In The News | Local View: Protect patient access by confronting pharmacy challenges

Duluth News Tribune

Author: Andrew Russell, PharmD, PUTT Board Member

For many Minnesotans, the local independent pharmacy is the most accessible and consistent point of care in the health system. Whether it's a senior managing multiple chronic conditions, a parent juggling work and caregiving, or a patient in a community where health care options are limited, pharmacies remain anessential lifeline.

Yet, behind the counter, independent pharmacies face mounting pressures from pharmacy benefit managers, or PBMs, whose practices increasingly threaten patient access. Reimbursement rates continue to fall below acquisition cost, unpredictable fees destabilize operations, and administrative burdens divert critical time away from patient care.

These pressures are especially acute in rural Minnesota, like much of the Northland, where a single closure can create an immediate pharmacy desert and leave entire communities without reliable access to vital medications.

PBMs often argue that efforts to regulate them will harm affordability. But their claims obscure the real issues: opaque pricing structures, spread pricing, retroactive clawbacks, and steering practices that prioritize profits over patients. Independent pharmacies are expected to absorb the impacts of these decisions while maintaining the same level of access and care, an expectation increasingly impossible to meet.

Some PBMs have attempted to deflect criticism by pointing to Pharmacy Services Administrative Organizations, which provide administrative support that independent pharmacies often do not have the time or resources to manage on their own. They assist pharmacies with compliance and licensure requirements, credentialing, contract management, and data reporting. Pharmacy Services Administrative Organizations do not control pharmacy reimbursement rates or PBM payment practices. They can help independent pharmacies, but they cannot correct the systemic problems created by PBMs. Suggesting otherwise is a deliberate attempt to redirect scrutiny away from the real source of harm.

Minnesota policymakers should focus on preserving patient access, not PBM profit margins. Strengthening oversight of PBM reimbursement practices, ensuring transparency in drug pricing, supporting a sustainable payment model for independent pharmacies, and acknowledging Pharmacy Services Administrative Organizations for what they are — support partners, not decision-makers — are essential steps in protecting Minnesota patients.

If Minnesota is serious about safeguarding pharmacy and healthcare access, especially for rural and underserved communities, it must confront PBM practices directly. Independent pharmacies are doing everything they can to continue serving their patients. They deserve policies that allow them to keep their doors open and continue providing high-quality care that Minnesotans rely on every day.

About the Author:

Andrew Russell is a registered pharmacist, the co-owner of Elko New Market Family Pharmacy in Elko, Minnesota, and a statewide advocate for pharmacy issues and patients.