A publication of the Kentucky Center for Public Service Journalism

Sam Willett: Despite their claims, pharmacy benefit managers hurt Kentucky Patients

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Pharmacy Benefit Managers claiming they’re in business to help consumers? Forgive me for borrowing words from a classic country song, but if you’ll buy that I have some ocean front property to sell you in Arizona.
As a retired pharmacist, I was angered when reading the latest propaganda from the Pharmacy Benefit Managers, commonly referred to as PBMs. I can assure you the faceless PBMs do not have patients’ best interest in mind. In fact, in my experience, their only interest is increasing their profit.
In my 40 years as a community pharmacist, I spent my time caring for patients while PBMs continued to put more hurdles in place, increasing costs of medications while decreasing access to care. I was—and still am—sickened at the way PBMs treated both pharmacists and patients with shady, profit-motivated, behind-the-scenes schemes.


Perhaps the most blatant example of how PBMs are bad for consumers is the practice of overcharging patients for prescription medications and keeping the profits to boost their bottom line. This practice, known as a clawback, forces a pharmacist to charge a full copay for a prescription, even if the copay is higher than the amount the pharmacist will be reimbursed for the drug. The PBM pockets the difference and Kentucky patients are paying more for their medications than necessary.
For example, if a patient fills a prescription that has a $30 copay, I was required to charge $30 even if the cash price for the medication was only $5. The PBM then “clawed back” the difference, padding their profit while providing no additional benefit or savings to my patient or pharmacy.
What makes clawback even worse is that I knew it was going on and was powerless—by contract with the PBM—to inform my patients that they were being swindled for their life-saving medications. PBMs conduct this practice in the dark and most patients, unless they ask, have no way of knowing that they are paying too much for their medication. 
Despite what they want you to believe, PBMs are not generally regarded as the “good guys” in health care. In fact, each of the three major PMBs have been publicly accused of purposefully deceiving and overcharging patients in need of life-saving medications. They are also working hard to put independent pharmacies—part of the small business community that forms the backbone of local economies—out of business with mandatory mail-order prescriptions and other egregious practices. 
These mail-order pharmacies simply cannot match the patient benefits of a brick-and-mortar pharmacy. Face-to-face consultation between a pharmacist and patient, the most effective type of intervention to ensure that patients adhere to their prescribed medication regime and are counseled about possible negative side effects, is replaced with emails and calls to 1-800 numbers to seek assistance from an out-of-state corporate organization.
The PBM business is a lucrative one, and recent consolidation in the industry has served only to drive up prices for consumers, limit access to medications and increase their out of pocket costs. Three PBMs now control nearly 80 percent of the industry. And while the PBMs are winning with higher profit margins, patients are losing.
Let’s be clear—PBMs are not about saving consumers money. They are not about promoting access to care. They are shadowy middlemen who play a complicated shell game of supposed rebates and clawbacks to maximize their profits at the expense of our patients.
I’ve seen firsthand what they are all about it. And it’s time to put an end to it. That is why pharmacists and patients are working together to push the Kentucky General Assembly to pass legislation that will ensure patients will get the maximum benefit for lower prescription drug costs.
Sam Willett is a retired pharmacist from Mayfield who practiced for 38 years. He has served 11 years in leadership positions with the Kentucky Pharmacists Association, including six months as the interim Executive Director in 2017.

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