The added transparency and restrictions that the Pennsylvania legislature placed on pharmacy benefit managers (PBMs) has been an important step in assisting community pharmacies. Fortunately for the 900 independent pharmacies in the Commonwealth, HB 941, signed into law last November, is adding transparency to the prescription drug market and lowering costs by allowing the state’s Legislative Budget and Finance Committee to review and oversee PBMs when they reimburse independent pharmacies.
It has been widely reported that dealing with PBMs and navigating their one-sided contracts has long been an uphill battle for many small pharmacies, and it is welcome news that lawmakers are beginning to seek measures that rein in PBMs. With this legislation, we are beginning to get a window into pricing practices and, hopefully, preventing them from stripping pharmacies of our reimbursements—one of the leading causes of many pharmacy closures.
Moving forward, it is important for the survival of independent pharmacies that Pennsylvania’s legislature maintain these restrictions and not allow PBMs or their lobbyists to abdicate responsibility for the complicated prescription drug market. I have witnessed unfair practices on the part of PBMs firsthand that directly impact patients and pharmacies and know they will continue in this manner if left unchecked.
Unsurprising to many, PBMs have already taken to deflection tactics in response to new measures to rein them in, pushing lawmakers to unfairly and unnecessarily regulate pharmacy advocates, pharmacy services administrative organizations (PSAOs). Unfortunately, imposing mandates on PSAOs could be counter to the intent of HB 941—to protect community pharmacies—and lead to additional independent pharmacy closures and burdens.
One of the most important responsibilities of our PSAO partners is to navigate difficult negotiations with PBMs and the contracts that follow. PSAOs bring together independent pharmacists under a network, giving us leveraging power and resources we would not have otherwise and helping us to secure more favorable terms. While PSAO services are certainly helpful in advocating on our behalf and ensuring we are compliant with contracts, PBMs still wield immense power over the prescription drug market and use it to their advantage—often at our detriment.
Lawmakers should not and cannot further hamstring PSAOs from assisting pharmacies. Doing so would strip us of our small, but meaningful bargaining powers and add immense administrative burdens to our plates, preventing us from seeing patients.
In addition to helping with contracts and negotiations, PSAOs play a crucial role in the administrative tasks necessary to running a healthcare business. They help us manage the records and data we are required to keep track of and assist in completing paperwork we must file appropriately. PSAOs also communicate with other supply chain entities, streamlining our business and creating efficiencies, ultimately saving us time and money.
Even with this new legislation passed by the Pennsylvania legislature, PSAOs play a major role in our ability to run a business and dedicate time to patient care. PBM negotiations and bureaucratic tasks threaten to push us into the backroom, spending much of the day doing paperwork instead of working with patients who need our guidance. PSAOs must retain their abilities for the sake of pharmacies and the patients we serve.
If PBMs successfully convince our legislature to unnecessarily restrict PSAOs, they will not only continue reducing the reimbursements we are owed but also hinder our ability to get away from the massive amount of bureaucratic tasks we must manage. The care we provide will be seriously compromised and may ultimately force us to shut our doors just like many independent pharmacies in Pennsylvania and across the country before us.
Alone, pharmacies are constantly at the whim of PBMs and healthcare bureaucracy and patients will not be able to get the care they deserve. But with this legislation and the help of PSAOs exactly, we are able to stay in business and continue providing the best patient care possible to all our community members.