Imagine that you’ve sold your house. At closing, you receive a fair price, settle your bills and move into your new home. Five months later, you get a letter from the new homeowners telling you they believe they overpaid for the house and now, instead of receiving the selling price, they decide that they’re just not going to pay what you’re owed. This would never happen in real estate, but, it happens all the time at your local community pharmacy.
Pharmacy Benefit Managers, or PBMs, are massive “hidden” corporations that negotiate with insurance companies to set the prices that patients pay at their pharmacy for medications. They also decide which pharmacies patients must use. Some PBMs own their own pharmacies and force patients to use them. Additionally, they also charge local pharmacies a fee for every prescription after the point of sale (fees known commonly as DIR fees).
These DIR fees work something like the scenario laid out above. It’s common for pharmacies to get a bill months after they dispense the medications, often resulting in the pharmacy receiving less for the medications than they paid for them, with no way around this as the medication has already been dispensed to the patient and paid for by the pharmacy.
The typical independent pharmacy pays more than $70,000 per year in DIR fees. Unfortunately, this combination of hidden fees and price fixing is driving local pharmacies out of business across the country. This hurts our patients and the communities we serve. I don’t want to see that happen here in Indiana.
In a few weeks, members of the Senate Finance Committee will get back to work on legislation aimed at bringing down the cost of health care. A major focus of the bill should be fixing the way prescription drugs are priced. Drug pricing and PBM tactics are hurting patients, pharmacies and communities.
Pennsylvania Senators Pat Toomey and Robert Casey serve on the Senate Finance Committee.
Voters who care about the high cost of medicine and the survival of locally owned, independent pharmacies should contact their offices and urge them to stop this shakedown and rein in the PBMs.
Stephanie Smith Cooney, Pharm.D.
President, Gatti Pharmacy