Pharmacist groups are raising concerns about several issues facing their industry this week, including concerns about state-run Medicaid programs, and the encroaching amount of power held by corporate pharmacy benefit managers.
According to a letter to the editor in The Witchita Eagle this week, the switch to managed care in Kansas could have the same disastrous results that occurred in Texas.
From the letter:
Since Texas transitioned to managed care in March, roughly 30 independent pharmacies have closed or been sold to retail chains. When Kentucky transitioned to a managed-care system in November, independent pharmacists experienced an 80 percent reduction in professional fees and draconian cuts to drug reimbursement.
Under the new system, Kansans who rely on local, rural pharmacies for their medications may be in danger of decreased access to care unless the administration ensures a level playing field for the state’s independent and chain pharmacies.
It seems independent pharmacies just can't catch a break these days. Managed care programs slowly spreading to more states are forcing some community pharmacists out of business, and the ones who still survive also have to worry about pharmacy benefit managers (PBMs). PBMs were created 30 years ago as a mechanism for insurance companies to process claims for prescriptions. They’ve evolved into companies that control what pharmacies are allowed to charge and sometimes even compete with the very companies whose claims they process.
According to the North Jersey Record, these are the four biggest challenges facing your corner drug store:
Pharmacy benefit managers: These large companies hired by insurance plan sponsors to process pharmacy benefit claims also limit the reimbursement a pharmacist can receive and steer patients to their own mail-order services or specific chain stores.
Mandatory mail order: Pharmacists say their customers with continuing conditions that require medicine and supplies all year increasingly are being told they must get prescriptions filled through mail-order companies instead of their local pharmacies.
Specialty drugs: The most expensive drugs, and the most profitable to dispense, increasingly are being classified as specialty drugs, which can only be dispensed by specialty mail-order pharmacies, usually connected to PBMs.
Competition from chains, discount stores and supermarkets: Most local pharmacists feel they can hold their own against competition but say the large chains have an unfair advantage in negotiating prices from drug suppliers and PBMs.
To find out how you can help community pharmacies, please visit
Pharmacy Choice and Access Now.