Our seniors need relief at the pharmacy counter. Our legislators need to look at PBMs

Rising health care costs are of great concern for all Idahoans, but particularly for our seniors. This problem is most acute at the pharmacy counter where seniors are paying a greater share of their limited income for the medicines they need.

A critical step toward lowering costs for patients at the pharmacy counter would be preventing pharmacy benefit managers from abusing their size and position in the drug supply chain. These middlemen drive up the cost of medications and services for everyone, including our most vulnerable patients. Pharmacists are often patients’ closest and most trusted health care providers, particularly in rural parts of Idaho.

Unfortunately, we have seen a significant decline in rural community pharmacies over the years as a result of the unfair, predatory business practices of pharmacy benefit managers. Pharmacy benefit managers are supposed to reimburse pharmacists for the prescriptions they sell, but pharmacists are often reimbursed for less than the cost of buying and selling medicines. This has driven nearly 16% of rural pharmacies out of business in recent years, forcing patients to travel further to find lifesaving prescription drugs.

Why are pharmacy benefit managers able to get away with pushing community pharmacists out of business or into retirement? Their outsized market share.

The three largest pharmacy benefit managers control 85% of the pharmacy benefit manager market. Their nearly unchecked role allows them to manipulate the prescription drug pricing process for their own benefit to the detriment of community pharmacies, plan sponsors and, most importantly, patients.

While claiming to lower prescription drug costs by negotiating rebates and discounts with drug manufacturers, the reality is that negotiated discounts and rebates never reach patients because it would impact pharmacy benefit managers’ bottom lines. In 2016 alone, pharmacy benefit managers netted $11 billion in profits. To maximize their earnings, pharmacy benefit managers fight transparency at every turn, and repeatedly opposing legislation that would lower out-of-pocket costs.

Additionally, insurers and pharmacy benefit managers across Idaho have adopted copay accumulator programs, which block third-party cost-sharing assistance from counting towards patients’ deductibles and out-of-pocket limits. Research from the AIDS Institute found that every insurer operating in Idaho employs copay accumulators — yet another tactic that increases pharmacy benefit managers’ profits which forces Idahoans to pay more out-of-pocket at the pharmacy counter — in their insurance policies.

We need to demand that our elected representatives take actions to restrain the abuses of pharmacy benefit managers through better regulation and increased transparency, this will lead to predictable and affordable prescription drug costs. It’s time that Washington starts focusing its attention on measures that will actually make a difference for our local pharmacies and patients.

This story was originally published December 13, 2021 at 4:00 AM.