In a story for Oregon Public Broadcasting, rural pharmacies, already overwhelmed by the current pandemic, are in danger of more closures, as insurance companies and pharmacy benefit mangers add more costs that the already struggling pharmacies must pay.
From the story: “Two major factors are creating the trend, said Rick Chester, owner of Medicap Pharmacy in Talent, a town of 6,500 between the Cascades and the Coast Range near the California line. First, insurance companies are pushing people to get prescriptions by mail, taking business from already struggling rural pharmacies and, because of slower mail service, is often impractical for rural residents.
The other issue is profit-seeking policies from lightly regulated pharmacy benefit managers, the middlemen that stand between pharmacies and insurance companies. “Basically, when someone gets a prescription through an insurance or Medicare plan, the PBM is supposed to reimburse the pharmacy for the drug cost and some overhead. But in recent years, PBMs started decreasing the amount they reimburse when pharmacies don’t meet certain sales markers,” Ehrlich reports. “According to a report by the U.S. Centers for Medicare and Medicaid Services, PBMs have increased their fees for Medicare plans by more than 91,000% in the last two years. PBM reimbursements have gotten so low that sometimes pharmacies say they actually lose money when they fill prescriptions from certain insurers. And some pharmacies … just can’t make it work financially. The PBM Trade Association disputes that PBMs are the reason for rural pharmacy closures.”
States are fighting back with new laws targeting the PBMs, others want Congress to introduce more oversight. Regardless, right now rural pharmacies and their customers are struggling to make ends meet and get their prescriptions.
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