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Patients, pharmacists march against PBM business model

Patients, pharmacists and their advocates marched at Express Scripts Headquarters in north St. Louis County Friday in opposition to the PBM business model.

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Patients, pharmacists and their advocates marched at Express Scripts Headquarters in north St. Louis County Friday in opposition to the pharmacy benefit manager (PBM) business model.

A PBM acts as a liaison between insurance companies and pharmacies when working with your prescriptions.

Express Scripts is one of several PBMs currently under investigation by the Federal Trade Commission (FTC) because its business practices may affect the affordability of prescription drugs.

Advocates said PBMs create a two-fold problem.

Loretta Boesing is against the model because she said it created problems for her family after her son’s liver transplant.

“We were told he’d need medication for every 12 hours for the rest of his life, medications are his life, so it’s important he has safe access to medications,” she said. “Being able to mail-order pharmacy and forced away from the local hospital pharmacy that works closely with physicians and closely with other children with similar conditions was extremely heartless.”

According to Douglas Hoey, the CEO of the National Community Pharmacists Association, there are several problems for small pharmacies.

“The number one thing we hear about is that the patients are coming into their pharmacies they’re paying higher prescription drug prices because of the PBM,” he explained. “The other thing we hear i sthat pharmacies are being paid below their cost to buy the drug.”

In a statement to First Alert 4 about the protests, a spokesperson for Express Scripts said, “The health of our customers is at the center of all we do. “We work relentlessly to ensure our customers can access their medications at the lowest possible cost and in the way that is most convenient for them. Our flexible pharmacy networks include pharmacies of all scales and sizes, including large chains, regional and independent pharmacies, as well as home delivery options.”

Locally, St. Louis Hills Pharmacy’s owner, Dr. Tyler Taylor, said serving patients and working with PBMs is a balancing act.

“We’re trying to make sure the patient gets what they need, but at the same time, I have to be open tomorrow, and if I can’t get to an economical standpoint where it makes sense, then there’s nothing I can do about it,” he said. “It’s very frustrating and it’s how can we help the patient get what they need somewhere else and do what we can to help them.”

Boesing said she is encouraged by what’s to come of the FTC’s investigation.

“Change is for our patients in America to have access to their local pharmacies in their coverage, to not be forced to jump through all these needless obstacle courses to be able to get the medications their physicians prescribe,” she said. “For our local pharmacies to remain open and for these monopolistic practices of them being able to reimburse pharmacies below their cost to stop.”


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