Rally For Independents

Rally For Independents
As if we needed another reason to take the profit motive out of health care: Allow us to introduce pharmacy benefits managers.
As noted in a story last week, PBMs, as they are called, actually were introduced decades ago as a way to negotiate discounts on what consumers pay for prescriptions by behaving as large-scale purchasers. Over time, however, they have consolidated down to, essentially, three large entities that operate in such secrecy that it is unclear to whom any savings is passed on. In fact, there’s a bigger unanswered question about in whose interests they operate — particularly considering the fact that one of the three is affiliated with the CVS pharmacy chain and another with the UnitedHealth insurance company.
This has raised suspicions about conflicts of interest and questions about how well the principles of fair competition, and thus the direct interests of consumers, are being served. PBMs can set reimbursement rates and incentivize customers to move over to chain stores and mail order services — which can put smaller, independent pharmacy owners at an unfair disadvantage. Some, looking out, as always, for their customers, are forced to turn down prescriptions and even send people to those other providers — because it’s best for the patient’s pocketbook, but sometimes it also avoids the independent pharmacist actually losing money on the transaction.
That is why some of a dwindling number of owners of surviving independent local pharmacies planned to participate in a rally on Wednesday, October 23, at Southrifty Drugs in Southampton. They want Governor Andrew Cuomo to sign a bill — already approved by the State Legislature in June — that would require PBMs to secure licenses to operate in New York. The measure also would require them to eliminate conflicts of interest, as well as deceptive and anti-competitive practices, and would give patients and pharmacies to right to sue PBMs, among other protections.
The bill sounds reasonable in terms of protecting both consumers and small, independent businesses, and we hope the governor will sign it. Prescription medications can be seriously, sometimes devastatingly, expensive, yet critical to health or to life itself. It seems dangerous and unwise to allow a middleman like a PBM to set its terms in secret like a puppeteer operating a marionette from behind a curtain.
The American health care system is a mess, in large part because profit has become the primary force driving it at every level. There’s no clearer example of that, and no sadder effect than when another beloved neighborhood pharmacy goes dark.