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Pharmacy Benefit Managers (PBMs) Harm Pharmacies and Patients Alike

May 24, 2022
man's hand with pills spilled out of the container .

By Aliyah N. Horton

Pharmacists play an essential role in the healthcare delivery system. Each day, their top priority is helping patients access medications they depend on to meet their healthcare goals. Every effort is made to ensure that medications are provided at affordable prices. Pharmacists appreciate the value of pharmaceutical innovation; yet rising prescription drug costs represent an ever-pressing problem to managing chronic diseases. Pharmacists continue to raise the alarm about ongoing threats from PBMs and other factors to the delivery and accessibility of affordable medications.

PBMs are middlemen in the prescription drug supply chain that neither develop products, nor have any direct interactions with patients. However, they have found many ways to reap massive financial benefits as the “go-betweens” among pharmaceutical companies, health insurers, patients, and pharmacies. They collect fees all along the health care delivery supply chain, including rebates from pharmaceutical manufacturers, overcharging insurers and state Medicaid plans (also known as spread pricing), as well as “clawbacks” of reimbursement revenue owed to pharmacies. Clawbacks involve PBMs taking additional money from pharmacies post-dispensing, claiming the pharmacy was overpaid. This practice leaves pharmacy owners unable to calculate their actual operating costs reliably, and has led to pharmacy closures, shortened pharmacy staff hours and reduced availability of patient-care services. By siphoning off revenue, PBMs effectively raise the costs of prescription drugs and limit accessibility to them.

While pharmacists are dedicated to their role in helping patients meet their health goals, community pharmacies often receive reimbursement payments from PBMs at 40% below drug costs. It is unsustainable for pharmacies to operate in this manner and many pharmacies struggle to stay open while operating within this scenario.

In 2015 alone, the three PBMs that control nearly 75% of the national market collected over $10 billion in profit. This prosperity comes at the expense of local pharmacies and patients, as out-of-pocket costs

rise and pharmaceutical companies in Maryland and across the country consider lessening their investment in research and development.

Pharmacists should be able to do their jobs of providing medications to patients, unimpeded by PBMs’ profit motives. Healthy margins for pharmacies are needed to allow them to stay in business and provide better access and affordability for patients who depend on prescription medications. This would be a welcome improvement to sustaining critical pharmacist-patient relationships.

On a local level, community pharmacies benefit thousands of Maryland residents. They serve as a triage point where healthcare services are provided to many rural and low-income communities. These small businesses have strong relationships with their patients. Additionally, pharmacists in these areas often contribute to tackling the opioid crisis by monitoring medications and distributing the life-saving drug, Narcan.

These are just a few examples of how pharmacists serve patients and help to improve healthcare of patients daily. In Maryland and across the nation, pharmacists provide essential patient-care services in many unnoticed yet vital ways. Our community pharmacies supported us during a global pandemic that brought the world to a halt. In return, Marylanders and those across the nation should support pharmacists’ efforts to best serve their communities by minimizing PBMs’ ability to siphon profits from pharmacy revenues. Take a moment and ask your local pharmacist about these issues and others and the lengths they go through to stay open despite challenges presented by PBMs.

As it stands, PBMs are actively abusing Maryland residents and patients across the country by profiting on the backs of community pharmacies, creating limited to no value while hampering investment for medical innovation. Now, it’s time to convert these profits into savings on both sides of the pharmacy counter and support PBM transparency and lower prescription prices for patients. Such a change to the pharmacist-patient relationship would not only result in better healthcare outcomes but also provide greater access to life-saving medications at a lower cost.

Aliyah N. Horton is the Executive Director of the Maryland Pharmacists Association.

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