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Rural pharmacies plead for help

Pharmacies, especially rural independent pharmacies, have been hurting during the past several years because of pressure to reduce costs from insurance intermediaries, regulations that limit their ability to earn money with testing and immunizations and higher costs and lower income due to COVID-19, according to participants at a state Senate committee hearing Monday in Duncansville.

An “alarming number” of independent pharmacies are closing or selling out to chains, said Greg Drew, president of Value Drug, a pharmaceutical distributor whose headquarters was the site of the hearing and who joined with others in asking for help from the members of the Majority Policy Committee.

The “silent destruction” of independent community pharmacies that lose money due to unsustainable contracts negotiated by pharmacy benefit managers, coupled with unreasonable limitations on revenue opportunities threatens to leave a “gaping hole” in what is the most easily accessible “ambulatory” health care in rural areas, said Frank Straub of St. Marys, a Value Drug board member.

“We have to help our pharmacies,” said Sen. Judy Ward, R-Blair, the committee member who requested the hearing. “It’s time to get rid of (regulatory) barriers” that restrict “point of care” testing in pharmacies and administration of immunizations, she said, while adding that fixing the pharmacy benefit managers problem through some agreeable formula would be trickier.

“Community pharmacies should be embraced, not exterminated,” as they can provide telehealth, medicine review, vaccinations, disease management assistance, medical adherence accountability, rapid testing results, nicotine cessation help, life coaching and blood pressure monitoring — services that are especially valuable in areas where there’s a shortage of primary care doctors, according to Straub.

Pharmacy benefit managers and their negotiated contracts are the biggest problems, participants said.

Those problems as identified by pharmacists represent success, from the PBM point of view:

“Pharmacy benefit managers reduce prescription drug costs and improve convenience and safety for consumers, employers, unions, and government programs,” states the website of the Pharmaceutical Care Management Association, the trade association that represents PBMs. “PCMA’s mission is to lead the effort in promoting PBMs and the proven tools they utilize, which are recognized by consumers, employers, policymakers and others as key drivers in lowering prescription drug costs and increasing access.”

Ward has sponsored a couple of bills, one that would liberalize rules that restrict the ability of pharmacists to give injections and one that would eliminate a requirement for pharmacists to have two years of experience in a lab to offer “point-of-care” rapid-results testing.

Pharmacists already give flu shots, but they could have a major role to play in the distribution of a vaccine for COVID, participants said.

Point-of-care tests for COVID can give results quicker than those sent away to pharmacy lab partners, said a Walgreen’s spokeswoman.

Many other states don’t have a rule requiring pharmacists to have lab experience, according to participants.

One way to help alleviate the PBM problem is by enforcing “transparency” — eliminating the secretiveness surrounding pharmacological discounts negotiated by the PBMs, according to Ward.

“PBMs don’t have to answer to anybody,” she said.

But PBMs are likely to save “employers, unions, government programs, and consumers $654 billion –up to 30 percent — on drug benefit costs over the next decade,” the PCMA website states.

They do it by offering home delivery of meds, creating select networks of affordable pharmacies, encouraging use of generics and affordable brands, negotiating rebates from manufacturers and discounts from drugstores, managing high-cost speciality meds and reducing waste, according to the PCMA website.

Insofar as they apply to small pharmacies, those discounts are especially damaging, because small pharmacies lack the sales potential on other items to offset the losses, participants said.

Mirror Staff Writer William Kibler is at 949-7038.

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