Nationally, oversight and regulation of PBMs have been the topic of every State Pharmacy Association and legislative leaders across the country, so, should there be concern about this in the District of Columbia? To answer this question, it’s helpful to get some personal perspective on the issue.
Historically, PBMs were tasked with negotiating drug prices on behalf of healthcare insurances but also run their own mail order pharmacies, thus establishing monopoly practices that drive the reimbursement of medications for Mom and Pop pharmacies out of business. In the last year, pharmacies located in the District on Good Hope Rd, in Southeast and H Street, Northeast have closed and this should be alarming because there are more who struggle each and every day to remain open!!
Community pharmacies are increasingly closing their businesses because of underwater reimbursements from PBMs. Also mail order pharmacies have now removed the patient from having to see their neighborhood pharmacist. Mail order pharmacies frequently refill prescriptions without even asking if patients need them and delivering them every 90 days which is very profitable for PBMs.
But what about patient care? Frequently, a counter argument is that mail order pharmacies save alot of money for the insurance plan, but unfortunately, patients often accumulate a lot of expensive brand prescription medications delivered by mail order pharmacy. What if the patient is diagnosed with a chronic disease? How do you identify medication compliance when there is no established relationship with that neighborhood pharmacist?
PBMs have been working under a very opaque system with very little oversight as they get to negotiate prices from manufacturers and receive kickbacks to have their products on PBMs formulary. PBMs add additional price to the actual cost of the medication and collect that high cost from employers and insurance companies, and they never need to disclose the cost to public. PBMs keep most of the profit and pay community pharmacy a low negotiated price on each prescription filled with no additional service fee, and this reimbursement is even lower than the cost of the prescription drug. Local pharmacies have no choice but to fill the prescription under the terms of contract with PBMs or lose the customer to mail order pharmacies owned by PBMs.
For community pharmacists it is very difficult to stay in business when faced with these challenges and a troubling trend is that community pharmacies are increasingly going out of business or selling their pharmacies to one of the PBM owned chain pharmacies. This creates a monopoly market where there are no more options to choose from, or get better service from a community pharmacy!
So, let me ask a question; Who are the losers here?
With this pseudo monopoly health care market, pharmacists and technicians are forced to work for PBM owned mail order pharmacies and chain pharmacies which has also given rise to workplace metrics that can impact patient safety. Metrics such as # of prescriptions filled each hour have replaced patient safety and this is something each of us in the pharmacy profession should still hold dearly. Organizations like the National Community Pharmacist Association (NCPA) and American Pharmacists Association (APhA) have been sounding the alarm on these workplace metrics but it should not absolve us of our own responsibilities right here in the District of Columbia. There are over 2000 pharmacists and 1000 pharmacy technicians registered to practice in the District of Columbia. No matter what special interest groups are out there fighting to preserve PBMs just the way they are…imagine the impact we can have if we all come together to address these concerns in the pharmacy community!
As an independent pharmacy owner, I make a plea to my pharmacy colleagues to join the fight and mobilize today. This is not about the differences between us as pharmacists, pharmacy students or pharmacy technicians but making our voices heard on an issue that will continue to have devastating impact on patient care if we do not make a stand in the District of Columbia.
Manjula Chitkula, RPh is a pharmacist and independent pharmacy owner in the District of Columbia. The views expressed here are those of the author and do not represent the views of the WDCPhA Board of Directors or its leadership. This article serves to highlight some of the issues and topics impacting the DC Pharmacy Community and we encourage our readers to join WDCPhA to get involved today and share your thoughts.
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