

By Mary Lau, RAN President/CEO
THE STATE OF THE POLITICAL PROCESS IS CURRENTLY
known as chaos. In some respects, it has always been that way, but in the present moment the sea of change is very tumultuous with the assignation attempt of former President Trump followed by the surprise exit from the race by President Biden.
Currently in the United States there are six parties that qualify to be on the federal ballot: Republicans, Democrats, the Green Party, Libertarian, Peace and Freedom and Independent parties. The public is only aware of or pays attention to the Republican and Democrat parties; however, independent parties are starting to show a higher voting bloc than the Democrats and Republicans. Clark County is a good example. Jon Ralston published in his Ralston Report on July 1, 2024, “Dems are not making up any ground on Repubs in urban registration. The numbers in Clark show the Repubs gained about three hundred voters last
week, moving the Dem lead closer to 109,000 voters, or 7.6 percent. Non-majors added three and a half times as many voters to the rolls, giving them close to 43 percent of the county’s voters. In Washoe, which finally updated its numbers on the site, the Repubs maintain a 2.3 percent lead, or 7,700 voters”.
This is a clear reminder that political parties change – the United States’ first parties were The Federalist Party, and the loyal opposition was known as the Anti-Administration Party. Over time their policies and names evolved into the system we know today.
As the parties continue
to evolve, it raises the question, are people truly changing their voter registrations, or is this the outcome of the cleanup efforts required as a result of Nevada’s “motor voter” registration program passed by the legislature, making it easy for anyone to register to vote at the DMV. Some experts feel that those registrations reflect a holding pattern, request to avoid primaries, privacy and some say DMV dumping ground as some do not want to tell their preferences and some do not care.
Additionally, income and education levels always create change in politics. It has never
By Liz MacMenamin
(PBMS) HAVE become significant players in the healthcare industry, managing prescription drug benefits for a large portion of the U.S. population. While they were originally intended to help control drug costs, there is increasing evidence that some PBM practices may actually contribute to the rising cost of prescriptions. This article explores how PBMs influence drug pricing and
the broader implications for consumers and the healthcare system.
PBMs serve as intermediaries between health insurers, pharmacies, and drug manufacturers. They are responsible for negotiating drug prices, deciding which drugs will be covered by health plans (formulary management), and setting the terms for reimbursements to pharmacies. While this position theoretically allows them to leverage bulk purchasing to lower drug costs, several practices have raised
concerns about their impact on prices.
PBMs often negotiate rebates with drug manufacturers, which are payments made by manufacturers to PBMs in exchange for favorable placement on a formulary (a list of covered drugs). These rebates are typically based on the list price of a drug, not
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been clearer than in the recent elections in the United Kingdom (aka Britain) and France. The drifting away by the parties that represented the working class, liberal, labor, more affluent elites have co-opted blue collar. This shift has upset many formerly entrenched voters and started the progressive slippery slope away from their core constituencies. The conservative parties are now considered more representative of the working class. This becomes more obvious when you look at voter preferences for redistribution, investment in education and immigration.
France shows us the pure chaos of “coalition governing” and by having multiple votes to determine an outcome of an election you can flip the intent of the voters and gang up on the previous first round winners. France is now left with a President and Prime Minister whose party is out of power and no other party having a clear majority. Does this promote compromise? Only time will tell.
That brief global view becomes a mirror for the chaos that the United States is going
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through. Who would have ever thought that the donor class would have more influence on election outcomes than the voters who think they are determining which candidate they prefer?
In addition to candidates, Nevada voters are also poised to make some decisions about how elections will work in this state into the future. Question 3, Ranked Choice Voting, is laying the groundwork for the political theater we see elsewhere in the world. Every voter needs to research how this works, or does not
(ne: Alaska), and choose wisely. Voters will also weigh in on identification requirements for voting, another interesting decision to offset the election security questions that were amplified when same-day voter registration became the law of the land in Nevada. Will all this chaos affect our state and local races? We just do not know yet. RAN will be evaluating all channels up to the election itself, and, as the results seem more apparent, Bryan Wachter, Sr. VP and Liz MacMenamin, VP GA will keep you informed.
to be one of the most pivotal, if not most unique, in recent U.S. history, with significant implications at both the federal and state levels. In Nevada,
all eyes are on whether the Democratic Party can secure one additional seat in the state legislature to achieve supermajorities in both houses. If successful, this would enable Democrats to override any gubernatorial vetoes issued by Republican Joe
Lombardo starting in 2025, effectively giving them a free hand in shaping state policy. This development could lead to substantial legislative challenges, eliminating the need for Republican contribution to policy proposals. Nationally, the
the actual transaction price. Consequently, manufacturers may set higher list prices to offer larger rebates, which benefits PBMs but can result in higher costs for patients, especially those with high-deductible health plans or who pay a percentage of the drug’s list price as coinsurance.
Another practice is “spread pricing,” where PBMs charge health plans more for a drug than they reimburse pharmacies for dispensing it. The difference, or “spread,” is kept by the PBM as profit. This practice can drive up the overall cost of drug benefits, which may be passed on to consumers through higher premiums, deductibles, or copayments.
PBMs manage formularies to prioritize drugs that provide them
political landscape has been thrown into disarray following a dramatic series of events. The assassination attempt on former President Donald Trump followed by President Joe Biden’s unexpected announcement that he
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with the best financial returns, often through rebates. Sometimes, less expensive drugs may be excluded from formularies if they do not offer substantial rebates, forcing patients to use more expensive alternatives. This practice can increase the overall cost of care without necessarily improving patient outcomes.
PBMs determine the reimbursement rates for pharmacies dispensing medications. Sometimes, these rates can be set below the acquisition cost for certain drugs, particularly generic medications. While this practice can benefit PBMs financially, it may reduce the availability of lowercost options for consumers if pharmacies are forced to limit the availability of these drugs or even close due to financial unsustainability.
The combination of these practices can lead to higher out-of-pocket costs for consumers. Even with insurance, patients may face higher copayments or coinsurance due to elevated drug prices, or they might be forced to pay the full price for excluded medications. Additionally, these cost increases can lead to reduced access to essential medications, as some patients may forgo filling prescriptions due to financial constraints, potentially leading to worse health outcomes.
Growing awareness of these issues has led to calls for greater transparency in PBM operations. Advocacy groups, lawmakers, and industry stakeholders are pushing for reforms that
include:
l Requiring disclosure of rebate amounts and how they are shared with insurers and consumers.
l Eliminating spread pricing to ensure that savings from negotiated discounts are passed on to consumers.
l Ensuring fair reimbursement practices for pharmacies, particularly for generic drugs.
Greater transparency and regulatory oversight are essential to ensure that PBMs operate in ways that truly benefit consumers by lowering drug costs and improving access to essential medications. As the conversation around healthcare reform continues, addressing the role of PBMs will be crucial in the effort to make prescription drugs more affordable for all Americans.
Assembly 29
Republican Carrie Buck (i) vs.
Democrat Jennifer Atlas TOSS UP
Democrat Joe Dalia vs. Republican Annette Owens LIKELY D
Republican Heidi Kasama (i) vs. Democrat Ron Nelsen LEAN R
Democrat Sharifa Wahab vs. Republican Rebecca Edgeworth LEAN D
Democrat Selena La Rue Hatch (i) vs. Republican Diana Sande LIKELY D
Assembly 37
Republican David Brog TOSS UP
Democrat Shea Backus (i) vs.
Reno has been selected as one of 12 leading tech hubs in the U.S., receiving $21 million to become a global leader in lithiumion battery production. This funding is part of the Biden Administration’s Creating Helpful Incentives to Produce Semiconductors (CHIPS) and Science Act, aimed at advancing American manufacturing and technology jobs. U.S. Secretary of Commerce Gina Raimondo and Sen. Jacky Rosen highlighted Reno’s significant lithium deposits, the largest in North America, as a key asset for this initiative. The investment will be managed through the University of Nevada Reno, offering educational opportunities and boosting local economic development. The 12 hubs were chosen to decentralize tech advancements and utilize diverse national resources.
News 3 Las Vegas
A Nevada judge has denied the Oakland Athletics’ request to join a lawsuit challenging the public
funding of up to $380 million for a new Las Vegas stadium. The suit, filed by the political action committee Strong Public Schools Nevada, claims the funding bill (SB 1) is unconstitutional. The A’s sought to intervene, citing their role as the developer partner and Major League Baseball team involved in the project, and argued they could be harmed if the bill is repealed. However, Carson City District Judge Kristin Luis ruled that the state of Nevada and Clark County, the named defendants, are capable of representing the same interests as the A’s, and including an additional party would delay the case. A hearing date has not yet been set. The Nevada State Education Association, affiliated with the PAC, contends that the funds would be better allocated to the state’s education system.
News 3 Las Vegas
Nevada voters might decide in November whether to join the three dozen states that require valid identification for voting. Conservative organizers claim to have enough signatures to place this measure on the ballot, which would amend the state constitution to mandate ID at polling places or on mail-in ballots.
Support for voter ID laws is high, with 84% of Nevada voters and 81% of U.S. adults in favor, according to recent polls. However, voting rights advocates argue that such laws could disenfranchise young, Black, and Latino voters. Studies show mixed effects on voter turnout, with some suggesting minimal impact due to increased mobilization efforts by Democrats. Meanwhile, states like New Hampshire and Maine are also considering similar measures. Advocates emphasize the need for accessible and affordable IDs to ensure equitable voting opportunities.
Las Vegas Sun
Nevada’s Secretary of State has confirmed that a ballot question to enshrine abortion rights in the state constitution will appear before voters in November. This initiative, organized by Nevadans for Reproductive Freedom, aims to provide constitutional protection for abortion rights, surpassing the current state law that permits abortions up to 24 weeks. The measure must be approved in both the 2024 and 2026 elections to amend the state constitution. This move comes as several
Republican-led states have tightened abortion restrictions, while many Democratic-led states have protected access. Proponents submitted over 200,000 signatures, with nearly 128,000 validated, surpassing the required 102,000. This development is part of a broader national effort to secure abortion rights through state constitutions following the Supreme Court’s overturning of Roe v. Wade.
Associated Press
The Nevada Democratic Party has filed a lawsuit to block the Green Party from appearing on the 2024 ballot, alleging insufficient valid signatures for ballot access. The suit, filed in Carson City District Court, requests that the Secretary of State invalidate the Green Party’s gathered signatures. Democrats claim their review of a limited number of signatures revealed many did not meet state requirements, though this review did not include signatures from Clark and Washoe counties. The Green Party collected nearly 30,000 signatures, exceeding the required 10,095, and announced their qualification for the ballot. The Democratic Continued on page 11
Sam’s Club is experiencing significant membership growth driven by Gen Z and millennials, according to Walmart CFO John David Rainey. At the Bank of America London Investor Conference, Rainey revealed that Gen Z membership surged 63% and millennial membership grew 14% over two years. This trend is attributed to Gen Z’s costconscious nature, shaped by economic challenges such as the Great Recession and the COVID-19 pandemic. In Q1, Sam’s Club’s U.S. stores reached record membership levels, with over 13% growth in membership income. The digital experience, especially the Scan & Go technology, has resonated with younger customers, contributing to a 50% increase in its adoption over the past three years. Sam’s Club is also enhancing its in-store technology and expanding its physical presence with plans to add 30 new stores in the next five years. Additionally, the retailer is engaging members in product co-creation for its private label, Member’s Mark, to enhance personalized shopping experiences. Last year, Sam’s Club reported $84.3 billion in total revenue.
Grocery Dive
SPENDING TO SURGE BY NEARLY 22% THIS YEAR
Parents are expected to increase their back-to-school spending by 21.8% this year, reaching $475 per child compared to $390 last year, according to a JLL survey of 1,026 parents. The top shopping destinations include Walmart (46.4%), Amazon (35.4%), and Target (32.6%), with fewer parents planning to shop at retailers like Costco, Old Navy, and Dollar General. The survey also found that about 25% of parents have already started their back-toschool shopping, with others planning to begin in June (22.1%), July (20%), and August (16.8%). Retail Dive
FOR GROCERY RETAILERS
A recent study by the Food Industry Association reveals that theft and fraud have become the leading challenges for grocery retailers, with 85% citing these issues as major concerns. Although problems with supply chain, transportation, and labor have eased, asset protection remains a critical issue. Additionally, 64% of retailers report societal challenges, such as lack of civility, drug use, and violence, negatively impacting operations. Despite these hurdles, grocery retailers invest in innovative strategies like in-store technologies
and artificial intelligence to enhance customer experience and growth. The industry has seen significant improvements in supply chain efficiency, resulting in a decrease in out-of-stock rates from 10.7% in 2022 to 6.5% in 2023. However, inflation and regulatory complexities have driven profit margins down to pre-pandemic levels. Retailers are also adapting to changing consumer habits by expanding in-store space for freshly prepared items and increasing offerings of private brands and locally sourced foods. Concerns about inflation and economic challenges influencing shopper behaviors remain high. Chain Store Age
WITH TRADEBEYOND TO BOOST SUPPLY CHAIN EFFICIENCY
Walgreens Boots Alliance (WBA) is partnering with TradeBeyond to enhance its sourcing and supply chain operations. The implementation of TradeBeyond’s platform, starting in fall 2024, aims to replace WBA’s legacy systems with more efficient and transparent digital solutions. This partnership will help Walgreens improve supply chain transparency, accelerate market speed, unify processes, and manage collaboration with suppliers. Adam Swallow, WBA’s VP of global sourcing and quality,
emphasized the benefits of these improvements. Additionally, Walgreens is leveraging artificial intelligence for better demand forecasting and inventory management, though it paused its microfulfillment center expansion in 2023 to reassess its strategy.
Supply Chain Dive
The lines between food service and retail are increasingly blurred as ondemand delivery services expand their offerings. Companies like Wonder, which acquired Blue Apron, and partnerships between Instacart and Uber Eats, and Amazon with Grubhub, exemplify this trend.
Consumers now expect the convenience of ordering groceries and restaurant meals simultaneously. Platforms such as DoorDash’s DoubleDash and GoPuff’s integration with Starbucks illustrate this shift towards a unified shopping experience. This evolution is driven by consumer demand for convenience, instant gratification, and the ability to purchase diverse items from a single app. This trend is reshaping traditional food service and retail, with companies adapting to meet the new expectations of seamless, multifaceted delivery services.
Association of Nevada • www.rannv.org
NRS requires all existing members of a self-insured group to be notified of all new members. NRNSIG new members are listed below.
Las Vegas Kayak LLC
Scoobyz LLC dba Scoobyz Thrift Store
True Investigations Inc
Western 72 LLC dba D1 Traileer Sales and Rental
NRNSIG members who wish to register a negative vote on a new group member, please write NRNSIG at 575 S. Saliman Road, Carson City, NV 89701, indicating which member and the reason(s) for the negative vote
In August, life slows down, and we savor the sweetness of summer. It is a time to soak up the sunshine and let your soul be filled with warmth.
Membership Information: Find out more about RAN’s self insured group. Call Pro Group, 800-859-3177, or the RAN office at 775-882-1700 (toll free in Nevada 800-690-5959). Don’t forget to check out our website, www.RANNV.org.
Party argues that some signatures were collected before necessary approvals, and there were irregularities in petition forms. The Secretary of State’s office is currently reviewing the lawsuit.
Nevada Independent
FOR FAIR DRUG PRICING
Over the past decade, Nevada has taken steps to bring transparency to drug pricing, but further reforms are needed for Pharmacy Benefit Managers (PBMs). PBMs, which sit between drug manufacturers, insurance companies, pharmacies, and patients, significantly influence drug prices and access.
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However, their interests often prioritize profits over patient care, particularly since major PBMs are now owned by large health insurance companies like UnitedHealth Group. This integration has led to increased profits for PBMs at the expense of consumers. PBMs negotiate lower drug prices with manufacturers but often pocket the savings instead of passing them on to patients, who are charged higher co-pays based on the retail price. Additionally, PBMs earn substantial profits from manufacturer fees linked to drug prices, incentivizing them to favor expensive medications. This flawed system sees middlemen like PBMs taking up to 75% of drug costs. Nevada leaders, including
Sen. Catherine Cortez Masto, are calling for greater transparency and reforms to ensure that savings are passed to patients and to break the link between high drug prices and PBM profits. Legislative action is needed to tie patient co-pays to the lower prices negotiated by PBMs and to eliminate incentives for promoting high-cost drugs, which would lower prices and improve access to essential treatments.
Las Vegas Sun
Retailers like Kroger, Walmart, and Natural Grocers are offering significant promotions to help consumers manage
will not seek re-election has added additional uncertainty to the electoral map. We were already seeing indications that the presidential campaigns are focusing their efforts in the Rust Belt instead of the Sun Belt in 2024, removing Nevada from our swing state position.
Also on the Nevada ballot, voters will face several constitutional questions this November. The proposal to
implement ranked-choice voting, appearing for the second time as required for a constitutional amendment, is a significant focus. If passed, this system would allow voters to rank candidates by preference, regardless of party.
Voters will also be asked whether Nevada should establish a constitutional right to abortion in Nevada and whether Nevada should mandate voter
the rising costs of July Fourth barbecues amidst high inflation. A Rabobank report highlights that hosting a 10-person barbecue this year will cost $99, the highest recorded. Essentials like beer, beef, soda, and lettuce constitute 64% of this cost. Walmart has introduced a summer cookout basket priced under $50, which includes items like hot dogs and watermelon for eight people. Kroger offers $15 grilling recipes and a grilling bundle priced at $4 per person, along with numerous holiday recipes on its blog. Natural Grocers provides up to 55% off select summer picnic items. Beyond July Fourth, Walmart is also promoting a “largest savings event ever” from July 8 to 11, offering discounts on a wide range of products. Grocery Dive
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identification at the polls is also up for consideration. It’s clear these questions are the result of efforts by both major political parties to energize their base.
As we approach the final stretch of the 2024 election, the political landscape remains highly fluid. The unexpected developments of the summer have introduced unprecedented levels of uncertainty. Predictions are challenging to make, as the situation continues to evolve rapidly. As the dust settles from these July surprises, a clearer picture may emerge, offering more concrete insights into the direction of the country and the state of Nevada. Until then, stakeholders and voters alike are navigating an electoral landscape filled with unknowns, making this one of the most unpredictable elections in recent memory.
410 South Minnesota Street
Carson City, Nevada 89703-4272
Mary F. Lau President/CEO
Bryan Wachter Senior Vice President
Elizabeth MacMenamin Vice President of Government Affairs
Piper Brown Vice President, Finance and Administration
Megan Bedera Editor
Sue Arzillo, Alphabet Soup Inc. Newsletter Design & Layout
National Retail Federation
AS OF EARLY JULY, MORE THAN HALF (55%) OF back-to-school and college shoppers have already begun buying items for the upcoming school year, according to the annual survey released July 11, 2024 by the National Retail Federation and Prosper Insights & Analytics.
“The back-to-school and college season is an important time for retailers and consumers,” NRF Vice
President of Industry and Consumer Insights Katherine Cullen said. “Families and students are eager to get a jumpstart on their shopping for the start of the school year.
Retailers have anticipated this early demand and are wellpositioned to offer a variety of products at competitive prices.”
While shopping is well underway, the majority (86%) of consumers still have at least half of their purchases left to complete. The top reasons
consumers still have shopping to do are because they are waiting for the best deals (45%) or they don’t know what is needed yet (45%).
As retailers kick off summer deals from Circle Week to Deal Days to Black Friday in July, consumers are taking note. Similar to last year, 85% of back-to-class shoppers say they will take advantage of Prime Day and other retailer sales in July to buy classroom staples and other school necessities.
Families with children in elementary through high school plan to spend an average of $874.68 on clothing, shoes, school supplies and electronics. This is approximately $15 less than last year’s record of $890.07 but is the second-highest amount in the survey’s history.
Total back-to-school spending is expected to reach $38.8 billion, also the secondhighest figure on record, after last year’s high of $41.5 billion.