Why Would Community Pharmacists Travel 1,522 Miles to Ask "Less Government" Legislators for MORE Government?
When New Orleans hosted the American Legislative Exchange Council conference last week, community pharmacists traveled distances greater than 1,500 miles to ask the “limited government, free markets and federalism”-favoring legislators for MORE regulation over pharmacy benefit managers (PBMs).
Pharmacies are excluded from the “free market” system by unregulated, middlemen PBMs who have been allowed to take over the pharmacy industry, co-opting the role of physicians by deciding patients’ drug options and coverage; gagging pharmacists from informing patients when it’s cheaper to pay out of pocket than use insurance; and keeping manufacturer rebates instead of giving them to the patient. And that’s only a few of the tactics PBMs use to control the supply chain from drug manufacturer to pharmacy counter to patient.
PBMs rig the system by designing benefits plans to appoint themselves -- mere claims administrators -- as the final authority on plan formularies, pharmacy reimbursements and plan premiums and copays. Their system is “proprietary” - but that’s just code for “arbitrary and capricious” because no one knows how they actually determine plan prices and reimbursements. They are not required by law to divulge this information - even to taxpayers, whose hard-earned dollars fund Medicaid and Medicare.
PBMs are also allowed to own retail and mail order pharmacies, despite the obvious conflict of interest between designing the drug benefits plan and deciding where patients may go to fill their prescriptions. Although PBMs contract with large chain and independent community pharmacies to create the illusion of network coverage, PBMs drive customers to their own pharmacies by lying to patients and their doctors, telling them they must use PBM-owned pharmacies or their medications will drastically increase in price. Or they simply mandate the use of their own pharmacies as part of the benefits plan they design.
Because PBMs cannot be held to account for their pricing and billing tactics, they engage in exorbitant spread pricing, as investigations in Ohio, Kentucky, Iowa, Florida and Arkansas have proven. Taxpayers are the unwitting funders of this crass profiteering scheme.
Small business pharmacy is not allowed to operate in a free market system because PBMs control the contracts, the reimbursements and access to patients.
This is why PUTT made the journey - to ask “less regulation” lawmakers for help restoring the right of free and unfettered competition to pharmacy -- for the good of our patients.