Kudos to the Texas Legislature for their decisive actions this session to curb Pharmacy Benefit Managers (PBMs). Pharmacies across the state worked closely with lawmakers to pass House Bills 1763 and 1919, two measures that preserve patient access to affordable, life-saving medicines while protecting small pharmacies from overbreadth of the drug. PBM which threatens their activities.
For too long, the lack of transparency in PBM’s operations has allowed them to increase drug costs while stifling competition in the retail pharmacy space. But lawmakers have shown that they understand PBM’s practices and have now taken important steps to curb their dominance of prescription drug benefits. They made a strong statement with their 177-0 vote to endorse HB 1763, which prohibits retroactive reductions in pharmacy reimbursements, protects the ability of pharmacies to send and deliver mediations to their patients, and prohibits PBMs from paying their fees. affiliated pharmacies more than they reimburse other pharmacies. for the same drugs or services. HB 1919 prohibits self-operating PBM practices that direct pharmacy patients to pharmacies owned by PBM and use patient-identifiable data to drive their pharmacy marketing efforts. Passage of these two vital bills is a strong testament to our legislature’s commitment to the well-being of Texas pharmacies and the patients they serve.
PBMs are obscure middlemen that control over 80% of the country’s pharmaceutical services. They have a disproportionate influence on insurers, large employers, pharmacies and their patients. They determine which drugs are covered by an insurance plan and which pharmacies can participate in provider networks. They set prices and determine costs and patient co-payments. At the same time, they operate their own retail and mail order pharmacies which compete directly with chains and independent stores. They are using their power over pharmacy networks to divert patients from community pharmacies to their own affiliated operations. This focus not only keeps patients away from local pharmacies – who are already struggling – but also makes access to drugs less convenient for patients.
In addition to all this, PBMs control reimbursements from insurance plans to pharmacies. They have steadily reduced payments to community pharmacies to the point that reimbursements are now often lower than the cost of acquiring the drugs by the pharmacy. They also pay their own affiliated pharmacies more for the drugs they dispense than they pay other pharmacies for the same drugs, increasing costs for plan payers.
Because PBMs have the upper hand over small pharmacies, they often force these companies to enter into “take it or leave it” contracts. Pharmacies have for the most part no flexibility, no negotiating power and cannot defend themselves and their customers, even with the administrative organizations of pharmaceutical services (PSAO) which defend their interests. The point is, PBMs are Fortune 50 corporations whose wealth and power have grown exponentially with their control over prescription drug benefits. They have prioritized the profits and growth of their own pharmacy operations over the needs of the plan payers and the patients they are tasked with serving. As local businesses, our state’s small pharmacies are deeply invested in the health and well-being of the communities they serve. Serving patients is always the number one priority, as demonstrated by their dedication to maintaining operations and vaccinating thousands of Texans during the COVID pandemic.
By signing the House Bill 1763 and allowing the passage of HB 1919, Governor Abbott has shown that he shares our commitment to protect patients’ access to affordable medicines and to ensure a level playing field for them. Texas community pharmacies. With these landmark bills, Texas has taken action to preserve the vital role our local pharmacies play in supporting their communities.
Editor’s Note: The above column was written by Michael Wright, executive director of the Texas Pharmacy Business Council. The column appears in The Grande Guardian with the author’s approval. Wright can be contacted at [email protected].
Editor’s Note: The main image accompanying the guest column above shows the Kinsey Pharmacy in Tyler, TX.
Quality journalism takes time, effort and…. Money!
Producing quality journalism doesn’t come cheap. The coronavirus has caused a drop in income in newsrooms in the United States. However, The keeper of the Rio Grande is committed to producing quality news reporting on issues of concern to border residents. The support of our members is essential to ensure the achievement of our mission.
Can we count on your support? If yes, click HERE. Thank you!