Letter to the Editor

PBM protections against pharmacy fraud

Dear Editor:

Recently, a marketing manager at an independent pharmacy in Slidell, Louisiana pled guilty to illegally pressuring pharmacists to fill non-medically necessary prescriptions for patients, ultimately submitting fraudulent claims for reimbursement and pocketing the money. This kind of fraudulent activity negatively impacts patients and taxpayers and is also 700% more likely to occur at independent pharmacies opposed to chain or retail pharmacies. I formerly worked in the press shop for the Louisiana Attorney General and, in this capacity, saw arrests very similar to this across the state. There is always a victim on the other side of a crime. Cases like this show how severely bad actors can defraud everyday people out of their hard earned money. I am relieved this case ended in justice for the victims.
Earlier this year, these same special interest independent pharmacies pushed Louisiana lawmakers to weaken protections against this sort of fraud – a maneuver designed to undermine their competitors through heavy-handed regulation and boost their own profits.
Specifically, independent pharmacists have advocated for legislators to outlaw tools used by pharmacy benefit managers (PBMs) to catch and stop fraud and abuse and provide lower drug costs for consumers. The Slidell case provides a clear example of why lawmakers must reject these proposals.
PBMs play a critical oversight role by auditing pharmacies they work with. This helps stop bad actors like the one in Slidell.
As lawmakers prepare to return for the 2022 legislative session, I hope they’ll work in the best interest of patients who rely on entities like PBMs to keep prescription drug prices down while also providing oversight of potentially bad actors in the pharmacy system. Lawmakers must get serious about protecting Louisiana families and patients – both from the hyper-inflated drug prices at the hands of bad actor independent pharmacies and from fraud that could cost our state millions.

Camille Babineaux
New Iberia, LA

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