To a Pharmacist, A Patient is a Friend, Neighbor, or Community Member. Who is the Patient to a PBM?

Frontline healthcare providers have a unique insight into the depths of systemic injustice. As independent frontline healthcare providers, we have first-hand experience of systemic injustice, and just how brutally it affects patients, especially those in communities of color, in rural areas, or those of lower socioeconomic status.

While the rest of the country is just beginning to examine how these communities have been disproportionately affected by COVID-19, the independent pharmacies who serve those populations have long been sounding the alarm about how much more damaging it will be if these patients lose their neighborhood pharmacies. 

A JAMA Internal Medicine letter published last fall explored the impact of “pharmacy deserts” on poor and minority communities, gaining much media attention but little change. Last year this compelling Al Jezeera story shed light on the problem, but again, no change. As pharmacists, we are tired of the platitudes and excuses, and as we have seen in our fight against PBMs, we must work together to see progress across our country. 

Pharmacy deserts are the result of the PBM business model, which relies on secrecy,  exploiting loopholes, abusing pharmacies, and playing patient-steering games in the name of saving somebody - no one knows for sure who - money. These PBM-created pharmacy deserts will cause larger divides in healthcare access, inevitably creating problems across our communities that we won’t be able to fix.

The best antidote for these despicable PBM tactics is transparency. Transparency is a tenant PUTT was built on. Transparency highlights where reform is most needed. Reform should provide stability and allow equal opportunities for communities within the system, enabling stronger, more united communities to flourish. It can also bring to light to truths many people did not previously see or want to acknowledge. A complement to transparency is advocacy, and advocacy stimulates change.

Since the pandemic began, we’ve seen evidence in Florida and other states of PBMs blatantly ignoring Governors’ executive orders to allow patients to receive 90-day prescription fills and pharmacies to be paid for dispensing them. In classic passive-aggressive style, PBMs have been blocking or slashing reimbursements, forcing pharmacies to reconsider participating in the Medicaid network. Just when the positive light of community solidarity is needed most, there go the PBMs: gaming the system, squeezing every available dollar from Medicaid for themselves and forcing pharmacies to subsidize patient care off of dangerously shrinking margins.

Many who desperately depend on their local pharmacies are within the hardest-hit communities by the pandemic and its economic fallout. And while the coronavirus doesn’t discriminate on the basis of skin color or socioeconomic status, PBMs do - by using policies that all but ensure those pharmacies serving minority, rural, and poorer communities are driven out of business or scooped up by giant retailers at fire-sale prices. 

PBMs will gladly route those patients into mail order, a costly and wasteful system that generates millions in additional revenue for corporate shareholders. But it's a slap in the face to the communities and patients who most need access to healthcare and an even more disturbing statement of where PBM loyalties lie. Spoiler alert: it’s not with the patients.

As pharmacists, our patients are our top priority, and we have all given so much to help our communities during these difficult times. It is not enough to simply say we support our communities. We must strive to be more inclusive and understanding of what our friends, neighbors and customers are enduring. We spend an incredible amount of time educating patients in our stores, but genuinely listening is a valuable part of educating ourselves.

Currently, with the overwhelming effects of social unrest and a worldwide pandemic, the need for reform is greater than ever. Feelings of anger, bitterness, sadness, and grief cause deep divisions that have bubbled to a breaking point. The senseless deaths of Rashard Brooks, George Floyd, and countless others in our own communities, needs to end now. Patients need accessible healthcare providers who fight for them. As community pharmacists, we advocate on behalf of our patients daily, but being the best healthcare champions we can be requires advocating for fairness in all areas, especially in the most routinely silenced segments of our own cities and towns.

The issues created by PBM biased business tactics and unfair patient treatment will never be resolved if we do not take a stand on behalf of our patients and fellow pharmacists. The past few months have forced us to put our priorities in order. Bricks and mortar can be replaced. Patient lives lost due to injustice or blind corporate greed cannot. 

At PUTT we support equality for all members of our communities regardless of their skin color, age, or economic status. We are united in the need to end racism and inequality because only when everyone is treated equally can we say we are truly honoring our oath as pharmacists  "to consider the welfare of humanity and the relief of suffering as (our) primary concerns".

M. Scott Newman, PharmD
Board President
Pharmacists United for Truth & Transparency