In Georgia, independent pharmacies like Adams Family Pharmacy struggle against powerful pharmacy benefit managers (PBMs) that control drug pricing and access. Recent attempts to legislate fairer reimbursements were vetoed by Governor Kemp, straining local businesses further. The disparities in payouts favor larger chains, forcing many independents to close and driving up costs for patients. As advocacy for transparency and reform grows, the survival of these small pharmacies remains in jeopardy.
In Cuthbert, Georgia, customers at Adams Family Pharmacy enjoy a unique shopping experience, combining prescription pick-ups with coffee and homemade sweets. Pharmacist and co-owner Nikki Bryant strives to maintain profitability amidst challenging economic pressures driven by pharmacy benefit managers (PBMs), who act as intermediaries between drugmakers, pharmacies, and insurers. With Congress, the FTC, and state authorities scrutinizing PBMs due to escalating drug prices, independent pharmacists like Bryant face substantial hurdles accessing fair reimbursements for their medications. Despite support from local legislators for reforms aimed at leveling the playing field, Governor Brian Kemp vetoed a bill intended to increase reimbursements for independent pharmacies, citing a projected state cost of $45 million annually. This veto comes as small pharmacies battle broader trends favoring larger chain supermarkets that receive significantly higher reimbursements for the same drugs. For instance, while CVS pharmacies received an average of $54 for bupropion, an independent pharmacy barely received over $5. Antonio Ciaccia, a consultant, highlights the stark differences in reimbursement rates within Georgia and calls out PBMs for their manipulative pricing and access controls, which inflate costs for both patients and employers. In response to the mounting criticism, the FTC recently sued three major PBMs—CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx—claiming their practices pushed drug prices higher while denying allegations of misconduct. Bryant likens the PBMs to the mafia, asserting they dictate reimbursement rates and extract excessive profits from healthcare systems. This spread pricing practice leads to independent pharmacies losing money on certain prescriptions and favors large chains with PBM affiliations. The repercussions are dire; many small pharmacies, like Bell’s Family Pharmacy, have ceased operations, unable to compete effectively. Governor Kemp remains outwardly supportive of independent pharmacists while calling for a study on PBM practices. Critics assert that PBMs manipulate reimbursement rates, significantly contributing to the closure of independent pharmacies nationwide. Currently, nearly one independent pharmacy closes each day in the U.S., particularly creating challenges for rural areas lacking easy access to alternative providers. Despite Kemp’s veto, frustrations with PBMs have reached even the Department of Community Health board, where members argue for parity between independent and chain pharmacy payments. Community Health officials acknowledge the issues but maintain they are bound by existing contracts with PBMs. In the face of adversity, Bryant finds a silver lining as her pharmacy thrives by offering personalized service alongside baked goods—a competitive edge in an increasingly strained market.
The ongoing conflicts surrounding pharmacy benefit managers (PBMs) impact independent pharmacists across the United States, particularly in rural areas where access to medication often hinges on local pharmacies. As intermediaries in the prescription drug ecosystem, PBMs are under scrutiny for their role in inflating medication prices and hampering competition between small, independent pharmacies and large chain pharmacies. Recent legislative efforts aimed at regulating PBM practices reveal the persistent struggle faced by small-business pharmacists striving to survive within a landscape dominated by powerful corporate interests.
The landscape for independent pharmacies is fraught with economic challenges primarily fueled by the practices of pharmacy benefit managers. With recent legislative attempts at reform thwarted, local pharmacists continue to find creative ways to attract business while seeking equitable reimbursement rates. The struggle for survival underscores the need for regulatory clarity and support for independent pharmacies, as their fate intertwines with access to medications for countless patients in their communities.
Original Source: www.usnews.com
