Community pharmacies struggle to stay open
The closure left customers with a choice: Find another local, family-owned independent drugstore and travel a little farther, or switch to a big nationally owned chain.
"The whole time we've lived here, 20-plus years, we've used Baxter's," said
Baxter's was the second independent community pharmacy in
"Pharmacies today are experiencing such low reimbursements, it's forcing some pharmacies to close," Squitieri said.
Covering the spread
There are two issues straining independent community pharmacies, both driven by pharmacy benefit managers (PBMs), pharmacy advocates say: the low reimbursement rates, and the tendency of PBMs to try to steer customers toward their affiliated pharmacies.
What's happening here is happening elsewhere, said
"It's become an epidemic," she said. "It's become too difficult as an independent pharmacy to work within the PBM framework."
PBMs were created to be middlemen among health insurers, drug manufacturers and pharmacies, the idea being that PBMs would make prescription drugs more affordable and accessible to consumers. PBMs manage formularies, process claims, negotiate drug prices with manufacturers and set reimbursement rates for pharmacies.
"Now, they're dictating the rules of the game," Squitieri said.
PCMA says PBMs encourage competition among drug makers and pharmacies and give customers incentives to "take the most cost-effective, clinically appropriate medications."
PBMs negotiate price concessions -- rebates -- with drug makers, to lower the cost for consumers, PCMA says.
Three corporations control more than 80 percent of prescriptions in the
PBMs profit by what's known as spread pricing. The PBM has a contract setting a discount to the manufacturer's average wholesale price of a drug for the buyer, or plan sponsor; and another contract setting the maximum allowable cost, plus a small dispensing fee, for the pharmacy. Any positive margin ends up in the PBM's coffers.
"They operate in an arena that's not transparent," said
"Take a self-insured employer, like a municipality," he said. "A PBM will say 'You'll save money if you use our mail-order pharmacy.' They never tell the municipality 'You'll pay
In
On
A report published
In response, the
The law is awaiting Gov.
"We've been calling for this reform for years," Moore said. "We've been calling for an end to spread pricing for 20 years."
The federal Affordable Care Act tried to rein in PBMs and insurance companies by mandating the Medical Loss Ratio, requiring insurers to spend 80 percent of their money on care and keep just 20 percent to pay administrative costs and expenses.
"All that did was give them incentives to raise their prices," Moore said.
Opioid tax backfire
As of
Some drug manufacturers and distributors decided they wouldn't sell in
"I don't think it was the intent of the law for pharmacies to bear the burden," Moore said.
As a result, pharmacist
"It's created such a chaotic environment for so many patients," said Giangiacomo, who owns
Squitieri said he's been talking to Skoufis and Assemblyman
The local touch
Giangiacomo bought
He said he saw a more hands-on approach as the future of pharmacy: things such as administering immunizations and checking blood pressure, and so he went back to school and earned his doctorate.
"It makes it so much harder when you have all these other things pulling away from what pharmacy is supposed to be," he said.
According to the
"The pharmacists take the brunt of everything," he said. "We have to deal with the customers, insurance, the wholesalers, et cetera."
Sometimes that happens even with the PBMs' customers, Squitieri said, pointing to a recent major recall of a blood-pressure medication.
"The answer the mail-order pharmacies had," he said, "was 'go to your local pharmacy.'"
"If push comes to shove," Squitieri said, "if they take us out of the community, there's going to be a big loss."
Mail-order services can fall behind changes in dosage or medication, and they don't provide the counseling local pharmacists can, Squitieri said.
"They don't give the personal touches an independent pharmacist can give," he said. "We do it because we get to know people."
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