Garth Reynolds column sig

Illinois community pharmacists have been working tirelessly throughout the pandemic to deliver patient care to families across our communities.

Whether at-risk and vulnerable or relatively healthy, we sprang into action, ensuring patients could get prescriptions and medical advice while maintaining social distancing and other COVID-19 protocols. We continue performing coronavirus tests, and some pharmacists are even administering vaccines — all on top of our daily responsibilities.

Pharmacists are always focused on patient care and outcomes. As many patients’ most trusted and closest health care provider, both are at the core of what we do.

And as lawmakers seek to improve health care and prescription medication access over the next several months, I hope they will protect and empower community pharmacists. Doing so will lead to the best, most affordable and accessible care for patients — just as we saw during the COVID-19 pandemic.

With competition and confusion mounting in the marketplace and network participation becoming more difficult than ever, small pharmacies are struggling to stay in business, which is a major detriment to patients. Even with partners like pharmacy services administrative organizations (PSAOs) who help pharmacies navigate the complexities, administrative burdens, and communications with other supply chain entities, independent pharmacies are seeing profits squeezed and they are being boxed out of patient care by pharmacy benefit managers (PBMs).

By definition, PBMs represent insurers, large employers, and even the government to administer prescription drug benefits. PBMs and their proponents claim that these entities protect patients from the high price of prescription drugs, streamline the process for pharmacies, and save taxpayers millions of dollars annually.

However, as a pharmacist who must coordinate with PBMs directly, I know that is not the case.

For far too long, PBMs have used their market influence within the prescription drug market to increase their power. Currently, PBMs control which drugs are covered under a health plan’s formulary, which pharmacy locations are included in a plan’s network, and how much a pharmacist will be paid for filling a prescription — yet, they have barely any government oversight.

With all of this power and influence, pharmacies are forced into contractual agreements with PBMs, where PBMs completely control the terms.

PSOAs, on the other hand, have recognized the troubles that PBMs cause for pharmacies, and they have tried to help provide assistance.

For me, my PSAO partner does its best to represent our interests during PBM contract negotiations and it handles other administrative duties related to pharmacy operations, so I can focus on patient care instead of paperwork and compliance. Yet, PBMs are still too powerful for PSAOs to make a significant difference despite their efforts.

Senate Bill 2008, a bipartisan bill introduced by Senate Assistant Majority Leader David Koehler, D-Peoria, is designed to help correct the imbalance of PBMs’ power and incorporates patient access and reimbursement regulations.

I and other independent pharmacists testified in support of the bill last month. Small independent pharmacists across the state, from Harrisburg and Marion to Naperville and Carol Stream, have publicly pushed for the legislation.

The only way for community pharmacists to truly and wholly care for patients is for Springfield to not just rein in the powers of PBMs, but to understand them as well. There is no doubt PBMs will try and deflect, placing blame elsewhere to maintain their power.

However, lawmakers should take it from the people who actually have a vested interest in patient care — not the multi-billion-dollar corporations looking to increase profits.

Now is the time to stop PBMs.

Garth Reynolds is the executive director of the Illinois Pharmacists Association (IPhA).

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