To the editor,

Are you concerned about the cost of your prescriptions? Are you concerned about being able to fill your medications at the pharmacy of your choice? Have you had to fill your prescription at another pharmacy because your preferred pharmacy is not contracted with your insurance? If you answered "yes" to any of these questions, allow us to explain why there is a clear and immediate threat to many retail pharmacies across our country, especially those that are locally owned.

Pharmacy Benefit Managers, or PBMs, are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. They act as negotiating entities between drug companies, insurers, and pharmacies, and they are usually the ones responsible for paying the drug costs to your pharmacy on behalf of your insurance. PBMs are often owned by or affiliated with your insurance company; some examples are Express Scripts, CVS Caremark, and OptumRx (these three own nearly 80% of the market share). And, often, they are paying your locally owned pharmacy WAY below the cost for them to purchase and dispense your medication (sometimes hundreds of dollars below the pharmacy's cost to purchase a single medication, and sometimes tens of thousands of dollars below cost for prescription claims in a single month!) Their contracts are typically "take it or leave it" for your local pharmacy and often offer low or below-cost reimbursement rates as their only option.

Numerous articles have been published in the past several weeks criticizing the role of PBMs and their role in inflating drug costs to consumers while simultaneously decreasing payments to retail pharmacies, including the New York Times, Wall Street Journal, and the Federal Trade Commission. These articles have pulled back the veil of how PBMs have been limiting your pharmacy choice, driving up drug costs, and putting independently owned pharmacies out of business at an alarming rate. (In Pennsylvania, over 140 pharmacies have already closed in the first half of 2024!) PBMs are KILLING locally owned pharmacies across the country.

The FTC report left no doubt that these PBMs are creating unfair advantages for themselves that are driving up costs for consumers, limiting consumer choices, and killing access to quality pharmacy care. They pay their own mail order pharmacies more, keep billions of dollars of "middleman" money for themselves rather than passing that savings money to you or your employer, sometimes make you purchase the more expensive brand name medication (so they can receive more rebate money from the drug maker), steer patients toward their own affiliated or mail-order pharmacies, pay independent pharmacies less amounts than their affiliated pharmacies, and have collected huge amounts of unfair "fees" from pharmacies over the past several years. They have made the retail pharmacy playing field unlevel, and as more independent pharmacies close, the quality of local healthcare will decrease dramatically, forcing many people to potentially drive long distances for prescriptions (if their local or preferred pharmacy is no longer in business), pay higher drug costs, and have longer wait times to access their medicine.

"What can I do?" you may ask. There are at least a couple ways to support the cause. One is to urge your employers to examine pharmacy benefits when plan renewals come due to see if the insurance company they work with uses a PBM that is cited in these articles mentioned above (the "big 3" PBMs, in particular). The second way is to urge your state and federal legislators to support these two bills that have bipartisan support:

• 2973, the Modernizing and Ensuring PBM Accountability (MEPA) Act(passed 26-1 out of the Senate Finance Committee)/H.R. 5378, the Lower Costs, More Transparency Act (passed the House of Representatives on an overwhelming bipartisan vote of 320-71)
  • Bans spread pricing in Medicaid managed care by requiring a fair and transparent reimbursement to pharmacies and saves over $1 billion!

• 3430, Better Mental Health Care, Lower-Cost Drugs, and Extenders Act(unanimously passed the Senate Finance Committee)
  • Includes the No PBMs Act which requires CMS to define reasonable and relevant contract terms in Medicare.

Here is an easy link to contact your legislators: https://www.fight4rx.org/action-center.html

If you are concerned about prescription drug costs, small business pharmacies, and your local pharmacy access, please reach out to your legislators for this common sense PBM reform that will help your local pharmacy receive fair reimbursement and keep their doors open. Many pharmacies will continue to close or not accept certain insurances in 2024 and beyond if this continues. Congress must not miss this opportunity to act! 

Sincerely,

Dave Willink, Pharmacist/Owner, Village Pharmacy of Baldwin, Ellsworth, and Glenwood City

Matt & Julie Johnson, Pharmacists/Owners, Chet Johnson Drug of Amery

Matt Huepfel, Pharmacist/Owner, Spring Valley Drug