Independent Pharmacies Say Drug Middlemen Are Making Them Sick
Published by Bloomberg Health Care Blog
Independent pharmacy groups in several states are sick of the low insurance reimbursement rates that middlemen, known as pharmacy benefit managers, or PBMs, pay them after drugs are dispensed and they’re pushing for greater oversight of the drug middlemen.
PBMs include companies like Express Scripts Holding Co., CVS Health Corp.’s Caremark, and UnitedHealth Group Inc.’s OptumRx, and independent pharmacies say those companies’ practices may threaten the survival of nonchain pharmacies.
The PBM reimbursement rates and post-sale fees they charge pharmacies are challenging the survival of independent pharmacies, according to the Alexandria, Va.-based National Community Pharmacists Association, a trade association for independent pharmacies, more than 80 percent of which are located in small population centers.
Moves are afoot in state legislatures, including Arkansas and Kentucky, to increase government regulation of PBMs.
In Kentucky, for example, a state Senate committee approved a bill Feb. 14 that would end state Medicaid payments to pharmacy benefit managers for managing the state program and let the state use the money to administer its own pharmacy benefits program.
“[PBMs] currently set all the rules with little to no government oversight,” Kentucky state Sen. Max Wise (R) said in a statement. “As a state senator, taxpayer, I don’t think that’s right.”
Recent Posts
-
Pharmacy Community Stands Together to Protect Seniors and Prevent a Long-Term Care Crisis
The Senior Care Pharmacy Coalition (SCPC), representing the nation’s long-term care pharmacies, the American Society of Consultant Pharmacists (ASCP), representing pharmacists and pharmacies dedicated to managing medications for older adults and medically complex patients, and the National Community Pharmacists Association (NCPA), representing community pharmacists nationwide, stand united in support of immediate action—whether through legislation or […]
-
Rep. Beth Van Duyne: Congress can save seniors’ access to medications before it’s too late
Seniors in nursing homes across the country depend on round-the-clock care and medications, perhaps more than any other American patient population. In turn, the nursing homes and assisted living facilities that care for them depend on a small number of specialized long-term care (LTC) pharmacies to ensure their patients have access to the prescription meds they need.
-
Bill Aims to Offset Reimbursement Losses for Long-Term Care Pharmacies Catering to Nursing Homes
Starting in January, falling prices for costly drugs may strain long-term care pharmacies, but proposed legislation backed by advocacy groups aims to subsidize some of this loss. And nursing home advocacy groups are among those urging Congress to pass the Preserving Patient Access to Long-Term Care Pharmacies Act.
Stay in the Know
Get the latest news and updates on issues impacting the long-term pharmacy community.