New York’s Staten Island. Rep. Nicole Malliotakis (R-Staten Island/South Brooklyn) was joined by an independent Staten Island pharmacist on Wednesday in Washington, D.C., to advocate for a crackdown on healthcare conglomerates that they claim are destroying companies like theirs.
Eltingville’s Delco Drugs owner, Robert Annicharico, stated that he hopes legislation that advocates claim will control pharmacy benefit managers (PBMs), the companies in charge of overseeing prescription drug coverage, is passed.
He said that the billion-dollar companies have resulted in poor payment rates for the services his pharmacy offers and increased out-of-pocket expenses for his patients.
As a pharmacist working in a private practice, I see firsthand how PBMs and patients interact,” he said. “My community pharmacy’s survival as well as my patients’ health are at risk due to these behaviors. And for that reason, I’m requesting reform.
For years, Annicharico, Malliotakis, and numerous other independent pharmacists from Staten Island have advocated for government reform of PBMs; yet, the firms have remained largely unchallenged.
The representative organized a roundtable for independent pharmacists in Eltingville in September to talk about how to maintain their companies. The impact of PBMs was the group’s primary concern.
One example of the wider issues with PBMs and their effects on prescription healthcare is the largest of those chain pharmacies, CVS.
PBMs were initially created to improve the efficiency of the distribution of prescription drugs, but they have since expanded into multibillion-dollar companies that Malliotakis and the business owners assembled Thursday claim are unfairly affecting the healthcare sector.
According to the lawmaker, PBMs’ vertical integration into bigger healthcare organizations is their primary problem.
For instance, the Federal Trade Commission (FTC) reports that CVS Caremark, the largest PBM with a 34% market share, is a division of CVS Health Corporation, which also includes the insurance behemoth Aetna, retail pharmacies, and health care providers.
The CVS PBM can influence prescription prices and deter consumers from visiting neighborhood pharmacies, as can Express Scripts, a division of Cigna, and Optum Rx, a division of UnitedHealth Group.
The representative has signed onto or sponsored a number of proposals that she claims would assist control PBMs.
Malliotakis claimed that PBMs make a lot of money by controlling what their rivals can make and that there is little to no transparency in their pricing policies.Mom & Pop pharmacies are being destroyed as a result, and the expenses are being passed on to customers in my area and throughout America. In order to safeguard our neighborhood pharmacies and assist patients who are having financial difficulties paying for their life-saving prescription drugs, Congress should now take up the bipartisan legislation that we passed out of the Ways and Means Committee to stop these predatory practices, improve transparency, and reduce the cost of prescription drugs.
In Medicare Part D and Medicare Advantage, the first bill, the Protecting Patients from Middlemen Act, would forbid PBMs and drug plans from charging patients more in cost-sharing than the drug’s net price. The Ways and Means Committee passed that bill.
The second, the Protecting Patients Against PBM Abuses Act, would mandate greater openness from the healthcare businesses and restrict the amount of money that PBMs might earn under contracts with Medicare Advantage or prescription drug programs.
Similar to the PBM Abuses Act, the Delinking Revenue from egregious Gouging (DRUG) Act would restrict some of the most egregious PBM practices, such as paying connected pharmacies more than independent pharmacies.
The Drug Price Transparency in Medicaid Act would enhance financing for pharmacy surveys, impose further pricing restrictions on PBMs covered by Medicaid, and make survey participation publicly available.
Finally, some of the COVID-era Medicare payments for things like pharmacist-administered COVID testing and immunizations would be extended to pharmacies under the Equitable Community Access to Pharmacist Services Act.
The Senate and President Joseph Biden would need to approve each of those five laws, which are now in different phases of the House legislative process.
Although the issue has affected pharmacies on Staten Island, it has been observed nationwide. According to Katie Krell of the National Community Pharmacists Association, a lobbying organization for the sector, one independent pharmacy closes its doors every day in the United States.
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