Senator Britt on Unacceptable Independent Pharmacy Closures Due to PBM Practices

Widespread Independent Pharmacy Closures

• 📉 Over 6,500 independent pharmacies have closed since 2010, with Alabama losing over 225 between 2015 and 2018.
• ⚠️ This trend is described as "absolutely completely unacceptable", particularly in rural communities where these pharmacies are often the sole healthcare provider.

Impact of Pharmacy Benefit Managers (PBMs)

• 💸 PBM practices, including retroactive clawbacks, DIR fees, and below-reimbursement rates, are squeezing independent pharmacies' bottom lines.
• 🏘️ These practices are pushing communities towards "pharmacy deserts", exacerbating the loss of essential healthcare access.
• 📉 One independent pharmacy reported a net loss of $95,000 in one year and $75,000 the next, with 25% of prescription claims being filled at a loss.

Rural Access and Community Impact

• 🏥 In rural Alabama, independent pharmacies are often the only healthcare provider within 20-30 miles.
• 🤝 These pharmacies are more than just businesses; they are trusted community members who provide essential services, including after-hours care and medication delivery.
• 🚫 The closure of these pharmacies negatively impacts community well-being and can deter businesses from locating in an area, creating "pharmacy deserts".

Employer and Patient Empowerment

• 📊 While employers rely on PBMs to manage costs, patients and employers are often the least empowered voices in the system.
• 🏦 The market is dominated by the big three PBMs (80% market share), limiting employers' choices.
• ❓ Employers would prefer direct price reductions over rebate-driven models, but lack the power to enforce this.

Need for PBM Reform

• 🔍 Greater transparency is needed so employers can assess if they are receiving a good deal from PBMs.
• ⚖️ PBMs should have fiduciary responsibility, allowing legal recourse if they do not act in the best interest of plan members or employees.
• 💊 Rebate-driven formula design and utilization tools often do not reflect sound clinical judgment, leading to struggles for nationally guideline-accepted medications.