When Oklahomans step up to my pharmacy counter, it’s usually because something is wrong. There is chronic disease, pain and trauma. As a pharmacist, it has been the privilege of my career to help fix what is wrong, and get patients the medication they need to heal, to thrive, to survive.
However, instead of looking into my patients’ eyes and seeing relief, all too often I see dread at the prescription’s price tag — and a deep worry they won’t be able to afford it.
There are many reasons the cost of health care in our country has risen consistently over the years. When it comes to the cost of prescription drugs, one big contributor often overlooked is Pharmacy Benefit Managers, also known as PBMs.
Most people have never heard of a PBM, but if you have filled a prescription, you have likely been impacted. PBMs are middlemen who have nothing to do with direct patient care, but greatly affect patients’ costs. They pull many of the drug pricing levers like negotiating prescription drug discounts with drugmakers, setting patient copays, setting pharmacy reimbursements, and extracting rebates from manufacturers. In fact, a recent study showed that 2020 was the first year where nonmanufacturer stakeholders — mainly PBMs — earned more on brand name medicines than the companies that invested in research & development and actually manufacture the drugs.
While PBMs and their insurer partners claim to look out for Oklahoma patients, providers, and employers, their actions tell a different story. The savings PBMs claim to manifest rarely trickle down to consumers, but rather translate into huge profits for a few companies.
The dysfunction in the system is so troublesome that the Federal Trade Commission (FTC) is currently investigating how PBMs have driven up costs and have asked Americans to share their stories. Until April 25, the FTC is collecting information on how abusive PBM practices impact patients, physicians, employers and pharmacies, and I encourage Oklahomans to share their stories.
I know the importance of speaking out. As a community pharmacist, I regularly advocate on behalf of patients, because I believe local access to quality health care is critical. During the pandemic, Oklahoma’s community pharmacies provided vital health care close to home. We pivoted our care during this trying time and provided COVID-19 immunizations, compounded hand sanitizer, and sat with very sick and contagious patients to administer monoclonal antibodies.
Local pharmacies are health care providers, but we are also small businesses that have been hit hard by this pandemic. While we are struggling to keep our doors open, the predatory pricing practices implemented by PBMs impact our patients and make it difficult to stay in business.
The good news for Oklahomans is that our Legislature has undertaken many efforts to increase access to care and reduce the hurdles so often placed in front of patients, but there is still much more to be done. PBMs have a direct, negative impact on Oklahomans who rely on prescriptions and on the pharmacies that serve them. As a pharmacist who had to close my small rural independent pharmacy, I can tell you the system is broken.
Several bills before the Legislature would help address these challenges. One would help level the pharmacy playing field and allow patients to choose where to spend their healthcare dollars, instead of PBMs dictating where they can go. Another would make sure that PBMs share the savings from rebates, putting rebates into the pockets of Oklahoma patients instead of keeping them to increase profits for Wall Street.
Community pharmacists want to continue serving you and your family for years to come. But to do so, we need changes to the way medications are priced, so middlemen are not profiting at your expense...
About the Author: Dr. Oliver Lackey is a pharmacist and formerly owned a rural independent pharmacy in Fairview, Oklahoma. He now manages a pharmacy in Enid.
Great article!