In This Issue:

• FTC Slams PBMs in Second Interim Report
• Poole named to Kentucky Board of Pharmacy
• Great CE Programs Planned for Annual Meeting
• Helpful Tips for Potential Increases in Reimbursement through Manual MAC Appeals
• On The Shelf: Biolyte

FTC Slams PBMs in Second Interim Report

Report focuses on generic specialty drugs

The Federal Trade Commission published a second interim staff report this week on the prescription drug middleman industry. The report focuses on pharmacy benefit managers’ (PBMs) influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV, and a variety of other critical drugs.

The report found that the "Big 3" - Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx) - marked up many specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and others by hundreds of percent. These markups generated more than $7.3 billion in revenue from dispensing these drugs in excess of the drugs' estimated acquisition costs from 2017-2022.

Click here to read the full release from the FTC.

Poole named to Kentucky Board of Pharmacy

Ron Poole

Kentucky Governor Andy Beshear recently appointed APCI Board Member Ron Poole to serve on the Kentucky Board of Pharmacy. Ron replaces John Fuller, who recently resigned, and will serve the remainder of the term expiring Jan. 1, 2027. Ron previously served on the Kentucky Board of Pharmacy from Jan. 1, 2017 through Dec. 31, 2020.

Ron is from Central City, Kentucky and is the owner of Poole’s Pharmacy Care. Ron’s leadership, knowledge and dedication will be beneficial as he works to fulfill the mission of the Kentucky Board of Pharmacy.

Congratulations Ron and thank you for your service!

Reminder: Great CE programs planned for 2025 APCI Annual Meeting

Registration open for March 20-23 meeting

We're putting the final touches on some GREAT CE sessions for the 2025 APCI Annual Convention with actionable intelligence that members can put to use immediately in their pharmacies after the convention! Learn more and register today at https://convention.apcinet.com/.

Helpful Tips for Potential Increases in Reimbursement through Manual MAC Appeals

The APCI Choice team has learned that members are seeing positive results when submitting manual MAC appeals to the following PBMs. The following tips are intended, when possible, to produce positive increases to losses incurred when adjudicating a generic prescription that was reimbursed at MAC reimbursement rate:

Express Scripts Portal: 
Pharmacist Resource Center | FAQs - After logging into the ESI portal, across the blue ribbon at the top, choose APPEALS and fill in the required info. This process is very straightforward and easy to do. You MUST submit an invoice showing your latest acquisition cost. Again, the instructions are very clear on how to do this. Redact EVERYTHING on the invoice except for what is required.

CVS Caremark Portal:
Sign In - After logging into CVS Caremark portal, across the black ribbon at the top, choose APPEALS MENU and then submit appeal. This process is very straightforward and easy to do. You MUST submit an invoice showing your latest acquisition cost. Again, the instructions are very clear on how to do this. Redact EVERYTHING on the invoice except for what is required.

As a reminder, Health Mart Atlas (HMA) submits eligible MAC appeal claims to the following list of PBMs:

• American Healthcare
• Blue Eagle
• Change Healthcare (now Optum)
• DST
• Elixir
• Magellan
• Maxorplus
• MedImpact
• MedOne
• Navitus
• OptumRx
• ParamountRx
• PDMI
• ProCare
• ServeYou

Biolyte: IV in a Bottle

Biolyte powdered drink mix contains all the benefits of BIOLYTE® bottles in a small, convenient package.

Simply mix with 16oz of water for fast dehydration relief. Punch, Citrus and Melon flavors available now!

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