Time for California to act: save community pharmacy and sign SB 966

OPINION – My patients don’t know what a pharmacy benefit manager (PBM) is or how much control they have over their healthcare. What they do know is that I am here to help them manage their illnesses . . .  but, for how long?

PBMs are the middlemen between health insurance companies, pharmacies, and pharmaceutical manufacturers. They manage prescription drug benefits on behalf of insurers, employers, and government programs. Their main roles include negotiating drug prices, processing claims, developing formularies, and providing clinical management services under the guise of controlling costs.

While the initial purpose of a PBM was to negotiate contracts on behalf of its clients (health plans), these enterprises have evolved into ones in which there often is an inherent conflict of interest and lack of transparency in how they operate. This is primarily due to vertical integration.

When you are owned by a health plan and also own pharmacies . . . who are you really negotiating on behalf of? It is certainly not the patient.

The “Big Three” PBMs threaten the viability of community pharmacies, who not only provide patients with life-saving medication, but also help manage chronic illnesses and provide a critical access point to a healthcare professional.

While the PBM middlemen are making record profits, their business practices too often make it impossible for pharmacies unaffiliated with a PBM to stay afloat.

This potentially monopolistic behavior harms constituents and the pharmacies that provide vital health care services to those most in need across the state.

PBMs commonly reimburse pharmacies far below the cost of acquisition for medications – and not including any reimbursement for the supplies and staffing costs. This places pharmacists in the untenable position of having to fill prescriptions at a significant loss, sometimes hundreds of dollars for one medication. This is an unsustainable business model.

This is one area that needs to be addressed, but there are many others: clawbacks, unfair audits, and patient steering to name a few.

Some 150 PBM reform laws have been enacted in the states over the course of the last three years, including actions in Alabama, Arkansas, Florida, Tennessee, and Texas. It is time for California to act.

Patients rely on the quality care services provided by pharmacists and pharmacies. On behalf of pharmacies and the patients for whom we provide care, I urge Governor Newsom to sign SB 966, by Senator Scott Wiener, District 11, encompassing San Francisco and parts of San Mateo County.

Clint Hopkins, PharmD, is the owner and CEO of Pucci’s Pharmacy in Sacramento. He focuses on patients who require special and compound medications.