Preserve community culture by reining in pharmaceutical middlemen

This op-ed originally ran in The Petersburg Observer.

Community-based pharmacies are the fabric of Illinois. As a lifelong pharmacist who’s practiced at both retail chains and local prescription shops, I’ve witnessed firsthand how far personalized care can go.

Unfortunately, shady healthcare middlemen called Pharmacy Benefit Managers (PBMs) are causing independent stores to shutter at historic rates—ripping the fabric of our local communities apart. Curbing the power of these corporate players would finally give pharmacists like me a chance to breathe.

PBMs came into the picture nearly 40 years ago to manage prescription drug benefits on behalf of health insurers. Their goal was to help patients by lowering the cost of drugs and reduce paperwork for pharmacists.

Fast forward to today and PBMs have expanded to control the entire prescription drug supply chain. The middlemen decide which patients walk into a pharmacy, set the prices they pay, and effectively play doctor by choosing which medications are covered by insurance.

By dictating which pharmacies patients can use, PBMs act like shepherds herding sheep away from lush, local pastures to overcrowded feedlots. Customers looking to refill their prescription drug bottles get steered toward larger chain stores like CVS—many of which are PBMs themselves.

This behavior erodes the pharmacist patient relationship that small communities cherish. And there’s no end in sight, since the nefarious practices of PBMs are currently largely unchecked.

The healthcare middlemen employ a reimbursement scheme known as “clawbacks,” where they charge independent pharmacies additional fees after the point of sale. These clawbacks significantly strain the bottom lines of independent pharmacies, making it nearly impossible for them to operate sustainably.

PBMs also make more money off expensive drugs since they receive a percentage of the cost rather than a flat fee. Therefore, they use their power to convince patients to buy top-dollar medications, contributing to the high costs that most consumers experience today. One economic analysis even shows that this behavior has a spillover effect on what medications doctors prescribe to patients.

Concentration of power in the healthcare market is largely to blame. Just three PBMs control 80 percent of the prescription drug arena, making it incredibly difficult for independent pharmacies to compete. They lack the negotiating power to secure fair drug prices or reasonable insurance rates, often forcing them out of business.

The closure of these independent pharmacies means more than just losing a local business; it means the loss of personal, community centered care that patients rely on. In my home state of Illinois, over 40 percent of independent pharmacies have shuttered since 2013—leaving thousands of patients with lower-quality care.

And this void has disproportionately affected low-income and rural populations. That’s because patients who live in rural communities must travel greater distances to access their local pharmacy or pay high premiums for mail-order prescriptions. It’s a lose-lose situation.

Fortunately, federal legislation is currently being pushed by both parties that would limit some of the power PBMs have over the prescription drug market. If passed, these bills would foster more transparency within PBM operations and rein in anti-competitive practices that hurt community-oriented pharmacies. They just need a final push to get across the finish line.

Until then, independent pharmacies across the country will continue to shutter—and Illinois patients who rely on personalized, local care will continue to feel the burn. I urge Sens. Dick Durbin and Tammy Duckworth to support federal legislation that would rein in the shadowy practices of PBMs.