affects “medication adherence” – it dissuades people from taking medications as prescribed. This leads to diminished health, reliance on more costly treatment, and higher overall healthcare costs.
The Centers for Medicare & Medicaid Services (CMS) recognizes that “when pharmacy price concessions are not reflected in the price of a drug at the point of sale, [patients] do not benefit through a reduction in the amount they must pay in cost-sharing, and thus, end up paying a larger share of the actual cost of a drug.”
Analysis Blows Lid Off $8.5 Billion PBM Scam, Says Community Pharmacy
Feb. 12, 2020 Yahoo Finance
A new report by one of the country’s top pharmacy industry analysts shows how giant corporate middlemen are using “obscure” fees to scoop up billions in additional profits at the expense of patients and their neighborhood pharmacies, said the National Community Pharmacists Association today.
“It should be shocking to state and federal lawmakers and regulators that pharmacy benefit manager corporations are using a government loophole to squeeze billions of dollars in fees from pharmacies, that those fees are driving up the cost of prescription drugs for patients, and that the sickest people in the country are subsidizing insurance premiums,” said B. Douglas Hoey, pharmacist, MBA, NCPA CEO.
“DIR pharmacy fees overall have skyrocketed by 1,600% in the last five years, totaling $8.5B since 2013,” says the report. According to the firm, “a loophole in the program allows health plans and PBMs to pocket an excessive amount of pharmacy DIR fees rather than offset prescription costs for seniors.” “DIR pharmacy fees overall have skyrocketed by 1,600% in the last five years, totaling $8.5B since 2013,” says the report. According to the firm, “a loophole in the program allows health plans and PBMs to pocket an excessive amount of pharmacy DIR fees rather than offset prescription costs for seniors.”
Newly Licensed Independent Pharmacy-Owned Indy Health Insurance To Launch Medicare-D Plan This Fall
Sick of being pushed around by giant pharmacy benefit managers (PBMs), independent pharmacies are taking matters into their own hands, founding a newly licensed health insurance company and debuting a patient-centered, pharmacy-friendly Medicare-D plan this fall.
Indy Health InsuranceCompany, domiciled in Arkansas and open for business, is the solution to problems community pharmacies and patients have suffered at the hands of large corporate PBMs.
“Our company is 100% independent pharmacy and pharmacy-organization owned and built on a network of 22,000 pharmacies across the country,” said Indy Health Chair Laura Atkinson.”We envision a more transparent, affordable, cost-effective alternative for community pharmacies and patients.”
Indy Health’s Medicare-D plan will offer seniors an affordable option to pair with their Medicare medical plan. Indy Health enrollees may receive their medications from their local community pharmacies in a preferred network that does not force the use of mail order or large retail chain pharmacies. “Participants may use their neighborhood pharmacy, and that pharmacy can provide mail service if needed, which is often restricted by other plans,” said Ms. Atkinson
Under Indy Health, pharmacies will pay no direct and indirect remuneration (DIR) fees — a type of “clawback” PBMs collect to offset Medicare plan member costs. In 2018 small pharmacies paid average DIR fees of $129,613 per store – an 87% increase from 2017, according to an industry survey. DIR fees are a primary factor in the epidemic of community pharmacy closures. “The absence of DIR fees is a big win for independent pharmacies, who could move from surviving the current U.S. drug pricing crisis to thriving,” said Ms. Atkinson.
Indy Health Announces New Executive Leadership Team
October 24, 2019
Indy Health Incorporated, the nation’s first MedicarePart D plan wholly owned by independent pharmacies and independent pharmacy organizations, will introduce its executive team at a by-invitation meeting at the National Community PharmacistsAssociation convention in San Diego, California on Saturday, October 28.
“We couldn’t be more excited to introduce this new leadership team,” said Laura Atkinson, CEO and co-founder of Indy Health Solutions LLC, the parent company. “We were fortunate to find these individuals, each of whom embodies the values and commitment Indy Health brings to the Medicare D marketplace. Together they bring a bold combination of spirit, commitment to care and a fierce desire to provide much-needed transparency which some PBMs have failed to do resulting in high drug costs for consumers over the last many years.