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Proposed law aims for transparency, adds regulations to pharmaceutical industry

Posted at 6:16 PM, Apr 03, 2019
and last updated 2019-04-03 19:34:26-04

Some independent pharmacies here in Acadiana and nationwide say they are struggling to stay in business because of some industry practices.

Specifically, the way pharmacy benefit managers, PBMs, operate in Louisiana. Pharmacists are now looking to legislation to make a change.

PBMs are companies that act as the middleman between insurance companies, pharmacies and drug manufacturers.

The more well-known companies are Caremark, Humana, Optum and Express Scripts. Often times you can find the PBM of your insurance carrier in fine print on your insurance card. These groups manage how much insurance companies pay for prescription drugs, how much pharmacies are reimbursed for the cost of the drug, and what drugs are covered by a specific insurance plan.

Sen. Fred Mills, who also is a pharmacist, authored a bill that would aim to bring transparency. He said it would essentially regulate PBMs and ultimately help independent pharmacies, like Cashway Pharmacy in Abbeville, stay open.

To read the proposed bill, click here.

“We’re not greedy but we do need to get paid for our value and our job,” said Cashway’s owner, Tammy Stutes. “It’s gotten to a point where the reimbursements or the contracts are less and less and there’s no over sight so they can basically do whatever they want.”

Stutes has been a pharmacist for 30 years. She said lately it’s been even more difficult because PBMs won’t fully reimburse for the cost of medication.

“It’s just not right. I like to call it ‘organized crime,’ well actually I call it the ‘mafia.'”

Most of the time, she said, they won’t update the price of medications regularly to keep up with the increase from manufacturers. So when the PBMs pay the pharmacies, they’ll pay for less than the cost of the drug.

“It’s not all about money, it’s about patient care. However you have to make money to stay in business. We want to be there for our patients, but we’re concerned about access of care. And if we can’t stay afloat then they don’t have access to us,” she said.

Wednesday night, dozens of pharmacists from across Acadiana gathered to discuss their concerns, hoping to come with a solution.

“A lot of times we take the loss but it’s gotten to the point that I’ve had to decrease my staff and our volume is so high that we’re busting at the seams. Now it’s time for all of us in the ranks to speak up,” said Stutes.