KFF Health News reports on the disparity between pharmacy benefit manager (PBM) payments to large pharmacy chains compared to small drugstores:
“[An American Pharmacy Cooperative] analysis early this year showed chains were paid well beyond the family business for many of the same medications: For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54, the analysis said. For a drug used to treat blood pressure, amlodipine, chain pharmacies received an average of $23.55, while Bell’s got $1.51.
“Bell’s Family Pharmacy closed earlier this year.”[Emphases added]
Earlier this year, the FTC released a report accusing major PBMs of overcharging clients, which noted that “dominant PBMs can often exercise significant control over which drugs are available, at what price, and which pharmacies patients can use to access their prescribed medications.” The agency also sued three major PBMs last month for artificially inflating insulin prices.
Pharmacists who run independent drugstores say they take financial losses on some prescriptions because PBMs set reimbursement rates that benefit large chains. “PBMs are like the mafia,” said Nikki Bryant, pharmacist and co-owner of Adams Family Pharmacy in Cuthbert, Georgia. “They pay us what they want to pay us. They are sucking all the money out of health care.”
The increased focus on unfair pricing practices is raising calls for PBMs to change their business model. At this month’s HLTH 2024 Event, health care executives said they want to see an end to the current middleman structure in which PBMs use spread pricing, rebate games, and other tactics to deceptively profit at the expense of independent pharmacies as well as insurers and employer health plans.
