Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am a retail pharmacist that has worked in our independently owned community pharmacy for more than 40 years. Our population of patients includes newborns to great-grandparents. Over the last few years, you can see the dramatic shift that the Pharmacy Benefit Managers (PBMs) are causing to small community pharmacies like myself forcing us to lose business everyday. We have had patients that like coming here for years that are no longer able to do so because their insurance now mandates where they can get their medications from. The patients no longer have a choice in their health even with having insurance because they may not be able to get to the pharmacy location that is being specified to use, their co-pays have skyrocketed where it is no longer feasible to get the medications they need for their health so they go without. Many times we are offering the patient the cash price for the medications where it may become a little more affordable for the patient. Which raises the question that the patient always ask, how come my insurance copay is more money than the cash price of the medication? This is now an everyday conversation that we have to have with our patients besides counseling them to improve their health. Patients are scared and afraid that the medications will no longer be affordable for them in the months to come. When is the FTC going to start taking action against the PBM's? Another issue is DIR Fees (Direct/Indirect)linked to the PBM's. For example, say we have a prescription for Drug X and our cost is $150.00. The message from the PBM says your reimbursement will be $185.00 and the patient's copay will be $10.00. The patient comes to pick up their prescription and pays their copay of $10.00. About a week later our pharmacy gets the remit invoice from this specific PBM and on this prescription our reimbursement is now $130.00 due to DIR Fee of $55.00. We have now lost money on this prescription. This is happening more often than not. How do they expect pharmacies to stay in business and care for patients when this keeps happening? Again I will ask when the FTC is going to start taking action against the PBM's? There are many other issues regarding PBM's however now I will go explain to a patient again why their insurance copay is more than the cash price of the medication.