MARCH 27, 2013 – THE BATTLE BETWEEN PHARMACY BENEFITS MANAGERS AND PHARMACIES (INCLUDING NATIONAL CHAINS) HEATS UP. WHAT WILL PENDING LEGISLATION IN THREE STATES MEAN FOR DRUG PRICES?
The independent pharmacist is an endangered species. As you might imagine, they have been getting squeezed for years by powerful national chains like Walgreen’s, Rite Aid, and CVS. These days, increased competition from big-box retailers like Walmart and Target, the rise of $4 plans, and a nationwide shift to generic drugs suggest that they might soon be extinct.
Pharmacists are now fighting back. According to Timothy W. Martin, writing in the Wall Street Journal, “The drugstores want lawmakers to require the middlemen to turn over arcane pricing data that would help drugstores negotiate bgigger reimbursements and avoid dispensing drugs that are money losers.” Those middlemen – PBMs – determine how drugstores are reimbursed for certain medications.
Legislation is now proposed or pending in eight states, with the idea that, “Requiring them to share the tightly guarded pricing data would show that PBMs are keeping too much profit for themselves.” In Oregon, for instance, two separate bills would require that PBMs divulge their generic-drug pricing, infomation that comes from a “Maximum Allowable Cost” or MAC List.
According to the article, “Two states – New York and Pennsylvania – passed legislation that blocks PBMs from automatically enrolling patients into mail-order delivery, when a brick and mortar pharmacy is willing to accept similar pricing.” The PBMs, for their part, argue that such legislation could inspire collusion among pharmacies and have accused the “Drugstore Lobby” of trying to raise prescription drug costs.
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