When It Comes to Health Care, We Must Prioritize People Over PBM Profits
By Cathy Hanna, PharmD
Reliable, affordable and local access to healthcare in our communities has always been important, but over the last two years, the need has become even greater.
During these difficult times, Kentucky’s community pharmacies have played a critical role in keeping healthcare close to home, ensuring Kentuckians’ access to their medications and providing much-needed consultation with a trusted provider, without delay.
Unfortunately, the services pharmacists provide remain under constant threat from the harmful actions of other major players in the healthcare system—most notably, pharmacy benefit managers (PBMs).
Many Kentuckians are unaware of the significant role PBMs play in deciding how and where they can access their medications, and what they pay for them. And while PBMs and their insurer partners say they’re looking out for the best interests of Kentucky patients, providers and employers, their actions tell a different story.
That’s why community pharmacists and the people we serve are counting on the Kentucky General Assembly to act during the remaining weeks of the 2022 legislative session. Specifically, we’re supporting two important pieces of legislation, House Bill 457 from Rep. Steve Sheldon (R-Bowling Green) and Senate Bill 134 from Senator Stephen Meredith (R-Leitchfield), that will benefit Kentuckians who depend upon prescription medications to stay healthy and manage their chronic conditions.
PBMs claim to lower drug costs and premiums for employers and patients by negotiating significant price discounts from drugmakers. But then they pocket the savings to increase their own bottom lines. SB 134 would ensure the cost savings negotiated by PBMs are passed along to benefit employers and patients, lowering their healthcare costs as intended.
PBMs also routinely force many Kentuckians away from their trusted community pharmacies by mandating the use of a mail order process. Too often this leaves patients with questions and concerns about their medications. Sometimes PBMs will even take advantage of the mail order process to implement a practice known as white bagging. This practice topples the normal patient safety checks pharmacists provide, such as checking for drug interactions and dosing for a specific patient’s weight.
HB 457 would address the mail order mandates and ensure Kentuckians have safe, reliable access to the brick-and-mortar community pharmacy they choose. This protects a critical link in Kentucky’s healthcare chain, particularly in rural communities where pharmacists are often the most direct and trusted provider contact for many individuals and families.
As frontline healthcare providers, pharmacists are all too familiar with the problems that PBMs are creating for our patients because we encounter them daily. But the PBMs are also putting our ability to practice at risk.
With nearly zero transparency into how PBMs set provider reimbursement rates, pharmacists are often left in the dark about what they’ll be paid to dispense a medication. The coverage and reimbursement rates for certain medications can change at a whim, without any explanation, leaving pharmacists unable to afford and provide the care their patients need.
These practices have a direct, negative impact on Kentuckians and are also detrimental for the pharmacies that serve them. At the end of the day, local pharmacies are businesses, too—and many are struggling to keep their doors open as these pricing practices continue to get worse.
Every time a local pharmacy is forced to shut its doors, it hurts the people who live in that community. PBMs and insurers are quick to dismiss these closures and say that Kentucky pharmacies are doing fine. As someone who is on the ground and speaking with pharmacists every day, I can tell you that many pharmacists and their staff are indeed struggling to stay afloat.
I commend our state legislators for their previous actions to help combat the harmful actions of PBMs. Now, we need their help once again as PBMs continue to find loopholes and workarounds for which Kentuckians and their providers are paying the price. It’s time to pass HB 457 and SB 134 and send a strong message to PBMs that patients matter more than their profits.
Your local community pharmacists want nothing more than to continue serving you and your family for years to come. To do so, we need changes to the way medications are priced, so middlemen in the healthcare system are not profiting at your expense. We hope our lawmakers in Frankfort agree.
