Pharmacists push for rescue package [The Press-Republican, Plattsburgh, N.Y.]

Dec. 24—PLATTSBURGH — State Assemblyman D. Billy Jones joined local pharmacists Wednesday to call on Gov. Kathy Hochul to sign three bills in the "Pharmacy Rescue Package" aimed at regulating pharmacy benefit managers (PBMs) into law.

"It's basically leveling the playing field," Jones (D-Chateaugay Lake) said at Condo Pharmacy on Montcalm Avenue in Plattsburgh. "It's providing transparency and fairness to our local pharmacies."

SPREAD PRICING

According to a press release from Jones' office, PBMs decide how much to bill health insurance companies per prescription as well as how much to reimburse pharmacies for dispensing the medications.

In a practice called "spread pricing," they pocket the difference between what the insurance companies pay and what PBMs pay pharmacists, which can often cause pharmacists to dispense at a loss.

"It's a complicated issue, but at the end of the day I think we can simplify it by saying a price is being forced upon the pharmacies that they have no control over and the middle people, the PBMs, are doing the negotiating — it's not even a negotiation, it's a one-sided negotiation and they're taking the money," Jones said.

Condo Pharmacy co-owner and pharmacist Steve Moore said PBMs first began operating in the state in the early 1980s as claims processors, and have since morphed beyond that original function to become "obscure middlemen."

He pointed to a study that estimates there's a $5 difference per prescription between what a pharmacy gets paid and what state programs pay for medications.

"You think, 'Five dollars? Well that doesn't sound like a lot.' Multiply that by the number of prescriptions in the New York State Medicaid program, it's a huge one," Moore said.

THREE BILLS

All three bills in the package passed both the State Senate and Assembly with broad bipartisan support.

Jones described A1396/S3762 as a transparency bill, which he cosponsored. According to its memo, it would "require licensure for (PBMs) and specify their duties and obligations as service providers."

The assemblyman also cosponsored A7598/S6603 which, its memo says, aims to "address unfair and unsustainable practices by managed care providers and PBMs to provide patient access to essential pharmacy care services."

Among other provisions, that bill would "require Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate" and prohibit PBMs "from limiting an individual's option to receive medications from non-mail order pharmacies."

Lastly, A5854/S3566 would "clarify and strengthen provisions in current law to ensure that consumers have the option to access every covered medication from a local network participating pharmacy and are not forced into mandatory mail order," its memo reads.

TAKE BILLIONS

PBMs end up taking billions from health care providers, Moore said.

"These are Fortune 15 companies that are setting record profits during the pandemic. We have providers that are going out of business, you have patients that are going without services."

Unregulated PBMs present a nationwide and pharmacy-wide problem, Moore continued, pointing to the closure of chains in the region like Rite Aid, which was acquired by Walgreens.

As a result of reimbursement issues with Medicare and Medicaid managed care plans, pharmacies in areas where such plans are prevalent tend to be the ones that close, he said.

"So it's our most vulnerable patients who are going to be the ones that are suffering."

CHRISTMAS PRESENT

Regulating PBMs will bring much-needed help for "hometown, local, independent pharmacies" and save taxpayer money on Medicaid costs, Jones posited.

The assemblyman said local pharmacies have stepped up to the plate throughout the pandemic, offering COVID testing and vaccines.

"The least we can do is give a Christmas present to these pharmacies and to the community."

Hochul has until the end of the year to sign the bills, otherwise the legislature has to pass them again in the next session.

'BEST OF EVERYTHING'

While the bills together are called the "Pharmacy Rescue Package," they're about patient access, Moore said.

"Health care is very personal and you should have access to the health care professionals that you feel most comfortable dealing with."

Longtime Condo Pharmacy customer Martha Bachman said she could have her medications mail-ordered, but she likes coming to the store, where everybody knows her name and will work to get her the medications she needs.

"They're efficient, they're very, very good at what they do and I would be really unhappy to see this pharmacy go out of business."

Leo "Skip" Maggy, the founder of Maggy Pharmacy in Dannemora, said he has enjoyed every bit of the business for more than 50 years.

"We try to give the best of everything to every customer, you know, all the independent pharmacies, and we're going to continue to do that. This legislation is very, very important to be passed and I think, with the support of everybody here, that it can be done."

Email Cara Chapman:

cchapman@pressrepublican.com

Twitter: @PPR_carachapman

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