Suspicious CVS Announcement 🤥

Janson Silvers  0:03  
Welcome to Healthcare Policy Pop. I'm Janson Silvers it's Tuesday, December 19 2023. If you're still in town on the hill, we're right here with you. Today's pop topics: CVS has announced they will change the way they price prescription drugs, does that mean patients will pay less at the counter? We're not so sure. And Patients Rising isn't the only group questioning the announcement. The CEO of the Purchaser Business Group on Health or PGBH said in a stat article quote, when you notice that this was announced on investor day, I think we know who their audience is with this. We sat down with PGBH's Vice President for Policy, Alan Gilbert to get to the bottom of this announcement from CVS. CVS says that his new pharmacy reimbursement model will bring more transparency to his drug pricing system that Gilbert says there are still a lot of unknowns.

Alan Gilbert  0:55  
I think the question for us is, without a lot of details, because there's we still don't know a lot of the details is this further baking in, say, for example, their own pharmacies and specialty drugs, we just don't know. I am very suspect of activities on ironically investor day for CVS that pretend to do, you know, sort of self regulating or, you know, voluntary codes 

Janson Silvers  1:23  
PGBH's his mission is to increase healthcare value for private employers and public purchasers. And Gilbert says if CVS's has changes aren't facilitating that, then what is really going on.

Alan Gilbert  1:35  
At the end of the day, if this is not providing less expensive medicines that our workers and their families need, then we're seeing they're just, you know, playing a shell game, right? It's just moving money around.

Janson Silvers  1:48  
Gilbert says it's an uphill battle for change because of how the market is set up.

Alan Gilbert  1:53  
When 80% plus of the marketplace in PBMs is controlled by three players, doesn't matter if you're the largest companies in the world for which we represent, you still don't have the market clout to demand any real audit rights or pricing information or the various games that go on upstream. And you know, across to the pharmacy counter. 

Janson Silvers  2:16  
This action by CVS also outlines the need for Congress to continue to do more on these issues.

Alan Gilbert  2:22  
I think the you know, the proof will be in the pudding. Look, we're encouraged by any market change that's happening out there. I just don't think that this is real pressure from competition that's in the marketplace, and Congress needs to act. And it really in my mind illustrates more than ever, the need for Congress to move to make changes and do more than just transparency.

Janson Silvers  2:46  
In the end, Gilbert says the announcement won't do anything to provide transparency and alleviate prices.

Alan Gilbert  2:53  
I'm concerned that it's just lip service, that it's not going to really translate to, you know, lower fees and lower prices and actual transparency such that, you know, as employers, again, providing almost 180 million Americans and their families, healthcare benefits are going to be able to, you know, sort of track and trace the prices and understand the costs involved and lower costs for their workers and their families. 

Janson Silvers  3:21  
He also adds that CVS's own announcement even hints that the price for some prescriptions will increase instead of decrease. We have a link to a couple of stories on the CVS announcement in the show notes.

Artificial intelligence was back in the news today. HHS has finalized new regulations requiring more transparency on AI used in clinical settings. The goal is to help providers understand potential risks. The regulations will apply to clinicians who use decision support software that's HHS certified. The overwhelming majority of hospitals and doctors offices nationwide, use such software. You can read the full story by using the link in the show notes. That's all for today. We're back on Thursday for another Healthcare Policy Pop, a resource of Patients Rising Now. I'm Janson Silvers, have a great day.