December 13, 2018

Auditor General DePasquale To Examine How Counties Buy Voting Equipment After Luzerne County Probe


On December 12, Auditor General Eugene DePasquale made the following statement regarding reports that the director of the Luzerne County Elections Bureau accepted trips from a vendor that provided the county’s voting equipment and electronic poll books, and announced he would be launching a statewide review--
“It was reported that the Luzerne County Elections Director was on junkets to Las Vegas for the voting equipment company that the county hired. Needless to say, that is outrageous. The idea that any public official in Pennsylvania would go on a junket, paid for by a company for which they’re helping to get taxpayer dollars, is a disgrace.
“We’re going to question this individual to find out what they did in Vegas. I want to know why the trip wasn’t reported on their ethics form. If the trip was appropriate, why wasn’t it listed on the ethics form?
“The security of our election system is a principal foundation of our democracy. There’s no debate; people must have faith in our system.
“We’re going to investigate this across Pennsylvania to find out which counties use these systems, whether any other election officials were paid to go on these junkets, and review the entire procurement process for how these vendors and machines are selected.
“I’m currently auditing the Department of State, and specifically the Statewide Uniform Registry of Electors. We’re going to offer recommendations to make sure that system is more secure moving forward because we’re one of the 21 states that the Russians tried to hack leading up to the 2016 election. We’re also going to be offering reforms to the electoral system to make sure we have a more secure system.
“Having any vendor pay for a junket is unacceptable. As far as I know, no laws have been broken. But I want to know what’s going on in the rest of our counties.”
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December 12, 2018

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December 11, 2018

Auditor General DePasquale Demands Oversight Of Pharmacy Benefit Manager Contracts, PA Should Manage Its Prescription Drug Benefits Directly

On December 11, Auditor General Eugene DePasquale released a special report calling for action to reduce Medicaid prescription costs by increasing the transparency of how pharmacy benefit managers do business.
A major recommendation in the report says Pennsylvania should directly manage its prescription drug benefits instead of contracting with health care managers to do so.
“Prescription drug costs continue to rise, despite the wave of less-expensive, generic drugs that are now available,” DePasquale said. “Pharmacy benefit managers have ballooned in the shadows of the marketplace, drawing in skyrocketing profits while flexing increasing control over who may access which prescription medications.”
Pharmacy benefit managers (PBMs) have come under pressure nationally for raking in huge profits while shrouding their business practices from oversight. The nation’s three largest PBMs each earn over $15 billion annually.
Most other states have already passed legislation aimed at making PBMs’ practices more transparent so that state leaders can ensure taxpayers are not paying for unnecessary services.
In 2017, Pennsylvania taxpayers paid $2.86 billion to PBMs for Medicaid enrollees, according to the state Department of Human Services. That marked an increase of 100 percent in just four years, up from $1.41 billion in 2013.
Originally formed to serve as third-party claims administrators, PBMs have grown to assume new duties such as developing lists that restrict which medications are covered and deciding how much money pharmacies are reimbursed for those medications.
Because PBMs operate as subcontractors, they can shield important information, such as how they select which drugs are covered and whether community pharmacists are reimbursed the same amount as their affiliated chain pharmacies for the same drugs.
To prepare the special report, DePasquale conducted hearings to accept testimony from independent pharmacists, industry representatives, and officials from the Washington, D.C.- based Pharmaceutical Care Management Association, which represents pharmacy benefit managers nationally.
Three major observations emerged from the input received:
-- Lack of transparency: PBMs operate with little to no transparency and have expanded beyond their original role as third-party claims administrators.
-- Lack of oversight: No federal or state oversight of the contracts that PBMs require community pharmacists to sign means that some PBMs have been presenting take-it-or-leave-it contracts with unduly restrictive clauses.
-- Reimbursement disparity: Independent pharmacists believe that PBMs are not paying fair prices to reimburse pharmacies for all the medications they dispense.
Nearly every pharmacist who testified spoke of their concern that PBMs would retaliate against them by canceling their contracts because they spoke out about what they regard as injustices that affect their ability to serve customers. Highlights of the testimony included:
“If you don’t sign them (the PBM contracts), you might as well go outside and close your doors,” one pharmacist testified in Delaware County. “During the day, all pharmacy operations are decided by PBMs. We, the pharmacists, decide what time the pharmacy opens and what time it closes – that’s it.”
“The system is flawed in that the motivations of the PBMs don’t align with the interest of providing quality patient care at the best possible cost,” another pharmacy owner testified in Beaver.
DePasquale said dozens of pharmacists noted that, a few weeks after a large PBM dramatically slashed reimbursements in late 2017, they began receiving letters from a related corporate entity offering to buy their pharmacies – citing those dropping reimbursement levels.
“I’m concerned that PBMs may use their ‘take-it-or-leave-it’ contracts to exert undue influence on the marketplace,” DePasquale said. “Federal rules require that there must be a high wall between the two sides of the business.”
DePasquale also noted that community pharmacists repeatedly testified about contracts containing so-called “gag rules,” which prevent pharmacists from being allowed to voluntarily tell patients they might be able to pay less for a medication if they paid the out-of-pocket price instead of using their insurance.
“Gag rules are perhaps the most infuriating aspect: a pharmacist may not be allowed to tell a customer how to save money unless the customer specifically asks them,” DePasquale said. “That’s not only patently anti-consumer, it’s so egregious that even the White House has spoken out against gag rules.”
Click Here to watch a video from DePasquale on these issues.
Legislative Proposals
Efforts to address some PBM practices fell short of passage in Pennsylvania’s most recent legislative session, but DePasquale advocated for the introduction of new legislation to do the following:
-- Allow Pennsylvania to directly manage its prescription drug benefits instead of contracting with health care managers to do so;
-- Increase transparency into PBM pricing practices;
-- Allow state oversight of PBM contracts; and
-- Require a flat-fee pricing model so that the state pays PBMs only for services rendered.
“Now is the time for the state and federal governments to act to bring transparency and oversight to the practices of these PBMs that are affecting consumers,” DePasquale said. “Your money, taxpayer money and patients’ lives depend on it.”
Click Here for a copy of the report.
For more information on these issues from a community pharmacists point-of-view, visit the PA Pharmacists Association website.

December 10, 2018

AG Shapiro Joins Other AGs To Oppose Trump Administration's Latest Attack On Legal Immigration

On December 10, Attorney General Josh Shapiro joined 23 Attorneys General and Attorneys General-elect, to file comments opposing President Trump’s latest effort to marginalize lawful immigrants in Pennsylvania and around the country.
The Trump Administration has proposed an overhaul of so-called “public charge” rules that could make it easier to deny adjustment of status to legal immigrants, reject green card applications, or remove immigrants from the country if they utilize certain healthcare, nutrition or housing programs.
The Trump Administration’s proposed rule would drastically revise and expand the definition of “public charge” from ‘a person who is very likely to become primarily dependent on government services,’ to a person who receives minimal public assistance for a relatively short period of time.
This would mean that the percentage of non-citizens who use benefits that could be considered in a public-charge determination would expand from 3 percent to 47 percent.
The proposed rule could force lawful immigrants to make a difficult and inhumane choice: protect their immigration status, or risk it by accessing healthcare programs or other programs for which they are legally eligible.
“Once again, President Trump is attempting to implement a policy which will have devastating consequences for immigrants and put the health of immigrant children at risk,” said Attorney General Shapiro. “This proposed rule change would effectively weaponize public assistance programs and harm the very people those programs were designed to help – most of whom are seeking a hand up to a better life, not a hand-out for the long term. It’s time for this Administration to stop dividing Americans by attacking those who are most vulnerable.”
Attorney General Shapiro and his colleagues filed official comments, co-written by Virginia Attorney General Mark Herring and New Mexico Attorney General Hector Balderas, explaining why the rule is both unlawful and bad policy that would cause significant harm to Pennsylvania, which is one of 25 states that account for 94 percent of all foreign-born individuals in families receiving benefits.
More than 167,000 children in Pennsylvania live in families that receive benefits, more than 80 percent of whom are U.S. citizens.
In addition to being bad public policy, Attorney General Shapiro believes that the proposed rule violates federal law because the Trump Administration has not presented appropriate evidence or analysis to justify the radical changes it has proposed.
The proposed rule also violates Executive Orders governing the issuance of new regulations.
So-called “public charge” rules have existed in immigration law for several decades. They have been understood to allow governments to deny entry to potential immigrants who are likely to become “primarily dependent” on public assistance.
Once a lawful immigrant has been labeled a “public charge,” he or she may be unable to successfully apply for a green card or adjust immigration status, and may even be removed from the country.
The Trump Administration’s proposal would upend decades of established practice and make lawful immigration much more difficult by:
-- Greatly expanding the scope of services that can be considered in determining whether someone is likely to be “primarily dependent” on public assistance to include Medicaid, Supplemental Nutrition Assistance Program (SNAP), and housing assistance;
-- Significantly lowering the threshold for declaring someone a likely “public charge” to as low as $150 per month; and,
-- Potentially exposing immigrant children to being labeled a “public charge” if they are enrolled in the Children’s Health Insurance Program (CHIP).
In their comments, Attorney General Shapiro and his colleagues argue that the proposed changes will be “destabilizing, discriminatory, and will cause harm to immigration populations and to the States,” particularly with regard to healthcare costs, which can be expected to climb as immigrants avoid healthcare programs like Medicaid and instead seek expensive emergency care.
For example, in the City of Philadelphia alone, more than 30,000 households with at least one immigrant resident utilize Medicaid or the Children’s Health Insurance Program (CHIP).
If experts are correct in predicting that this change will result in a 15-35 percent reduction in benefit enrollment rates among immigrant families, Pennsylvania will see more than 37,000 families lose access to health insurance, costing the Commonwealth $270 million in federal funds.
The proposed rule would also discriminate against people with disabilities and non-English speakers.
Joining Attorney General Shapiro in submitting today’s comments are the Attorneys General of California, Connecticut, DC, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and Washington DC, and the Attorneys General-elect of Connecticut, Delaware, Illinois, Minnesota, and New York.
Click Here for a complete copy of the comments.