Independent Thoughts

The Voice of Independent Community and Compounding Pharmacists 

The Alliance is directed by independent community pharmacists and is not obligated or tied to one single buying group or wholesaler. We are working to pass substantive legislation that makes a difference in your small business and community. 

September 6, 2019

Alliance News 

Join us for a Reception Honoring Chairman Kelly Hancock November 14

Please join us for a fundraising reception honoring Senator Kelly Hancock, Chairman of the Texas Senate Committee on Business & Commerce, from 5:30 to 7 p.m. on Thursday, November 14. The reception will be hosted at Frances Allen’s home at 5600 Miramar Lane in Colleyville. All pharmacists are invited to attend this great opportunity to engage with a key senator.

Chairman Hancock’s committee has jurisdiction over commercial PBM reform and many other issues that directly affect patient access and health care quality. If you can attend, please RSVP to Ashley Bishop at [email protected]. Regardless of whether you plan to attend, please visit this link to find out where you can send your contribution and help independent pharmacy show support for Chairman Hancock. 

Alliance Board Member Hosts Fundraiser for Congressman Michael Burgess 

Alliance Board Member Kelly Selby will host a fundraiser for Congressman Michael Burgess at his home in Denton at 6:30 p.m. on Saturday, October 5.

Congressman Burgess serves as the Ranking Republican Member of the House Energy and Commerce Subcommittee on Health, which has primary jurisdiction over most pharmacy issues, including Medicare, Medicaid, opioids, compounding, and FDA oversight. In the last Congress, Rep. Burgess was Chairman of the Subcommittee and was instrumental in passing legislation to prohibit the use of pharmacy gag clauses by PBMs. In fact, during a speech on the House floor, Congressman Burgess cited his close connection to constituent pharmacist Kelly Selby, who first made him aware of how gag clauses impact patients. Congressman Burgess has advocated for the role of traditional compounding with the FDA and ensured that community compounding pharmacies were represented as a witness at a hearing on compounding oversight with the agency. Additionally, Congressman Burgess serves on the House Rules Committee, where he has the unique ability to amend bills because the committee is the last stop for legislation before it goes to the full House for consideration. 

Click here to see more details.

October Workshop on Pharmacy Ownership

Please join us for a Mastering Pharmacy Ownership workshop from 9 a.m. to 4 p.m. on Saturday, October 5 at the Renaissance Dallas Hotel. The workshop will provide a comprehensive training day for independent pharmacy owners with hands-on examples and one-on-one interactions to help pharmacy owners achieve significant growth.

Topics to be covered include:

  • one-minute promo video for your pharmacy
  • cash flow
  • non-traditional income
  • return margins
  • employees’ worth & loyalty
  • new patient count & spending of current ones
  • monthly gross revenue

This workshop is simple, straightforward, and effective. Our hands-on examples and one-on-one interactions will ensure you have the tools needed to achieve significant growth.

Please register today for $99 at

Agency News

TDI Bulletin Addresses Whether PBM Pharmacists Can Deny Physician’s Order

The Texas Department of Insurance (TDI) issued a bulletin on August 28 reminding health plans, pharmacy benefit managers, and utilization review agents that a pharmacist cannot deny a physician’s order for a drug or treatment over questions of medical necessity or appropriateness.

The Alliance staff followed up with TDI to see if the bulletin was aimed at PBMs or pharmacists. TDI’s Valerie Brown responded, “The bulletin was targeted to Health plan and PBM pharmacists who are denying prior authorization requests for prescription benefits without a medical doctor reviewing the case, determining that the services are not medically necessary, and offering a peer-to-peer conversation. Only a physician can make an adverse determination. We are finding this scenario in many utilization review file reviews. We’ve had several enforcement cases on this issue. However, we continue to see it with each PBM audit and with carriers that use PBMs as their utilization review agent for prescription benefits. Some of the adverse determinations simply state, ‘agree with pharmacist’s decision to deny’ and do not contain all the required elements. If a pharmacist can’t approve the request, the request must be sent to a physician to make an adverse determination and offer the peer-to-peer consult before an adverse determination is issued. There was no intent to make this about opioids or the community pharmacist’s role in filling, or refusing to fill, prescriptions. This was strictly a reminder to follow the required utilization review processes as stated in statute and rule.”

The Alliance also asked whether there is a compliance mechanism if PBMs do not follow the law as outlined in the bulletin. Brown responded, “If a PBM is not following the UR processes as prescribed by statute and rule, a complaint can be filed with TDI. TDI will review all such complaints for compliance and take necessary steps to obtain compliance. You can find information on filing a complaint on our website. Alliance members are strongly encouraged to file complaints with TDI anytime PBMs are not following the law.

Draft Specialty Drug List Published 

HHSC has published its draft Specialty Drug List for the third quarter. We encourage pharmacists to review and provide the Alliance their thoughts on the new drug added to the specialty list. To see the list visit this link.

Please provide your comments to Audra Conwell at [email protected]

Alliance Suggests Cost Savings in Medicaid

Earlier this week, the HHSC Vendor Drug Program put out a request for input on how to reduce costs for Medicaid prescription drugs. Alliance CEO Audra Conwell responded with a letter highlighting the Deloitte study showing how the state could save money carving the pharmacy benefit out of Medicaid managed care. Conwell’s letter also pointed to the numerous instances in other states where PBM waste of taxpayer dollars was found, and the letter reminded the Agency of the recent Inspector General report showing how mismanagement at Molina and Caremark cost the state money and resulted in delays or denials for Medicaid patients needed prescription drugs. See letter to be submitted next week. 

Compounding News

Conference Call for Compounders

The International Academy of Compounding Pharmacists (IACP) will hold an Advocacy Town Hall Call for its members at 11 a.m. CST on Tuesday, Sept. 10.
The call will cover next steps in the group’s appeal of new beyond-use date regulations, as well as IACP's proposed 'middle way' on FDA's MOU with states. The call is limited to the first 100 people, so dial in a few minutes early if you want to join.

To connect, dial (646) 876-9923, meeting ID: 928-617-286

National News 

NCPA Seeking Steering Committee Nominations

NCPA is looking for people to serve on its steering committees. These Committees provide important feedback to NCPA’s CEO and assist in determining the direction of the association by providing valuable member insights. The Committees also serve to identify potential future NCPA leaders.

Specifically, NCPA is looking for nominees interested in serving on the following committees:

  • Compounding
  • Emerging Models 
  • Long Term Care Pharmacy Services
  • National Legislation and Public Affairs
  • State Legislation and Regulatory Affairs
  • Technology

The committee format is designed to engage the appointed members to be part of NCPA’s work on behalf of community pharmacy. The expectations of committee members are that they:

  • Are engaged for their full Committee appointment which runs from April through the following March;
  • Participate in regular committee conference calls and are responsive to committee email work;
  • Attend the NCPA Annual Meeting and the Congressional Pharmacy Fly-In (the NCPA Legislative Conference)
  • Consider supporting the NCPA LDF and/or NCPA PAC.

NCPA has asked for nominations by November 8. If you would like to be nominated, or if you would like to nominate another Alliance member, please contact Audra Conwell at [email protected]. You can also find the nomination form here.

Join us in Houston at PCCA’s International Seminar

Join the Alliance at the Hilton of Americas in Houston for PCCA’s International Seminar October 9-12. The Alliance will host its annual breakfast Saturday, October 12 at 7:30 a.m. in room 329.

RSVP to Ashley Bishop at [email protected]

See PCCA conference schedule and register here.

NCPA Deeply Disappointed by CVS-Aetna Approval

Late Wednesday afternoon, United States District Judge Richard Leon approved the controversial merger between CVS and Aetna. "I have concluded that the proposed settlement is well 'within the reaches' of the public interest and the Government's Motion to Enter the Proposed Final Judgment," Leon wrote in a decision that surprised many court watchers.

NCPA said, “NCPA raised numerous competitive concerns with the Department of Justice and state attorneys general. We also submitted comments to Judge Leon last year. While we are deeply disappointed by the decision, we remain committed to advocating on behalf of independent pharmacies – at the state and federal levels – against the anti-competitive practices of PBMs. In the meantime, click here to see what we've said previously on the merger.”

From the Axios Vitals newsletter: “CVS has been operating as if the merger was completed, and legal experts said the judge didn't have the authority to unwind the deal. This final order puts everything to rest, including concerns that combining CVS and Aetna will lead to anti-competitive conduct in different health care markets.” 





  • October 2: Fundraiser for Chairman Lucio III, Harlingen
  • October 5: Fundraiser for U.S. Senator Burgess, Denton
  • October 5: Mastering Pharmacy Ownership Workshop, Dallas
  • October 9-12: PCCA International Seminar, Houston 
  • October 26-29: NCPA 2019 Annual Conference and Expo, San Diego
  • November 14: Fundraiser for Senator Hancock, Colleyville


Thank you to our sponsors...


Diamond Level



Platinum Level 


 Gold Level



Partner Level  



 2019-20 Board of Directors

Compounding Advisory Committee

Preferred Vendors









Your Staff

Audra L. Conwell, CAE
Executive Director/CEO
(512) 413-4088

Ashley Bishop, CPhT
Membership Director

Honorable Jaime Capelo
Legislative Consultant

Robert Culley
Legislative Consultant

Jason Embry
New West Communications



Follow Us on Social Media



Independent Thoughts is the 
e-newsletter of the Alliance of Independent Pharmacists of Texas. 

P.O. Box 170323 | Austin, TX 78717 | (512) 260-7986  |