Members of the legislative study group assigned by Speaker of the House Nathaniel Ledbetter to contemplate the plight of independent pharmacies in Alabama being driven out of business by Pharmacy Benefits Managers met in Room 200 inside the State House during the morning hours of Thursday, August 29th of 2024. Study group members, Legislators, lobbyists and representatives from Blue Cross Blue Shield of Alabama as well as the Business Council of Alabama were ushered into the secretive Montgomery meeting while independent pharmacy owners and pharmacists were denied access and physically blocked from the room at the behest of Speaker Ledbetter. One temporary exception was Star Discount Pharmacy Director Trent McLemore of Huntsville who initially had been admitted into the meeting before being ordered to leave. This puzzling pattern of behavior by Speaker Ledbetter amounts to a de facto hijacking of the PBM reform legislation through orchestrating a proverbial smoke filled room full of good ol' boys replete with back slapping and horse trading galore. Objective bystanders are left looking in from the outside, helpless but to wonder why these deals must be cut in the dark of night.
Elevator going down for independent pharmacy owners and pharmacists
denied access to the PBM study group meeting.
What is the mystifying purpose of this convoluted study group if not to offer transparency and a path forward for independent pharmacies and their humble customers in Alabama? Is this merely some frivolous delaying tactic by Ledbetter to circumvent the Alabama Open Meetings Act and prevent independent pharmacists from witnessing the star chamber deliberations that will determine their fate? Will independent pharmacists be required to drink from separate water fountains going forward as well?
Under the scrutiny of examining the so called "study group" it becomes readily apparent that its inherent nature is at best immoral and could even be considered unethical based on two sets of criteria. If it is indeed a legitimate legislative committee, this meeting should have been open to the public which it clearly was not. If it is an illegitimate bastard committee which is not sanctioned under the Alabama Constitution and is therefore unauthorized then it fails to cut muster as well. In either case, the "study group" has merely become a vehicle for backroom deniability and in turn leads us to the inevitable question; which one is it?
Tennessee solved this problem for themselves three years ago by passing PBM reform legislation which was signed into law by their governor. Not in ol' Alabama though, with no leadership from our governor and a stunning dereliction of duty by the legislature in failing to protect the fragile independent pharmacy ecosystem that reliably services the state's workers and elderly patients year in and year out. There will be no clemency for the independent pharmacies from the death sentence that BCBSAL has hung above their head in the form of a modern day Sword of Damocles.
These tortured histrionics are all being played out before the backdrop of Ledbetter having stolen HB238 from the legislature without it ever seeing the light of day and receiving its due with an up or down vote on the floor during the 2024 legislative session. Instead, after allowing the bill to pass out of the House Insurance Committee, Ledbetter whisked it away to be unceremoniously tossed into the circular file and forgotten by tabling the proposed legislation under the guise of a "study group". This meant that HB238 had left the building before barely anyone could have caught word of it and in that vacuum of knowledge, the downtown Birmingham misinformation machine could fill the void with distorted falsehoods leaving the tail wagging the legislative dog. Nothing to see here folks.
It is no coincidence that the waters have been muddied beyond comprehension by BCBSAL in the course of their targeted online misinformation campaign designed to derail HB238. So many low information legislators have been left spouting off downtown Birmingham talking points regarding the PBM crisis to the point where only a select few people in the know have a clear understanding of the issue at hand. At the end of the day, it all comes down to one word.
embezzlement
Theft of funds by someone entrusted with their care.
Alabama has consistently been ranked as having one of the worst, if not the worst, healthcare systems in the nation. As much as BCBSAL wants to scream from the rooftops that they are a "non-profit" and blameless in this statewide failure, that lady doth protest too much. Reality dictates that health insurance companies, pharmacies, PBMs, hospitals, medical practices, drug manufacturers, et. al are part and parcel of a state's healthcare system which in the end is the sum of its parts. When one of those parts, in this case the PBMs and their corporate health insurance puppet masters, subtract funds from the sum and fiendishly place it in their own gluttonous coffers that is the textbook definition of embezzlement.
Hard earned paychecks intended for the working folks in Alabama have funds withheld from them by their employers to pay for their private health insurance. With a demented gleam in their eyes, the PBMs con the employers into believing that they will save them and their employees money by negotiating lower prices for prescription medications when the shameful truth is that they overcharge employers with inflated prices for brand name drugs and go on to undercompensate pharmacies by reimbursing them below cost. Skimming that monetary difference is the modus operandi of the PBMs and their paymasters at BCBSAL. Therein lies the rub. Let them forever be known in Alabama as;
PBeMbezzlers
Keep reporting on the corruption! Alabama does have the worst health care in the nation! Thanks to BCBSAL. I figured that out shortly after we moved here 18 years ago. Deplorables all of them.