From The American Prospect, December 27, 2022

Insurer UPMC and its new pharmacy benefit manager Express Scripts are squeezing local independent pharmacies, with residents caught in the crossfire.

In late November, at a strip mall in the rural Pennsylvania town of Bedford, Stephanie Over worked behind the Fisher’s Pharmacy counter, filling prescriptions into translucent orange pill bottles and administering shots. As strip mall pharmacies go, Fisher’s stands out. A recently restored art deco facade juts out, and the store’s name runs down vertically in Broadway font. The store is a local fixture in Bedford, population under 3,000, and has been around for almost 100 years, of which Stephanie has worked nearly 30.

Stephanie was about to check out for her lunch break when the letters flooded in. Regulars at Fisher’s began marching up to the counter, clutching notices from the University of Pittsburgh Medical Center (UPMC), a leading health insurer in Western Pennsylvania, and Express Scripts, the pharmacy benefit manager for UPMC.

The letter told them that under a new policy, UPMC’s insurance plan would not cover prescriptions at Fisher’s anymore. Instead, UPMC’s beneficiaries would be encouraged to go to other pharmacies in the health plan network for their own “convenience,” which meant national chains like Rite Aid, Walmart, or Giant Eagle, a regional grocery chain. Bedford is a remote town, 100 miles from both Harrisburg and Pittsburgh. Residents, many of whom had gone to Fisher’s for decades, would have to drive several towns over, maybe 30 or 40 minutes, just to get their prescriptions filled. Fisher’s knew them, their families, and medical history, a personal touch that would be lost at a chain.

“Why should our people have to drive through 20 signal lights to get a prescription filled when they could just call us and we’d have it ready,” said Over.

The letter offered no explanation for the policy change. Stephanie called the owner, Jennifer Leibfreid, who had not been notified by UPMC. Fisher’s tried calling other local pharmacies and associations to piece together whether other independents were receiving the same letters from customers.

Most had. In an overnight purge, UPMC, the third-largest insurer in the state and the most powerful hospital network, dropped over 1,200 pharmacies from its health plan, around half of the stores it previously carried. Most were independents. The decision impacted tens of thousands of individuals who bought their insurance on the state health insurance exchange, known as Pennie, as well as company plans for businesses with fewer than 50 employees. Patients covered by Medicare and Medicaid are not affected by the change.

The UPMC kill-off will have devastating consequences for pharmacies and patients across rural Pennsylvania. Fisher’s estimates that it might lose 20 percent of its customers, some of whom need prescriptions filled every other day. They’ll have to decide whether to drive several towns over or pay out of pocket at Fisher’s for generic drugs.

Thirty miles south of Bedford, Potomac Valley Pharmacy in Hyndman was another retailer cut out from UPMC’s plan. Pharmacist Dan Iseminger doesn’t know how much business he’ll lose because “frankly, I’ve been too scared to look.” In that area, as in many other rural parts of the state, UPMC is often the only health plan locals can afford.

Read the full article here.

ARC announced our first-ever Appalachian Regional Initiative for Stronger Economies (ARISE) award! Connect Humanity will help 50 underserved communities in Appalachia plan for broadband growth.

The Connect Humanity team will work with local partners across 12 Appalachian states to help communities develop tailored digital equity plans, secure funding for high-speed internet expansion, provide digital literacy and broadband job training, and more.

“Broadband access is essential for Appalachia to thrive and compete in a global economy; without this support, our most rural communities may be left further behind. I commend our states and community partners in every Appalachian subregion for coming together in order to fully participate in our digitalized world,” said ARC Federal Co-Chair Gayle Manchin.

The details on the funding are:

• Location: 50 underserved communities across every subregion of Appalachia (TBA)
• Local Partners: Center on Rural Innovation, Empire State Development, Enterprise Center, Fair Count, Generation WV, Mississippi Alliance of Nonprofits & Philanthropy, NC State University Institute for Emerging Issues, SOAR, Student Freedom Initiative, Center for Strategic Partnerships at the Pennsylvania Department of Community & Economic Development, Virginia Funders Network
• Community Need: Helping underserved communities in Appalachia compete for some of the $45 billion from the Broadband Equity, Access, and Deployment and Digital Equity Act funding, driving large-scale transformation around broadband access.
• Solution: Connect Humanity will help communities develop tailored digital equity plans designed to ensure high-speed and affordable internet, device access, and digital literacy training.
• Grants Received: $6.3 million ARC ARISE grant

Appalachian communities can get involved at connecthumanity.fund/arise.

  The National Institutes of Health, Centers for Disease Control and Prevention, and Health Resources and Services Administration hosted a workshop to find and fill research gaps on the use of provider-to-provider telehealth to improve health outcomes in rural areas. Here, you’ll find the panel’s final report and recommendations.

The Centers for Medicare & Medicaid Services (CMS) issued new guidance to clarify that state Medicaid and CHIP programs will be able to pay specialists directly when a beneficiary’s primary healthcare provider asks for advice. The aim is to help improve access to specialty care, particularly mental health care services.  Citing FORHP-supported research, CMS  notes that, “Rural areas face the most significant provider shortage challenges; more than 60 percent of nonmetropolitan counties do not have a psychiatrist and almost half of the nonmetropolitan counties do not have a psychologist.”  Up to now, providers referring a patient to specialty care were required to coordinate payment through separate agreements with the treating practitioner.  The new policy gives state-level Medicaid and CHIP agencies the flexibility to reimburse consulting practitioners directly.  Importantly, these consultations can occur when the beneficiary is not physically present. To be covered under Medicaid or CHIP, both the treating practitioner and the consulting practitioner must be enrolled in Medicaid or CHIP. For consultations that cross state lines, consulting practitioners must be enrolled in Medicaid or CHIP providers in the state in which the beneficiary resides. For more information, see the State Health Official Letter available on Medicaid.gov.

On January 11, HHS extended the current Public Health Emergency (PHE) declaration for another 90 days. The extension of the PHE means the continuation of flexibilities for healthcare providers, such as the COVID Waivers issued by CMS.

HHS extended the deadline for submitting comments on the updated draft HHS Tribal Consultation Policy to January 27, 2023. The updated draft addresses comments and recommendations received during the first round of consultation in spring 2021, as well as the input of the Secretary’s Tribal Advisory Committee (STAC) Tribal Consultation Policy Workgroup. Comments on the updated draft may be submitted to consultation@hhs.gov. Please see the Dear Tribal Leader Letter, linked above, outlining the major recommendations and changes in the updated draft. Also, please see the clean and redline version of the updated draft to facilitate the commenting process. – New Deadline, January 27.

 The Centers for Medicare & Medicaid Services (CMS) added a telehealth indicator on Medicare Care Compare, the site that allows consumers to search for doctors, clinicians, groups, and facilities accepting Medicare beneficiaries.  Last year, CMS reported a 30-fold increase in telehealth services.  The new indicator helps beneficiaries and caregivers more easily find clinicians who provide telehealth services.

 The Centers for Medicare & Medicaid Services (CMS) awarded the first round of Medicare-funded residency slots to 100 teaching hospitals across 30 states, the District of Columbia, and Puerto Rico, effective July 1, 2023.  The graduate medical education slots prioritize hospitals located in Health Professional Shortage Areas, and the majority are allocated for primary care – including obstetrics/gynecology – and mental health specialties.  CMS is set to create 200 new positions every year over the next five years.  The application period for the second round of 200 residency slots will open in January 2023 and close on March 31, 2023.

A new state law regarding blood lead tests for young children went into effect on Tuesday. The state Health Department gave notice in the Pennsylvania Bulletin regarding how Act 150 of 2022 is to be implemented by healthcare providers. The law requires that doctors should order blood tests for pregnant moms and young children if they determine that the women or children are at risk of lead exposure. The notice said a health care provider will consider possible lead exposure by evaluating risk factors in accordance with recommendations from the federal Centers for Disease Control (CDC) and American Academy of Pediatrics for children 24 months of age or under and the CDC and American College of Obstetricians and Gynecologists guidelines for pregnant women.