Friday, June 28, 2019

 

DMHC Announces Members to Task Force on Pharmacy Benefit Management Reporting

The California Department of Managed Health Care (DMHC) today announced the membership of a Task Force on Pharmacy Benefit Management (PBM) Reporting required by Assembly Bill (AB) 315 (Wood, Chapter 905, Statutes of 2018). 

“Pharmaceutical drug costs continue to rise, and often the “why?” remains unexplained,” said Assemblymember Jim Wood (D-Santa Rosa), author of AB 315. “I authored the bill to open the “black box” of how pharmacy benefit managers operate so that we can better understand their business model, how discounts and rebates are allocated, and who benefits. I look forward to the task force helping us ensure that PBMs are doing what’s in the best interest of patients, not increasing the PBM’s bottom line.”

The purpose of the Task Force is to recommend what information, if any, related to pharmaceutical costs health care service plans or their contracted pharmacy benefit managers should report to the DMHC. The Department will submit a report with the Task Force’s recommendations to the Legislature by February 1, 2020.

“Pharmacy costs are a major contributor to the overall cost and affordability of health care. The Task Force will consider what pharmaceutical cost information should be reported to improve transparency and better understand what’s driving increasing costs,” said DMHC Director Shelley Rouillard. “The members of the Task Force have extensive backgrounds and expertise in both the pharmaceutical and health care industries.”

AB 315 requires the Task Force to consider the following information related to pharmaceutical costs:

  • Wholesale acquisition costs of pharmaceuticals.
  • Rebates obtained by the health care service plan or the pharmacy benefit manager from pharmaceutical manufacturers.
  • Payments to network pharmacies.
  • Exclusivity arrangements between health care service plans or contracted pharmacy benefit managers with pharmaceutical manufacturers.
  • Information already reported by health plans related to the costs of covered prescription drugs as required by Senate Bill 17 (Hernandez, Chapter 603, Statutes of 2017). 

The Task Force will hold its first meeting on July 31, 2019 in Sacramento. All meetings will be open to the public. To learn more please visit the DMHC’s website at www.HealthHelp.ca.gov  and subscribe to the Department’s email list serve.

The Task Force members are listed below:

Sherri Cherman, PharmD, is president and CEO of Elements Pharmacy in Los Angeles. She also owns and operates Spinal Consulting, LLC, a consulting company for pharmacy organizations focusing on business strategy. Cherman previously was the President and Chief Operation Officer of ModernHEALTHcare, Inc., BioFusion, Inc. and Modern HC Pharmacy, Inc.

Shane Desselle, RPh, PhD, FAPhA, is the president of Applied Pharmacy Solutions and a professor of social and behavioral pharmacy at Touro University, California College of Pharmacy. He is also the founding chief editor of an international journal on pharmacy practice, Research in Social and Administrative Pharmacy. Desselle is formerly dean and professor at California Northstate University College of Pharmacy. 

Lisa Ghotbi, PharmD, is the director of pharmacy services for San Francisco Health Authority (San Francisco Health Plan). She has worked for several health plans including California Physicians’ Services (Blue Shield of California), Aetna Health, Inc. and Cigna Healthcare of California, Inc., where she served in pharmacy management positions with oversight of pharmacy benefit managers.

Clint Hopkins, PharmD, is owner and CEO of Pucci’s Pharmacy in Sacramento. He focuses on patients who require special and compound medications. Hopkins has experience in both community and hospital pharmacy settings and he previously served as an affiliate faculty member at Belmont University College of Pharmacy. 

Rochelle Pleskow was most recently the chief healthcare informatics officer at Hewlett Packard. Previously, Pleskow’s career encompassed working for Hospitals, Health Plans and Independent Physician Associations, including Tenet Healthcare, Humana, Emory Clinic, Blue Shield of California, Blue Cross Blue Shield of Georgia, Independent Health and Cirrus Health. Pleskow has created a startup in the Revenue Cycle and Clinical Informatics space.

Patrick Robinson, RPh, MBA, is a Pharmacy Manager for Sutter Health Plan (Sutter Health Plus). He is a Pharmacist and previously served as a Pharmaceutical Consultant at the Department of Health Care Services, the California Public Employees’ Retirement System (CalPERS) and for both EDS and ACS, a Xerox company, under the Medi-Cal Program.  He has also practiced pharmacy in the retail setting, with a pharmaceutical manufacturer and a pharmacy benefit management company. Robinson is a long-time member of both the National Council for Prescription Drug Programs (NCPDP), where he served as Co-Chair of Government Programs, and with the California Pharmacists Association (CPhA), where served on the Board of Trustees. 

Neeraj Sood, PhD, is a professor and vice dean for research at the University of Southern California (USC) Price School of Public Policy and a founding member the USC Schaeffer Center. His research on pharmaceutical supply chain has been cited by the President’s Council of Economic Advisors. Sood is on the editorial boards of the Journal of Health Economics, Journal of Policy Analysis and Management, and Health Services Research. He is a research associate at the National Bureau of Economic Research and a board member of the American Society of Health Economists. Prior to joining USC, Sood was a senior economist at RAND and a professor at the Pardee RAND Graduate School.

John Stenerson is deputy executive officer for Self-Insured Schools of California (SISC), where he is responsible for implementing all SISC programs that promote access to quality, appropriate and affordable health care. PBM transparency has been a major area of focus for Mr. Stenerson for the past several years. Stenerson serves on the Boards of the California Association of Joint Powers Authorities and the California Health Care Coalition. 

Nicole Thibeau, PharmD, AAHIVP, is director of pharmacy services for Jeffrey Goodman Special Care Pharmacy at the Los Angeles LGBT Center, a federally qualified health center. Thibeau previously was a pharmacy manager for Target and CVS Pharmacy.

About DMHC:

The DMHC protects the health care rights of more than 26 million Californians and ensures a stable health care delivery system. The Department has assisted approximately 2.3 million Californians through the DMHC Help Center. Information and assistance are available at www.HealthHelp.ca.gov or by calling 1-888-466-2219.