Several local independent pharmacies warn they may go out of business unless there’s more regulation on pharmacy benefit managers, or PBMs, who play a pivotal role in drug pricing.
Lawmakers recently introduced House Bill 9096, also known as the “Pharmacists Fight Back Act,” in the House.
The proposed legislation aims to make the prescription drug system more equitable for pharmacies and patients.
“Prescription drug prices have gone up, and they have passed those prices along to the patients at the pharmacy counter,” said Trent McLemore, Director of Pharmacy at Star Discount Pharmacy.
He points to PBMs as the main issue. PBMs act as intermediaries between insurance companies and pharmacies, often steering patients toward their own mail-order services for more profitable prescriptions.
“You may have two drugs like Ozempic and Mounjaro, both used for diabetes and weight loss. Which one is chosen often depends on which drug the insurance covers, driven by PBM rebates,” McLemore explained.
According to McLemore, PBMs often receive kickbacks amounting to nearly 50% of a drug’s cost to ensure the drug’s preference on the formulary. This practice, he says, has led to widespread pharmacy closures. In Alabama alone, 300 of the state’s 800 independent pharmacies have shut down over the past six years, according to the Alabama Pharmacy Association.
Major chains like Walgreens are also feeling the effects, with plans to close about 1,200 locations nationwide. In response, Representatives Jake Auchincloss (D-Mass.) and Diana Harshbarger (R-Tenn.) introduced the bipartisan bill.
The bill’s key objectives include:
1. Setting fair payment rules for pharmacies.
2. Increasing drug pricing transparency under government programs like Medicare and Medicaid.
3. Ensuring consistent pharmacy reimbursements across federal health plans. The bill currently has 34 cosponsors, and McLemore is hopeful for its passage. When asked if the lack of regulation puts lives at risk, McLemore was emphatic: “Absolutely. At the end of the day, PBMs are beholden to stockholders. We, as independent pharmacies, are beholden to the people across the counter.”
WAAY31 reached out to the Pharmaceutical Care Management Association, the trade group representing PBMs, and we are still waiting on a response.
