Independent pharmacies across the state took a stance last Wednesday, Feb. 5, with the State Legislature for a bill that would regulate practices by pharmacy benefit managers.
Several rural pharmacies, including Eureka Pharmacy and Batson’s Drug Store in Howard, were closed last Wednesday to afford staff to visit Topeka to meet in person with state representatives and senators.
Pharmacy benefit managers (PBMs) came into play when the practice of electronic insurance claims arose. Previously, insurance companies paid pharmacies and medical providers directly for prescription claims.
But when electronic claims came along, data companies started to collect claims from pharmacies, then transfer them to insurance companies and collect a fee.
Over time, insurance companies have allowed the PBMs to contract with pharmacies, which meant there was no control over how PBMs would run. It has been noted that PBMs could charge one rate to a pharmacy while charging a different rate to the insurance company.
Many rural pharmacies have noted that PBMs are charging so much that it’s cutting into profit margins and making it difficult to operate, to the point that some pharmacies can’t operate at all. The Prescription Safety and Access Act that has been proposed would adopt a dispensing fee model, call for transparency for employers and payers, close an insurance department authority loophole and strengthen a state statute regarding the removal of gag clauses from contracts. It also calls for protection against audits and egregious fees, institute network standards that exclude mail order, to allow for selective participation in networks and to protect against steering patients toward certain pharmacies.
