Letter to the Editor - PBMs need oversight

Nathan Vorac
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Small pharmacies have always been important to community health. Providing medical treatments and advice, administering prescriptions, improving patient adherence, dispensing annual flu vaccines, and testing for certain conditions are just a handful of our responsibilities. And, in the face of COVID-19, our role expanded exponentially, alleviating hospitals by treating patients, trying to ensure adequate supply and storage of needed medications, and some even providing patients with COVID-19 tests to help stop its spread. Now, we are working hard to get shots into as many people’s arms as possible to overcome this pandemic.

Local pharmacists show up each day working for our communities and promoting healthier lifestyles and disease prevention—no matter how difficult this has become. But in addition to the drastic shift in daily work functions and influxes in patients that continue to strain pharmacists and technicians, we are small business owners who have administrative duties. Unfortunately, these tasks and red tape can often take us away from patient care, and during a global pandemic, that has been even more concerning.

To lessen these burdens and help with other business tasks, many pharmacists choose to engage the services of pharmacy services administrative organizations (PSAOs). PSAOs are administrative providers that help community pharmacies navigate the complexities of the pharmacy benefit marketplace and help us to serve patients within our pharmacy networks. These services have been even more important during this global health crisis.

Still, despite the help of PSAOs and being such an important hub for public health, increasing outside pressures are threatening the livelihood of our businesses and our community’s health. Most concerning have been the practices of pharmacy benefit managers (PBMs).

Community pharmacies are essentially forced into contractual relationships with PBMs, who serve as the middlemen that manage prescription drug benefits for large employers, insurers, and the government. Under the guise of patient advocates, these multi-billion dollar companies have slowly taken over the prescription drug market, using their outsized influence to make it harder for patients to receive care and pharmacies to administer it.

PBMs have little regulatory oversight, allowing their practices to burgeon—and not in a good way. Now, PBMs dictate which medications are covered by a patient’s insurance, where a patient is allowed to get their medication, and how much a pharmacy is reimbursed for medications. And even though PSAOs try to represent pharmacies’ best interests during contract negotiations, there is little wiggle room, and contracts end up being one-sided to favor PBMs. As a result, PBMs continue to reduce reimbursements to small pharmacies, claw back payments months after a claim has been processed,

and often pay less than the medication costs. This leads to pharmacies often paying to dispense a prescription to a patient, instead of being paid to do so.

Making matters worse, it is well documented that PBMs manipulate the prescription drug market and increase medication costs from the rebates they charge manufacturers. In fact, in 2019, PBMs charged manufacturers $143 billion, adding nearly 30 cents per dollar to prescription drugs for patients. This is unacceptable, and PBMs have skated by for too long, pointing fingers at other entities and flying under the government’s radar.

It is refreshing to see the Illinois state government begin to seek transparency from PBMs and introduce legislation to regulate their practices that harm patient’s, taxpayers, and pharmacies. However, PBMs are still deflecting responsibility, just as they always do, now placing blame on PSAOs for the high cost of medication. For pharmacies, this is very disheartening. While PBMs try to profit off us, PSAOs work to ease burdens and make our businesses more efficient so we are able to dedicate our time to patients.

Pharmacies across Illinois are counting on lawmakers to rein in PBMs. At the same time, we hope lawmakers will also protect pharmacies and PSAOs against PBMs’ false claims. Failure to do both of these things could force many community pharmacists to close our doors, further harming public health and patients’ ability to access healthcare.

 Nathan Vorac is an independent pharmacist in Geneseo