CINCINNATI -- For 58 years, Hart Pharmacy has been the neighborhood pharmacy on a Glenway Avenue corner. But as they continue filling prescriptions for loyal customers, the reimbursement for meds is dwindling.
"As these PBMs, as they're called, get bigger and bigger and manage more and more plans, we're seeing lower and lower reimbursements," pharmacist Sarah Priestle said.
PBMs are pharmacy benefits managers. They're middlemen like Express Scripts and CVS Caremark that handle prescription coverage. But the lower reimbursement rates are taking a toll, according to Priestle.
"It's hard to keep those medications on the shelf," she said. "It's hard, you know, so when they come in I might not have it. I can't afford to stock that drug anymore."
Right now, it could actually be cheaper to pay for drugs out of pocket, versus using insurance. But pharmacies can't tell you that. Some lawmakers in Ohio are looking to change that.
House Bill 479 is currently pending in Columbus. It would require pharmacists to tell patients about lower drug prices.
Ohio is also looking at how CVS Caremark reimburses pharmacists and charges Medicaid. Auditor David Yost issued a statement saying, "When 40 cents of every dollar goes to Medicaid, transparency will create better policy and better decisions."
Affordable prescriptions is an issue the House is leading the charge on, working to find a reasonable solution for all Ohioans. I joined Auditor @Yost4Ohio and House leaders to push the effort to increase cost transparency & gather data on the state’s managed care plans & PBMs. pic.twitter.com/GsIl0uRMoO
— Cliff Rosenberger (@CARosenberger) March 14, 2018
According to the Ohio Pharmacists Association, some small independent pharmacies have closed because of lower reimbursements.
CVS Caremark issued the following statement:
"We are a committed, major employer and business operator in Ohio and look forward to having an open discussion with legislative leaders on this and any other topics or concerns. We are always willing to work with legislators of both parties to help them meet the needs of their constituents and we regularly make ourselves available to the State’s leadership as a resource as work to create sound public policy.
"CVS Caremark is focused on providing our pharmacy benefit management clients with opportunities to improve health outcomes for their members, while also managing costs and providing access to a broad network of pharmacies. CVS Caremark considers local, independently-owned pharmacies to be important partners in creating our pharmacy networks, and in fact, independent pharmacies account for nearly 40% of our network. Furthermore, we reimburse our participating network pharmacies, including the many independent pharmacies that are valued participants in our network, at competitive rates that balance the need to fairly compensate pharmacies while providing a cost-effective benefit for our clients."
