For more than a decade, independent pharmacist Jay Patel has built a close and enduring relationship with his customers, who come to him for help in sickness and in health.
But now there are interlopers: Drug middlemen, companies known as pharmacy benefit managers (PBMs) that influence which medicines can be bought, where to buy them and at what cost.
Patel and other independent pharmacists say their businesses are threatened by the growing influence of these companies, tied to huge health care conglomerates. In a system that is opaque and complex, patients are steered to affiliated pharmacies, such as CVS and mail-order pharmacies, they say. Pharmacists face high fees and low reimbursement rates, so are unable to cover their costs.
That could put Patel — and other locally-owned pharmacists — out of business.
“I want to do what matters to the community. But how long can I sustain this?” said Patel, 48, who owns Savco Pharmacy in San Jose’s West San Carlos neighborhood. “We are at their mercy.”
The PBMs respond that critics base their conclusions on incomplete evidence. According to the trade organization Pharmaceutical Care Management Association, they protect consumers from high drug prices by negotiating for discounts, called rebates, from drug companies.
The disappearance of independent pharmacies could limit consumer choice and health care access — especially in low-income or rural communities.
On Oakland’s Telegraph Avenue, Selam Pharmacy owner Michael Gebru called PBMs “a big black box.” He said “They bill me whatever they want, and can reclaim it. That’s pretty scary. It’s a Wild West.”
In the coastal village of Point Reyes Station, tiny West Marin Pharmacy recently lost its contract with PBM company Express Scripts, used by insurer Cigna and others. Now residents covered by Cigna must get their prescriptions by mail or make a 20-mile drive to find another pharmacy.
“If any of us, our children and families are ill, suffering from fevers, vomiting, diarrhea or worse, we may be forced to drive an hour or more to San Rafael, Novato or Petaluma just to get a prescription filled,” worried pharmacy customer Christine Cordaro of Inverness Park.
PBMs were created in the 1960s as a way to process prescription drug claims. They are responsible for paying pharmacies on behalf of insurance companies, employers and the government. The three largest companies are run by CVS Health, Cigna and UnitedHealth Group, which oversee prescriptions for more than 200 million Americans.
In 2012, the year San Jose pharmacist Patel bought his modest shop, PBMs processed fewer than 50% of prescriptions.
A series of mergers in 2018 created the current system, where health care conglomerates are vertically integrated — owning the insurer, the PBM and pharmacy. The giant health insurer Aetna combined with drug retailer CVS. Another large insurer, Cigna, bought Express Scripts. UnitedHealth built its own PBM. All three companies operate mail-order pharmacies.
“It’s like they’re taking the money from one pocket, and putting it into the other,” said Zsuzsanna Biran, pharmacist owner of West Marin Pharmacy.
Despite consumer opposition, the FTC approved the mergers. But now there are concerns …read more
Source:: The Mercury News – Entertainment
