John Hickman

President, Dyer Drug Store Inc.

[John Hickman @hickmanjd]

Congratulations Carter!

[Carter High @CarterHighRPh]

This past weekend I was awarded @TXpharmAssn RPh of the year for all my years (16 yrs and 7 #txlege sessions) of legislative pharmacy progress. Thank to everyone that supported me in my pharmacy journey😊

[American Pharmacies @APRxNews]

𝐔𝐒 𝐇𝐨𝐮𝐬𝐞 𝐏𝐚𝐬𝐬𝐞𝐬 𝐁𝐢𝐥𝐥 𝐭𝐨 𝐀𝐮𝐝𝐢𝐭 𝐓𝐑𝐈𝐂𝐀𝐑𝐄
Yesterday, the U.S. House passed the National Defense Authorization Act with a provision requiring an annual study of the TRICARE PBMs contracting to reveal differences in reimbursement rates and fees between PBM-affiliated and independent pharmacies, including clawbacks, price concessions, per-prescription administrative fees, prior authorizations, dispensing timeliness, and retail network adequacy. Furthermore, Long Term Care pharmacies will now be included in this study. The Senate will take up a similar measure soon.

Link to House Bill Text: https://t.co/0I5FEBL7zE

[American Pharmacies @APRxNews]

Today, Dr. Micah Lansford, owner of Roden-Smith Pharmacy in Clovis, New Mexico, and a member of the American Pharmacies Board of Directors, delivered compelling testimony before the US Senate Armed Services Committee, challenging Congress to take a closer look at the TRICARE pharmacy program.

“The issue before this Committee is whether the TRICARE pharmacy benefit is being managed for military families and taxpayers, or whether ESI is exploiting its contract structure to benefit itself at the expense of local access, patient choice, and community-based pharmacy care.”

The hearing examined whether the current TRICARE pharmacy benefit is serving military families or enabling conflicts of interest within its administration. Members of the Committee challenged Express Scripts CEO Adam Kautzner on whether ESI can fairly administer the benefit while also operating affiliated pharmacy businesses that may benefit from the program.

Military families deserve transparency, accountability, and a pharmacy benefit built around patient care—not one that puts local access, patient choice, and community-based pharmacy care at risk. It’s time to ensure TRICARE works for the service members, veterans, and families who depend on it.

You can view the full hearing here: https://t.co/rnCYLF2Yz1

[Texas Pharmacy Assn @TXpharmAssn]

Exactly one month from today, pharmacists, #pharmacy technicians, and student #pharmacists just like you will gather in The Woodlands to celebrate their Main Character Energy!
Pharmacy professionals are no longer just supporting cast members on the health care team. We're coming into our own as lead characters and active participants, elevating the profession and advancing the practice to care for patients all across Texas.
Don't miss out on the fun and the celebration! Register today to join us July 24–26 in the Houston area. https://t.co/KhU5Cph1UQ

[Ginny Crisp, PharmD @ginny_crisp]

When a PBM says "we pass through 100% of rebates," ask: 100% of what the PBM received, or 100% of what the manufacturer paid? Those are different numbers. A middleman sits between them.

[Senator Bryan Hughes @SenBryanHughes]

Last session, we passed SB 1236 to put a stop to anti-competitive practices by Pharmacy Benefit Managers (PBMs) that have driven up prescription drug costs and forced local pharmacies out of business.

Yesterday, the Senate Committee on Health and Human Services monitored the implementation of that legislation as part of a comprehensive look at how we can make healthcare more affordable.

Thank you, Chair @LoisKolkhorst, for pressing in on ways we can lower healthcare costs for Texas families.

[Save Independent Pharmacy @BrandiChane]

Ask every plan if they will go back to a true pass through PBM model @electcharles @LoisKolkhorst @MollyforTexas

[American Pharmacies @APRxNews]

𝐔.𝐒. 𝐑𝐞𝐩. 𝐁𝐮𝐝𝐝𝐲 𝐂𝐚𝐫𝐭𝐞𝐫 𝐢𝐧𝐭𝐫𝐨𝐝𝐮𝐜𝐞𝐝 𝐚 𝐫𝐞𝐬𝐨𝐥𝐮𝐭𝐢𝐨𝐧 𝐫𝐞𝐜𝐨𝐠𝐧𝐢𝐳𝐢𝐧𝐠 𝐎𝐜𝐭𝐨𝐛𝐞𝐫 𝐚𝐬 𝐀𝐦𝐞𝐫𝐢𝐜𝐚𝐧 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐬𝐭𝐬 𝐌𝐨𝐧𝐭𝐡. 𝐈𝐧 𝐫𝐞𝐬𝐩𝐨𝐧𝐬𝐞, 𝐀𝐦𝐞𝐫𝐢𝐜𝐚𝐧 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬 𝐂𝐡𝐚𝐢𝐫𝐦𝐚𝐧 𝐒𝐭𝐞𝐯𝐞 𝐇𝐨𝐟𝐟𝐚𝐫𝐭 𝐜𝐨𝐦𝐦𝐞𝐧𝐝𝐞𝐝 𝐑𝐞𝐩. 𝐂𝐚𝐫𝐭𝐞𝐫’𝐬 𝐨𝐧𝐠𝐨𝐢𝐧𝐠 𝐚𝐝𝐯𝐨𝐜𝐚𝐜𝐲 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐩𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐩𝐫𝐨𝐟𝐞𝐬𝐬𝐢𝐨𝐧 𝐚𝐧𝐝 𝐫𝐞𝐚𝐟𝐟𝐢𝐫𝐦𝐞𝐝 𝐭𝐡𝐞 𝐧𝐞𝐞𝐝 𝐟𝐨𝐫 𝐟𝐞𝐝𝐞𝐫𝐚𝐥 𝐩𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐫𝐞𝐟𝐨𝐫𝐦.

“American Pharmacies applauds Congressman Buddy Carter’s leadership in recognizing October 2025 as American Pharmacists Month — and for leading the way on the legislative reforms pharmacies and patients need. On behalf of our nearly 750 independent pharmacies across 38 states, we see every day how pharmacists deliver safe, accessible, and affordable care in their communities. We urge Congress to follow his lead and enact comprehensive PBM reforms that curb anticompetitive practices, bring transparency to reimbursement, and fairly value the care pharmacies provide. These changes are essential to preserving independent pharmacies and the patient access and public-health benefits they make possible,” said Steve Hoffart, Chairman, American Pharmacies/Owner, Magnolia Pharmacy

📑https://t.co/lxzoKhp3CT

[John Hickman @hickmanjd]

@APRxNews How is it that a company that’s supposed to provide services for the most vulnerable population of people can bill Medicare/Medicaid, collect the money, and just walk away from their tab when they get caught committing fraud?

[Antonio Ciaccia @A_Ciaccia]

PBM reform back at the starting line again.

[Save Independent Pharmacy @BrandiChane]

I couldn’t agree more with this statement!! @LIPAPharmacy @LAGovJeffLandry @TruthRX @MoniqueWhitney @GregAbbott_TX

[Wisconsin All Copays Count Coalition @WI4Patients]

NBC News wants to hear WI stories about predatory PBMs. Share your experience and how SB203 will finally force PBMs to stop their predatory policies here and make all copays count! Watch Cole’s story https://t.co/XwrgAvaPt5 And then contact NBC at [email protected]

[Save Independent Pharmacy @BrandiChane]

It’s clear that the Big 3 PBMs have no respect for the law and regularly disregard State laws.
And in Texas we have HB 139 that is being pushed to undo all of the laws our State legislature has worked so hard to put into place.
And can’t get a hearing for a fair reimbursement law SB1354/HB2978

What’s happening in Texas?! @TXLege_ @TexasGOP @TexasHouse @TexasSenateGOP @LoisKolkhorst @CodyforTexas @SenBryanHughes @reptinderholt @GregAbbott_TX @KenPaxtonTX

[InsuranceOligopoly @InsOligopoly]

This is how short I am paying drug bill(s) due Monday 2/10/25. I have no available savings ($100,000 drained in 2024) nor LOC left ($40,000)!

@Walgreens in my town is closing 2/25/25. I’ve received numerous transfers. We did over 1600 prescriptions last week, average of 300 per day.
The only other pharmacy in town busier than me is @cvspharmacy and @Walmart.
So, I’m doing the business. This is in addition to being the only HME/DME provider in 30 miles.
My salary is $50/hr. I have no large personal expenses being funded by my business (no boat, no RV, no airplane, no second home). My wife and I have 1 house. 1 child. 1 dog. A 5 year old Ford Explorer, a 10 year old GMC Sierra, and a 16 year old GMC Sierra. I have been a pharmacist for 20 years, so no school loans either.
What’s the problem:
@CencoraGlobal Pricing?
Elevate PSAO reconciliation?
Everyone letting PBMs racketeer?

@OptumRx I hate you
@CVSHealth I hate you
@ExpressScripts I hate you
@Humana I hate that you under pay over $30 on some Part D brands.

I hope I can stay in business long enough to see @GOPoversight @OversightDems @RobertKennedyJr @HHSGov regulate PBMs out of existence

[Steven Hylton @Saltvilledrug]

New Arkansas rule curbs unfair practices by pharmacy benefit managers, protect pharmacies https://t.co/Z1fgEA3aPH @VPhARx @ToddPillionVA @IsraelOQuinn @arnold4delegate @HokiePharmacist

[American Pharmacies @APRxNews]

House Republicans launch investigation into CVS Caremark for potential antitrust violations

#PBMs

🧾 https://t.co/G4TiV8nOfu

[Buddy Carter @RepBuddyCarter]

Republicans and Democrats agree: #PBMs are the barriers to accessible, affordable, and quality health care.

[Real Doc Speaks @realdocspeaks]

A suit was filed against Wells Fargo today by employees who claim that the drug expenses are too high. Wells Fargo currently uses Express Scripts, and the lawsuit claims that Wells Fargo does not fulfill their Fiduciary responsibility under ERISA.

This is similar to the lawsuit against J&J. PBMs don't have a Fiduciary responsibility, but employers do.
This puts employers in a difficult position, and they need to avoid contracting with any PBM that is not transparent.

Mark Cuban did post that for large companies who contract with a PBM that accepts rebates; it is not a question of if they will get sued but when.

This speaks to the urgent need for PBM reform. We all know what needs to be done, and it is a question of whether our politicians will do it!

[Real Doc Speaks @realdocspeaks]

I finished the FTC PBM interim report; my thoughts are noted below. I will start with overall impressions and then review what I consider to be the highlights.

Overall Impressions:
1. This is a report by a government agency that includes four publicly traded companies. There should be NO redactions! We need to see all the data and references used to produce the report. Redactions should only be used to protect the identity of innocent victims and national security, and they do not apply here.

2. All data shared with the FTC should be public and on their website. This would allow others with industry knowledge to analyze the data and prepare their impressions and keep the public informed and involved. We need complete transparency.

3. I want to thank Lina Kahn for releasing this preliminary report without waiting for all of the data. This report is getting a lot of press and will educate the public about the harm caused by the Big Three PBMs.

The report:
The Executive Summary reveals that some PBMs still need to fully comply with the request for records from two years ago. The PBMs who did not comply should be identified.

The PBM market is highly concentrated and involves immense vertical integration. The top three PBMs control almost 80% of the market, and the top 6 control over 90%. The big three PBMs control nearly 70% of all specialty drug revenue. When the big three PBM's contracts with other PBMs are considered, the big three control the brand and specialty market.

Four of the PBMs are subsidiaries of publically traded companies that also operate healthcare clinics. These include United Health Group, CVS Health, The Cigna Grou,p and Humana Inc.

In 2016 these Four had combined revenue of $456 Billion and controlled 14% of health care spending and today their combined revenue is in excess of $ 1 Trillion and 22% of health care spending. There is no way of controlling health care costs in the US without analyzing the business practices of these four companies.

Part II
1. Page six provides a great graph of the vertical integration of the six largest PBMs.
2. The growth of the four public companies is through mergers and acqusitions. From 2016 to 2023 the number of acqusitions were: UNH 88, CVS 53, Humana 39 and Cigna 14. Their revenue increase was largerly driven by this process.

The big three PBMs have recently established group purchasing organizations or GPOs. The report makes clear that these are not really GPOs but are rebate aggregators. These include Ascent, which works with Express Scripts, Prime and Humana, Zine which works with CVS and Emissar which works with Optum.

One report states that fees extracted form drug manufactures increased from $3.8 Billion in 2018 to $7.6 Billion in 2022. This document also states that commentators have stated that the GPOs formation is to avoid potential regularlatory or legislative reform. By saying they are a GPO they hope to fall into a safe harbor under the Anti-Kickback statuete. Two of the GPOs are located overseas, Emisar is in Ireland and Ascent is in Switzerland and this supports the theory that they are created to avoid scrutiny.

The most profound part of the report is the two case studies for specialty generic medications. The two drugs are Abiraterone Acetate which is a generic for Zytiga and is used for prostate cancer and Imatinib Mesylate wich is generic for Gleevec and used for leukemia.

Generic Zytiga was reimbursed by commercial health plans at $5,800 per month in 2022 or 25 times the acqusition costs of $229. The part D reimbursement was similar at 23 times cost.

The cost plus price for generic Zytiga is $26.90 for 250 mg tablets, the usual dose is 1,000 mg ane the total costs would be 107.6!

Generic gleevec was reimbursed at $2,700 per month by commercial insurance and more than 40 times the acqusition costs of $66. Part D plans were paying a similar amount at 36 times costs. The Cost Plus cost is $34.70 for thirty 400 mg talblets.

A PBM executive was concerned with the optics of gleevec costs as he reported the following costs:
1. non-preffered pharmacy, Costco $97
2. Preferred pharmacy, Walgreens $9,000
3. Preferred home delivery $ $19,200

Part D is part of the Medicare program and this amount of overcharging raises the question of Medicare Fraud and False Claims Act violations.

I always say to ask for the cash price, but I never knew the government has to ask for the cash price as well.
I do wonder if Mark Cuban Cost Plus Drugs has the bandwith to take on Medicare Part D business?@mcuban.

The report does a great job of documenting how PBMs are harming small and independent pharmacies through one sided and opaque contracts. The pharmacy reimbursements can change daily and often the pharmacy has no idea what they will get paid until the transaction is completed.

As I was reading about the PBM treatment of independent pharmacies, it struck me that this is identical to how independent physicians are treated by large payers. The problem is that politicians do not want independent phsyicians or pharmacies because there is no money in it for them.

FTC anti-trust actions take years to accomplish and they are necessary, however we need legislation now. The legislation needs to address the following areas:
1. eliminate any exemptions for kick-backs and this will eliminate the issues with rebates and GPOs
2. Outlaw spread pricing, fees tied to cost of drugs, formularies, step therapies
3. Prohibit insurance company ownership of PBMs and PBMs ownership of pharmacies
4. Ensure payments to pharmacies are adequate to cover cost, outlaw direct and indirect fees and audits
5. Stop gaming of performance measures.

I appreciate any input and this is a report with great content. I only higlighted a portion of this report and would recommend reading it.

[John Hickman @hickmanjd]

@CShindlerGolf Sorry Pro but your house shades your yard either early or late in the day cannot tell from photo East/West. The trees are trimmed as much as you can but zero sunlight during the day overhead. There’s not enough sunlight hitting the yard at anytime during day to keep it growing.