Pharmacies to close Feb. 5 to support reform
Staff writer
Many pharmacies throughout the state, including Lanning in Marion and Hillsboro Hometown in Hillsboro, will be closed Feb. 5 in support of Pharmacy Benefit Managers reform.
CK Pharmacy’s three locations in Peabody, McPherson, and Moundridge will be closed from 9 to noon.
According to Lanning Pharmacy, PBMs are big companies that decide what pharmacies get paid for medications. Payment often is below the pharmacy’s cost.
“PBM reform is more critical than it has ever been as approximately eight retail pharmacies close daily because pharmacy benefit managers refuse to reimburse community pharmacies fairly,” Lanning wrote in an online posting. “This unfair practice has left many communities without access to essential pharmacy services.
“We apologize for any inconvenience this may cause, but it is now or never for many Kansas pharmacies’ ability to serve their communities. To help ensure local retail pharmacies remain in business, tell lawmakers that PBM reform is needed. Please message us if you would like more information on contacting lawmakers.”
Kansas Pharmacists Association executive director Jared Holroyd said pharmacies, both large and small, lose money on a majority of prescriptions. It often puts a pharmacy out of business.
“We’ve lost 10 pharmacies in 2024 in the great state of Kansas,” Holroyd said. “When you lose money on 70% to 75% of every prescription you fill, it’s not about high volumes.”
Hillsboro Hometown Pharmacy owner Eric Driggers said he was monitoring the situation with PBMs closely.
“It is not to the level that I would describe as a deep negative impact, but that is definitely the reality of many Kansas pharmacies, including rural pharmacies that are located in communities the size of Hillsboro and Marion County,” Driggers said. “If the patient has insurance, a PBM is involved. Reimbursement rates are one of the major issues. Often, what the PBM decides to pay is below the pharmacy’s costs.”
Kansas Pharmacists Association members will meet with state legislators Feb. 5.
They hope the state will take action on how PBMs operate in Kansas, Holroyd said.
“It’s about PBMs needing some guardrails,” he said. “People have to pay higher insurance rates and higher prices at the counter.”
He encouraged people to talk to their pharmacists if they wanted more information on how PBMs affect them.
A federal bill to reform pharmacy benefit managers was placed on the Senate calendar in June, 2023.
This bill establishes requirements for PBMs with respect to services provided to health insurance plans.
PBMs would be required to make annual reports to plan sponsors with certain information about the PBM’s services, including the amount of prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total net spending by the health plan on prescription drugs.
PBMs also would provide supplementary report every six months with information about drugs that were dispensed under the plan by pharmacies that are wholly or partially owned by the PBM.
The bill prohibits spread pricing. Spread pricing occurs when a PBM charges an insurance plan, or an insurance plan charges plan participants, a price for a prescription drug that exceeds the price paid to the pharmacy for the drug.
Finally, PBMs would remit all rebates, fees, alternative discounts, and other payment received from a drug manufacturer to the plan sponsor.
According to the American Journal of Managed Care, independent pharmacies have filed three class action lawsuits against GoodRx and multiple PBMs. The suits allege the companies conspired to fix prices they pay for prescription drug claims, reducing reimbursements and increasing fees for the pharmacies.
Some well-known PBM companies include CVS Health/Caremark, Cigna, Express Scripts, and UnitedHealth/OptumRx.