Pharmacists Fight Back

Simple but Not Easy

Congress is debating health insurance this week. A bipartisan deal is unlikely. It’s achievable, though. I know that because last week I introduced bipartisan drug-pricing legislation. James Comer, leader of the Biden impeachment effort, and Rashida Tlaib, member of the Squad, co-sponsored the bill and spoke together at the press conference. Dealmaking is possible across other areas of health insurance and pricing, too.

My legislation, Pharmacists Fight Back, fixes critical links in the middle of the pharmaceutical value chain. It implements a transparent pharmacy reimbursement model using market-based pricing for generic drugs benchmarked to the National Average Drug Acquisition Cost. The bill also prevents Pharmacy Benefit Managers, the middlemen of drug pricing, which are owned by the Fortune 20 health insurance corporations, from steering patients to their own pharmacies, limiting patients’ pharmacy networks, or exploiting independent pharmacists.

The legislation is technical and specific. Yet last term, dozens of Members from both parties signed on and organized events in their districts about it. This term, more than 50 independent pharmacists from 18 states flew into Washington to reintroduce the bill with me. Here are three of their stories, in their words:

---

Nikki Bryant, Georgia independent pharmacist

“Four years ago, I opened a bakery and a coffee shop in my pharmacy. I wake at 4:30 each morning, I drive the 30 miles into my store and I have homemade biscuits and coffee ready, because I now make more money on coffee than prescriptions. In any given hour, I go from icing a cake, to giving an immunization, to pulling an espresso shot, to counseling and consoling a patient with a new terminal diagnosis and scooping ice cream.

…Now I need you to have my back, because PBMs ignore state laws and federal plans like Medicare and the federal employee benefit plan. Pharmacists Fight Back will level the playing field for all pharmacies, giving us a fighting chance to survive. Government contractors entrusted to administer pharmacy benefits for these plans have abused their powers. [The plans] now use my tax dollars to close and run me out of business while they watch their profits soar. I am the voice of 15,000 patients in every nook and cranny across 12 southwest Georgia counties, two of which have no pharmacy…”

---

Kyle Lomax, Arkansas independent pharmacist

“My wife, Kass, and I are both independent pharmacy owners and pharmacists from Arkansas. In 1974, my father opened the doors of our hometown pharmacy in a rural community in Northeast Arkansas, the kind of Main Street pharmacy you see throughout America. Last week, after more than 50 years of serving our community, we had to do the unthinkable. We notified our staff and our patients that we’d be closing our family pharmacy.

Over 40% of our prescriptions were for Medicare beneficiaries, and under today’s federally controlled PBM system, we simply could not survive. Arkansas has become ground zero for PBM reform…Medicare and federal plans remain governed by federal PBM contracts; those PBMs continue to manipulate drug prices, steer patients to their own pharmacies…while profiting off the very prescriptions we dispense. These practices just aren’t unfair. They’re unsustainable, and rural communities are paying the price. That’s why the Pharmacists Fight Back Bill bill is so important.

…Tonight, I will return home, so tomorrow, my father and I can work the last day in the pharmacy together. This is one of the hardest decisions I’ve ever had to make. And there are thousands of rural communities just like ours fighting the same fight, wondering if their community is next.”

---

Anna Noojin, Alabama independent pharmacist

“My name is Anna Noojin. I have been an independent pharmacist for 22 years. 40 years ago, I stood at my kindergarten graduation and I proudly said when I grow up, I want to be a pharmacist. That dream I have achieved, and I work so hard for, has become a nightmare because of PBMs.

I’m a second-generation pharmacist. I joined my father, who has been a pharmacist serving our Alabama community for 56 years. Today, we have 30 hard-working employees taking care of over 13,000 patients. He’s a real-life hero…Now my daughter is following in my footsteps, a third-generation pharmacist to me at Auburn University. I should be so excited about that, but I have an intense fear for her future.

…Last year alone, our pharmacy filled over 40,000 prescriptions that were reimbursed less than our acquisition cost. We filled an additional 10,000 prescriptions where our profit was less than the candy bars we sell on the front counter, making us, according to PBMs, less valuable than a vending machine.”

---

Pharmacists Fight Back touches a nerve because its themes cut across health care. The independent pharmacist (or physician) up against the power of big insurance and the federal government. Sky-high prices set by middlemen and monopolists who devour dollars that should go to the delivery of care. The bureaucratization and corporatization of the medical profession. Passing my bill is a start in reversing these trends across health care.