The PUTTcast

·E14

Reclaiming Pharmacy Revenue: State-Level PBM Enforcement & MAC Appeals

April 22
32 mins

Episode Description

Independent pharmacies face immense pressure from Pharmacy Benefit Managers (PBMs), often confronting the impossible choice of losing money on a prescription or turning a patient away. In this episode of The PUTTcast, host Lauren Young sits down with Kris Rhea from Pharmacy Marketplace to discuss a game-changing solution to this "pharmacy spiral." They dive deep into the world of MAC appeals and underwater claims, revealing how new software helps pharmacy owners fight back and reclaim rightfully owed revenue. Whether you’re navigating new state statutes or tracking the PBM divestiture bill in Tennessee, this episode offers actionable insights and a powerful tool to strengthen your pharmacy's financial health while fueling the momentum for nationwide PBM reform.

Music by cat_herding_diva | Production & Editing by Shannon Wightman-Girard

Key Takeaways

  • The Reality of the "Pharmacy Spiral": Understand the impossible decisions pharmacy owners face when dealing with underwater claims and how it impacts patient care.
  • Automating MAC Appeals: Learn how Pharmacy Marketplace's software identifies eligible claims, generates compliant invoices, and tracks the appeal timeline from start to finish.
  • State-Level PBM Reform: Discover which states are leading the charge in enforcing underwater payment statutes and how organized data empowers agencies to audit non-compliant PBMs.
  • Escalating Rejections: Find out exactly what to do when a PBM rejects your appeal and how to involve your state's Department of Insurance or Attorney General.
  • Advocacy in Action: Hear the latest updates on the Tennessee PBM divestiture bill and learn why independent pharmacies must actively participate to drive legislative change.

Resources

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