Now is the time to reform pharmacy benefit managers 

In 2012, shortly after working for a chain pharmacy I opened DePietro’s Pharmacy. I quickly realized patients deserved more personal attention than what was offered at a chain pharmacy. Since opening the pharmacy, we have gained a reputation for providing exceptional care. We’ve been recognized by the Scranton Chamber of Commerce for our Business Practices, Community Involvement and Small Business of the Year. We’ve also been voted “Best Pharmacy” ten years in a row by readers of our local newspaper.

Our pharmacy team knows our patients by name, offers unique services such as medication organization, home delivery, community vaccine clinics and help patients navigate the complex healthcare system.

We have laughed together, cried together, picked patients up from their floor, pulled garbage cans to their curb and even changed remote control batteries- we are family and we don’t just use it as a tagline.

We believe the role of a local pharmacy is to provide individualized service and exceptional quality care for our friends and neighbors.

But in the years since I opened my doors, I’ve been appalled to see what has happened with pharmacy benefit managers, or PBMs. These are the healthcare middlemen who sit between drugmakers, insurers, and pharmacies. PBMs decide which medicines your doctor can prescribe, how much your copay is, and how much pharmacies like ours are reimbursed. Often times we are paid less than what we actually buy the drug for. And far too often, those decisions are made with profits in mind, not patients.

I’ve spent more than a decade speaking out about PBMs because I see firsthand how their practices hurt people. State and Federal elected officials know me by first name because of my outspoken nature. Patients come to me with prescriptions they can’t access, even after their insurance is applied. Others face delays because a PBM is requiring them to “fail first” on a cheaper drug, even though their doctor prescribed something different. And too many times, I’ve had to explain to families why their insurance is steering them away from my pharmacy to a big chain or a PBM-owned mail-order business. That’s not choice. That’s manipulation.

The bigger issue is that this isn’t a partisan problem. It’s not a Republican or Democrat problem. It’s a kitchen table problem. Families across Pennsylvania are sitting down at the end of the month and asking themselves the same question: “Can we access the medicine we need?” That’s why I’ve always believed reforming PBMs should be a bipartisan effort.

Right now, Washington is paying more attention to PBMs than ever before. That’s a good thing. We also have an Administration talking a lot about lowering drug prices. And, the good news is, a real solution is staring us right in the face.

PBMs profit off the spread between a drug’s list price and the negotiated price they pay. They pocket rebates, which you and I would call kickbacks, from manufacturers instead of passing the savings on to patients. And they reimburse independent pharmacies like mine at rates so low that many of us can’t keep the doors open. Across the country, thousands of small-town pharmacies have been forced to close. When that happens, patients lose trusted care, and communities lose out.

Congress has the chance to fix this. The PBM Reform Act would delink PBM profits from the list price of drugs, meaning PBMs wouldn’t benefit from keeping prices high. It would also increase transparency so patients and employers can see where the money is going. Finally, it would help ensure that savings reach the people who need them.

For patients, that could mean lower out-of-pocket costs and less frustration while trying to improve their overall health. For independent pharmacies like mine, it means fair reimbursements so we can keep serving our communities. And for the country, it means a drug pricing system that works better for everyone, not just for a handful of powerful companies.

We’ve been talking about the high cost of medicine for years, especially during elections. Families are sick of empty promises. It’s time to act. I urge Pennsylvania’s leaders in Washington to support the PBM Reform Act. Patients, pharmacists, and communities can’t afford to wait any longer.

Tom DePietro is the owner of DePietro’s Pharmacy in Dunmore, PA.