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ALEXANDRIA, Va. — Legislative relief that would result in a more balanced business relationship between Ohio community pharmacists and PBMs is critical, according to the National Community Pharmacists Association.
“Across the Buckeye State 549 independent community pharmacies serve patients, employ 5,435 people and contribute greatly to local and state tax revenue,” stated NCPA CEO B. Douglas Hoey. “The viability of these small businesses is being undermined by the practices of billion-dollar companies known as pharmacy benefit managers, hired by most health plans to administer prescription drug benefits. For Ohioans, their communities and the future of these pharmacies, we encourage lawmakers to swiftly enact common-sense reforms to achieve a more balanced business relationship between PBMs and community pharmacies.”
Hoey singled out three trends that are particularly in need of legislation and further oversight:
- First, in order to care for Ohio patients covered by a given health plan, community pharmacists must sign take-it-or-leave-it contracts from Fortune 500 PBMs. PBMs use the authority imposed by these contracts to determine how they will reimburse pharmacies, especially for generic drugs, which account for nearly 80% of drugs dispensed. Thus, these small business providers are “flying blind” in terms of taking into account the operating costs of their prescription drug inventory, NCPA stated;
- Second, a pharmacy’s acquisition cost for scores of generic drugs are rising by as much as 600%, 1,000% or more, but the PBMs continue to reimburse community pharmacies at an outdated, lower price, NCPA stated. Pharmacists report repeatedly being faced with loses of $40, $60, $100 or more per prescription as the PBM waits several months before updating its reimbursement rates — and never retroactively; and
- Third, by reimbursing pharmacies at low rates and charging health plans at much higher rates — a practice known as “spread pricing” — the PBMs generate enormous profits while increasing insurance costs for employers, government agencies and consumers. The largest PBM generates approximately $100 billion in annual revenue and its CEO received more than $100 million in compensation over five years, Forbes.com calculated. Legislation increasing transparency in pharmacy benefit management could reduce the cost of PBM spread pricing and keep more health care dollars within Ohio.
NCPA noted that a recent Fortune magazine article documented inflated costs and other problems arising from the lack of transparency into drug benefit managers.
“NCPA is proud to support the work of the Ohio Pharmacists Association and all Ohio pharmacists in this effort,” Hoey added.