The Twins announced Sunday afternoon after their 6-2 loss to the Texas Rangers that they had optioned reliever Kody Funderburk. Funderburk had pitched quite a bit in the preceding games and the Twins planned on bringing in a fresh arm in the form of veteran right-hander Diego Castillo to replace him on the roster.

Instead, they encountered something that has become much less of an issue since they linked up with the Triple-A St. Paul Saints: They were unable to get the reliever to the Twin Cities in time for the game from upstate New York. where the Saints were playing the Buffalo Bisons.

The Twins did not officially make a roster move before Monday’s game, playing a man down in the bullpen.

It wouldn’t matter much in their 6-5 win over the Kansas City Royals as Joe Ryan threw seven innings and the Twins used three other relievers — Griffin Jax, Cole Sands and Jhoan Duran — to cover the final two innings.

It’s expected that the Twins will officially add Castillo to the roster ahead of Tuesday’s game after a solid two months with St. Paul. Castillo, 30, who signed a minor league contract with the Twins in March, had a 2.50 earned-run average across 18 innings for the Saints. He had struck out 22 and recorded five saves.

Manager Rocco Baldelli was a coach for the Tampa Bay Rays when Castillo debuted in 2018 and mentioned his dynamic sinker-slider mix, as well as his delivery, which he said he believes “messes with hitters.”

“I remember him being real good and I think he’s worked his way back into throwing the ball well,” Baldelli said. “I think he’s worked hard to get here and to be an option at the major league level again. … That’ll be good to see him. Good guy, too.”

Ryan throws record pitch

Joe Ryan threw a handful of pitches above 96 miles per hour on Monday. The fastest, 96.6 mph, came in the second inning to Nelson Velázquez and is now the hardest he’s thrown in his career.

“He’s a different animal when he’s throwing that hard,” catcher Ryan Jeffers said.

Ryan’s average four-seam fastball was up nearly a mile per hour on Monday in his dominant start against the Royals, clocking in at 94.7 mph.

“I think (it’s) trusting the process and what we’re doing before outings,” Ryan said. “Certain things I’ve learned over the years and what can help me feel better. I’m just kind of going on what I feel that day. If it’s down, it’s down. If it’s up, it’s up. Make pitches accordingly and just attack the zone. Good to see some higher numbers.”

Briefly

Brooks Lee’s rehab has been moved from the Florida Complex League to the Florida State League. The top prospect is rehabbing from a herniated disc in his back and should rejoin Triple-A St. Paul, where he finished last season, soon. Lee was 9 for 20 (.450) with a 1.026 OPS in five games played. … The Twins activated reliever Josh Winder from his rehab assignment and optioned him to Triple-A.

ROCHESTER, Minn. — Over its 65 years of business, Hunt’s Silver Lake Drug & Gift has built a reputation for taking care of the Rochester community’s pharmacy needs, said Phil Hommerding, a pharmacist and the owner of Hunt’s.

“We do service a lot of long-term care facilities, group homes,” Hommerding said. “(We) do a lot of hospice business as well, take care of a lot of people in their last days, so rewarding work.”

Hunt’s is Rochester’s only independent pharmacy, a type of health care provider that is becoming increasingly rare in Minnesota. In 1996, the state had 550 community, non-chain pharmacies, according to the Minnesota Board of Pharmacy. As of 2023, that number was down to 156.

“If we were just a community pharmacy with no front end and no other sales coming in … it would be super hard to stay in business right now,” Hommerding said. “And I think that’s why we’re losing a ton of pharmacies in smaller communities.”

The financial woes impacting independent pharmacies have been in the making for decades. The core issue: inadequate reimbursements from pharmacy benefit managers, or PBMs, which manage prescription drug benefits and claims between health insurance plans and pharmacies.

Oftentimes, when a pharmacy fills a prescription, the cost of stocking that medication is higher than what the pharmacy is paid after the sale.

“We get underpaid for so many prescriptions that we sell,” Hommerding said.

“In many instances, (pharmacies are) losing $50, $75 a crack on some of these medications,” added Jason Varin, a pharmacist and assistant professor in the University of Minnesota’s College of Pharmacy.

A pharmacy’s reimbursement for a prescription under a particular health care plan is set by the PBM’s contract, which is not negotiable, Varin said.

“If the pharmacist looks at the contract and realizes that, well, I’m not going to break even on this, or I will barely break even,” Varin said, “they have two choices. They can agree to the contract anyway, or … if they don’t agree to it, they’re going to lose whatever percentage of patients that go there.”

With the three biggest PBMs now covering 80% of the U.S. health insurance market, saying no to a contract could mean a pharmacy losing a quarter of its insured clients.

It’s a financial bind that has led to the demise of many community pharmacies, especially in rural areas, Varin said.

“There’s situations where if a pharmacy in northern Minnesota goes belly up, there is a 250-mile pharmacy desert, which is not beneficial for public health,” Varin said.

At the very end of its 2024 session, the Minnesota Legislature passed a handful of changes that will help the state’s pharmacies, including allowing pharmacy technicians and pharmacy interns to continue providing vaccinations — a service that pharmacies can still reliably make money on.

Those measures are bandages to help keep pharmacies financially afloat while the larger, national issue of PBM practices persists.

“What we’re trying to do right now is to ensure that we’re able to stay solvent short-term and continue to care for our patients,” Varin said, “while, on a national level, working on PBM transformation or transparency.”

PBMs explained

Before PBMs emerged in the 1960s, Varin said, patients typically had to pay for their prescription drugs up front, then submit a reimbursement claim through their health insurance provider to cover some or all of the cost. Sometimes, the patient would learn, after buying those drugs, that their insurance doesn’t cover them.

“There was no way to provide real-time information,” Varin said.

Early PBMs stepped in to process drug claims for health insurers, creating systems where pharmacies could check “that the patient was covered, what the drug is that’s either being covered or not being covered, and what the copay would be,” Varin said.

“Pharmacy was the first health profession to actually do this real-time adjudication,” Varin said. “It was great for the pharmacies. It was, more importantly, great for the patients because the patients didn’t have to guess if they were spending $20 on a prescription that wouldn’t be covered.”

Then, PBMs began providing formulary services for health insurers — creating lists of medications that the health insurer would cover. The idea, Varin said, was to help health insurers save money.

“If you have five (medications) that are in the same category, and you have two of them that appear to be the most effective and provide the most efficacy for the general population, and one of them is significantly more expensive for the health plan than another,” Varin said, “the idea is they would include the least expensive one, that’s equally effective, on the formulary.”

Today, PBM contracts determine how much the PBM will charge the insurer for the prescription and how much the PBM will pay the pharmacy for dispensing that medication. The difference between those two figures is known as spread pricing.

Under these contracts, pharmacies lose money on some transactions because the reimbursement doesn’t cover what it costs the pharmacy to stock that medication.

PBMs also negotiate deals between drug manufacturers and insurers, including securing rebates on certain medications. The problem, Varin said, is that those cost savings aren’t forwarded down the line to insurers and pharmacies.

“They don’t keep 100% necessarily; they may give a portion back to the insurer, but they’re not providing that,” Varin said. “In most instances, they’re keeping those rebates, or a large component of them, for services rendered.”

The three biggest players in the PBM space are CVS Caremark, Express Scripts and Optum Rx (which is owned by Minnesota-based UnitedHealthcare). As of 2022, the Federal Trade Commission is investigating these PBMs and three others.

Minnesota’s legislative action

A 1,430-page omnibus bill adopted by the Minnesota Legislature on May 19 contains a few provisions that will impact pharmacies. One provision will allow pharmacy technicians and pharmacy interns — under the supervision of a pharmacist — to continue giving vaccinations, a practice that started amid the COVID-19 pandemic to aid in the nationwide vaccine administration effort.

“Before the pandemic, specially trained technicians could not provide immunizations; they had to be done by pharmacists,” Varin said. “During the emergency declaration, they said OK, we need all hands on deck, so you have pharmacy technicians which are trained to do it, they should be able to provide immunizations as well, and it was pretty successful.”

Other provisions will:

— Increase pharmacies’ dispensing reimbursement through Medical Assistance

— Guarantee that commercial health insurance will cover services provided by pharmacists, and

— Allow pharmacists to prescribe HIV prevention medication.

At the federal level, several bills have been introduced to reform PBM practices in the past year, according to Reuters. These include the Pharmacy Benefit Manager Transparency Act of 2023, which would prohibit PBMs from engaging in spread pricing, among other changes.

In 2022, the Federal Trade Commission also launched an investigation into the nation’s six largest PBMs, work that is still ongoing as of this year; in March, FTC Chair Lina Khan said at a White House roundtable on PBMs that the agency is “undertaking this work with enormous urgency and focus.”

In the meantime, though, Hommerding said, “Realistically, we’re just going to be treading water to see if we can get better contracts in the future.”

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There was a brief moment of concern for Twins starter Joe Ryan when he slipped on the mound in the fifth inning on Monday, throwing the ball straight into the ground. Ryan tried to wave off manager Rocco Baldelli and head athletic trainer Nick Paparesta, but they emerged from the dugout to check on him nonetheless.

It was funny, Ryan said, because he had been “talking (expletive)” about slipping on the mound and sure enough, he was the one to do it.

The duo departed soon after, clearly content with what they heard from the right-hander. The Twins certainly had to be content with what they saw from him, as well.

Ryan pitched seven innings, helping the Twins to a 6-5 win — one that got tense in the ninth inning, well after his departure — over the division-rival Kansas City Royals in the series opener at Target Field.

“He was awesome,” Baldelli said.

Ryan was tagged for just four hits in his start — three of them in the sixth inning, producing the Royals’ (34-21) only run of the day off him. He didn’t allow a walk and struck out nine.

Ryan got 15 swinging strikes in the outing, including 11 on his four-seam fastball, which accounted for 52% of his pitches. He also threw the hardest pitch of his career, which clocked in at 96.6 miles per hour.

His seven-inning start was his second consecutive outing of that length and the third time he completed seven innings in his last four starts.

“I think that’s just the nature of it — limit pitch counts and see how deep I can go in the game,” Ryan said. “That’s pretty much the goal, so definitely happy with that result.”

Ryan received his run support from a couple of big swings from third baseman Jose Miranda and outfielder Trevor Larnach. Miranda’s two-run home run off starter Alec Marsh in the third inning, a two-run shot, was tracked at 437 feet.

Larnach’s traveled even further.

After a pair of walks earlier in the inning, Larnach crushed a fastball from Marsh left over the heart of the plate to the second deck in right-center. It went 441 feet.

“He’s got good stuff,” Larnach said. “I just want to put together a good at-bat, no matter what it is that he throws. I’m just trying to be ready and prepare well.”

The Twins (6-5) tacked on a run in the eighth thanks to some shoddy defense by the Royals as they were unable to catch a couple of balls with two outs. Alex Kirilloff’s single eventually scored Max Kepler.

That run ended up being particularly important because in the ninth, the Royals put balls in play and made things interesting. After Cole Sands allowed three hits, Jhoan Duran entered with a four-run lead, needing just one out.

It didn’t come easy, but finally, after four runs had scored in the inning, Duran got Bobby Witt Jr. — the last hitter the Twins wanted to see at the plate with the lead hanging in the balance — to ground out softly to wrap up the win and his seventh save.

“They just tapped them to where we couldn’t get to them. But you have to finish the game and you have to find a way to make a play or just get the last out,” Baldelli said. “There was a little more drama than most 6-(1) games when you go into the ninth inning may have but I liked the way that we just kept going.”

Bill Walton, who starred for John Wooden’s UCLA Bruins before becoming a Hall of Fame center for his NBA career and one of the biggest stars in basketball broadcasting, died Monday, the league announced. Walton, who had a prolonged fight with cancer, was 71.

He was the NBA’s MVP in the 1977-78 season, a two-time champion and a member of the league’s 50th anniversary and 75th anniversary teams. That followed a college career in which he was a two-time champion at UCLA and a three-time national player of the year.

“Bill Walton,” NBA Commissioner Adam Silver said, “was truly one of a kind.”

Walton, who was enshrined in the Hall of Fame in 1993, was larger than life, on the court and off. His NBA career — disrupted by chronic foot injuries — lasted only 468 games with Portland, the San Diego and eventually Los Angeles Clippers and Boston. He averaged 13.3 points and 10.5 rebounds in those games, neither of those numbers exactly record-setting.

Still, his impact on the game was massive.

His most famous game was the 1973 NCAA title game, UCLA against Memphis, in which he shot an incredible 21 for 22 from the field and led the Bruins to another national championship.

“One of my guards said, ’Let’s try something else,” Wooden told The Associated Press in 2008 for a 35th anniversary retrospective on that game.

Wooden’s response during that timeout: “Why? If it ain’t broke, don’t fix it.”

They kept giving the ball to Walton, and he kept delivering in a performance for the ages.

“It’s very hard to put into words what he has meant to UCLA’s program, as well as his tremendous impact on college basketball,” UCLA coach Mick Cronin said Monday. “Beyond his remarkable accomplishments as a player, it’s his relentless energy, enthusiasm for the game and unwavering candor that have been the hallmarks of his larger than life personality.

“As a passionate UCLA alumnus and broadcaster, he loved being around our players, hearing their stories and sharing his wisdom and advice. For me as a coach, he was honest, kind and always had his heart in the right place. I will miss him very much. It’s hard to imagine a season in Pauley Pavilion without him.”

Walton retired from the NBA and turned to broadcasting, something he never thought he could be good at — and an avenue he sometimes wondered would be possible for him, because he had a pronounced stutter at times in his life.

Turns out, he was excellent at that, too: Walton was an Emmy winner, eventually was named one of the top 50 sports broadcasters of all time by the American Sportscasters Association and even appeared on The New York Times’ bestseller list for his memoir, “Back from the Dead.” It told the story of a debilitating back injury suffered in 2008, one that left him considering taking his own life because of the constant pain, and how he spent years recovering.

“In life, being so self-conscious, red hair, big nose, freckles and goofy, nerdy-looking face and can’t talk at all. I was incredibly shy and never said a word,” Walton told The Oregonian newspaper in 2017. “Then, when I was 28 I learned how to speak. It’s become my greatest accomplishment of my life and everybody else’s biggest nightmare.”

The last part of that was just Walton hyperbole. He was beloved for his on-air tangents, sometimes appeared on-air in Grateful Dead T-shirts; Walton was a huge fan of the band and referenced it often, even sometimes recording satellite radio specials celebrating what it meant to be a “Deadhead.”

And the Pac-12 Conference, which has basically evaporated in many ways now because of college realignment, was another of his many loves. He always referred to it as the “Conference of Champions” and loved it all the way to the end.

“It doesn’t get any better than this,” he once said on a broadcast, tie-dyed T-shirt on, a Hawaiian lei around his neck.

Walton will always be synonymous with UCLA’s dominance.

He enrolled at the school in 1970, before freshmen could play on the varsity team. Once he could play for Wooden, the Bruins were unbeatable for more than two years — Walton’s UCLA teams won their first 73 games, the bulk of the Bruins’ extraordinary 88-game winning streak.

UCLA went 30-0 in each of his first two seasons, and 86-4 in his career on the varsity.

“My teammates … made me a much better basketball player than I could ever have become myself,” Walton said at his Hall of Fame speech in 1993. “The concept of team has always been the most intriguing aspect of basketball to me. If I had been interested in individual success or an individual sport, I would have taken up tennis or golf.”

He also considered himself fortunate to have been guided by two of the game’s greatest minds in Wooden and Celtics patriarch Red Auerbach.

“Thank you John, and thank you Red, for making my life what it has become,” Walton said.

Walton was the No. 1 pick by Portland in the 1974 draft. He considered Bill Russell his favorite player and found Larry Bird the toughest and best he played with, so it was appropriate that his playing career ended as a member of the Celtics. “Playing basketball with Larry Bird,” Walton once said, “is like singing with Jerry Garcia,” referencing the co-founder of the Grateful Dead.

“What I will remember most about him was his zest for life,” Silver said. “He was a regular presence at league events — always upbeat, smiling ear to ear and looking to share his wisdom and warmth. I treasured our close friendship, envied his boundless energy and admired the time he took with every person he encountered.”

Walton died surrounded by his loved ones, his family said. He is survived by wife Lori and sons Adam, Nate, Chris and Luke — a former NBA player and now a coach.

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