Guest column: The cure for pharmacy benefits managers’ grip on Rx drugs

This op-ed originally ran in The Worcester Telegram & Gazette.

The Federal Trade Commission recently reported that just six of the country’s largest health care middlemen, known as pharmacy benefit managers, control 95% of the prescription drug supply chain.

From inconsistent reimbursement schemes to competing for my patients, these corporate players are causing headaches for independent pharmacy owners like me. It’s time their powerful grip is loosened by our elected leaders in Congress.

PBMs were created to negotiate prescription drug discounts on behalf of insurers. Their role enabled drug manufacturers to have their products included in prescription drug plans, resulting in cost savings for patients at the pharmacy counter.

Their function was beneficial for the drug supply chain at the start. But as the health care market became more consolidated, PBMs took control of nearly every role in the prescription drug supply chain — from dictating who walks into a pharmacy, to setting the prices, to choosing which medications get insurance coverage.

For small, community-oriented pharmacies like mine, having control over who walks into my doors is crucial. That’s because my patients are more than just customers; I know their names and medical histories, which allows me to form close relationships.

The same bonds cannot be formed at major pharmacy chain stores like CVS — which also owns a PBM — since they deal with thousands of patients every day. And PBMs work tirelessly to steer patients toward these corporate giants.

As if worrying about my client base wasn’t enough, PBMs constantly threaten my bottom line with predatory schemes like “clawbacks.” These middlemen impose additional fees after a sale, causing store owners to lose money on many prescriptions and making it nearly impossible to stay afloat. Every transaction feels like trying to fill a leaky bucket.

To compound this issue, PBMs are notoriously known to mandate brand medications but reimburse pharmacies for less than the cost of acquisition. Because of their stranglehold over state-run Managed and Accountable Care Organizations — health care plans that are designed to manage patient care — PBMs dictate which drugs are suitable for reimbursement.

And for Main Street pharmacies, which often operate on razor-thin margins, this practice can be financially devastating. It forces pharmacy owners to either absorb higher costs or pass them on to our already-burdened patients, undermining the personalized care we strive to provide.

The consequences of these behaviors are glaringly apparent. In my home state of Massachusetts, pharmacies are shuttering at alarming rates. Meanwhile, patients are suffering from sky-high prescription drug costs that have climbed nearly threefold since the year 2000.

Thanks to the opaque practices of PBMs, both patients and pharmacy owners are being dealt bad hands.

Fortunately, federal legislation may offer some hope. A bipartisan coalition of lawmakers is advancing measures that would reform the practices of the health care middlemen. The bills would mandate greater oversight over the nefarious practices of PBMs and overhaul how they are compensated. They just need an extra boost to make it over the finish line.

If passed, community-oriented pharmacies could finally return to providing quality care to their patients — preserving the culture of countless local communities. I urge Sens. Elizabeth Warren and Ed Markey to side with Main Street pharmacies and cast their support for these bills.