Vulnerable Patients Hurt Most by Predatory Practices
As the CEO of Kelly-Ross Pharmacy, a network of 4 independent pharmacists in Seattle, WA, I and my colleagues provide care for historically underserved communities right in the heart of the city. A large proportion of our population is managing HIV or taking PrEP, an HIV prevention medication. The Pharmacy Benefit Manager we contract with has been lowering reimbursement for these therapies below the cost of what it takes for me to acquire them. I’m committed to continuing to serve my community even if it means taking a loss on providing these medications, but other providers could be disincentivized to carry HIV or PrEP medications.
Seniors on Medicare Part D being Overcharged for Medicine
When 3 PBM corporations control roughly 80% of the marketplace, I don’t have much of a choice – I can either work within the broken system that exists, or go out of business. Seniors on Medicare Part D, who often have few resources available to them, are consistently being overcharged for their medications so the PBMs can “claw back” additional fees after a sale occurs at my pharmacy counter. I want the system to change so my patients are better able to afford their medications.
“Claw Back” Fees Raise Prices at the Pharmacy Counter
One particularly vicious way that PBMs steal money from patients and community pharmacists is by clawing back money after they have overcharged at the pharmacy counter. Recently, a PBM decided to charge a generic medication at a brand list price, resulting in an over-inflated out-of-pocket cost to the patient. The PBM then retroactively assessed a “fee” to the pharmacy that clawed this over-inflated co-payment from the patient back to the PBM. The result is patients paying about 30% more at the pharmacy counter than they should have.