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Pa. Pharmacies Fight Back Against Middlemen
11 Jun
Summary
- Over 1,000 pharmacies closed in Pennsylvania since 2020.
- A proposed bill aims to regulate Pharmacy Benefit Managers (PBMs).
- Critics argue the bill might not save money and could cost millions.
Pennsylvania is confronting a crisis of over 1,000 pharmacy closures statewide since 2020, with lawmakers introducing legislation to address the issue. The core of the problem lies with Pharmacy Benefit Managers (PBMs), middlemen who pharmacists argue are driving them out of business. Representative Rob Matzie's proposed bill would direct the state's Department of Human Services to contract a single PBM for all Medicaid plans.
This consolidation aims to give the state greater control and potentially increase reimbursement rates for pharmacists. Supporters point to Ohio's similar model, which reportedly yielded significant savings. However, Sally Kozak from the Department of Human Services expressed concerns, stating the proposal could add costs and risks without guaranteed savings, and would only affect a small portion of prescriptions.
Pharmacists contend that shrinking reimbursement rates from dominant PBMs make operations unsustainable. A 2020 study indicated the average cost to dispense a drug is around $12.40, yet PBMs often offer fees as low as $1.00. Matzie's bill seeks to establish fairer reimbursement, while other proposals advocate for dispensing floors and greater transparency across both Medicaid and commercial insurance plans.
