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PHARMACIES: PBMs are killing independent owners


As a local pharmacist, it was refreshing for me to see an article in The Press about the challenges facing pharmacies today. Low insurance reimbursement does not affect only rural pharmacies, however, but is leading to the demise of all independently owned pharmacies. Contrary to what Greg Lopes would want you to believe, PBMs are definitely and primarily responsible for the closure of many pharmacies. Not only, as the article pointed out, are 25% of claims paid below cost, but many more pay mere pennies above the cost of the drug. After adding the direct cost of the vial, lid and label, easily 50% of claims are paid at or below cost.


Unfortunately, similar to protection schemes that organized crime was once notorious for providing to small businesses in their districts, it is impossible for a pharmacy to stay in business without accepting the conditions “offered” by PBMs. Most claims are paid based on “actual acquisition cost” which looks acceptable on the surface. But the PBM gets to decide what that cost is, whether or not it has any basis in reality. I see daily many claims for prescriptions that get paid at $45 or more below our true acquisition cost. Don’t be surprised if your favorite local pharmacy is forced into closure unless somehow these unfair business practices by PBMs can be addressed.


Author: ALLEN ORTMANN, RPh

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