The Justified Pharmacist Answers 3

What happened to you? I was defamed and removed as a participating prescription medicine provider for Express Script of St. louis, MO. I was removed as a retaliation exclusion because I raised concerns about the pharmacy benefit managers not fulfilling the legally required community reinvestment.
What would you like to see happen? I want to see ExpressScript and all Prescription Benefit Managers reinstate their victims and make whole those that have been harmed by their retaliatory reinvestments, statements and punishments.
How do you think others can help? I think the patients, citizens, congress and stakeholders in public health should require that the PBM’s be transparent and reverse decisions that are recklessly under-serving small businesses and neighborhoods.

8-1-24 Update

Organizing support is growing for Detroit’s last two established community-based pharmacies.

 

 

7-11-24 Update 

The Federal Trade Commission files charges against Pharmacy Benefits Manager over insulin pricing, and this is once again pointing to the injurious practices that directly undermine the most vulnerable markets.

6-1-24 Update

Excerpt from USA TODAY 

Investigation By Emily Le Coz 

In today’s world, 7 out of 10 medicines dispensed by a pharmacy are dispensed at a loss,” Hogue said, referring to the non-generic drugs that stand for pharmacies’ largest expense. Pharmacy benefit managers, commonly referred to as PBMs, act as a middleman between the insurers, the drug manufacturers and the pharmacies.
They negotiate drug prices with manufacturers, determine which drugs will be covered by insurance plans and set reimbursement rates for pharmacies that buy and sell the drugs. As the power of PBMs rose over the years, they demanded bigger rebates from drug manufacturers and pocketed increasingly bigger shares of those savings instead of passing them along. 

They also lowered pharmacy reimbursement rates and tacked on hefty fees known as Direct and Indirect Remuneration. The three largest PBMs – ExpressScripts, owned by Cigna; CVS Caremark, owned by CVS Health; and OptumRx, owned by the same company as UnitedHealthcare – control most of the market. While PBMs’ collective profits skyrocketed over the past decade, their tactics plunged retail pharmacies into financial distress and left them scrambling for alternative sources of revenue, like vaccinations, to stay afloat. 

The Federal Trade Commission launched an inquiry last year into PBM practices, which have already been the subject of several lawsuits. Independent pharmacies have been hit especially hard. Not only are their reimbursement rates lower than those of chains, but their patients have been steered away by PBMs that insist they use a preferred chain pharmacy instead.