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Demonstrators

BE AN ADVOCATE

Pharmacy Benefit Managers (PBMs) are corrupt corporate middle men that stand between you and your pharmacy care, determining where your prescriptions can be filled and what medications are covered by your insurance plan. They've also been chronically underpaying independent pharmacies like us for decades, fueling the spread of pharmacy deserts, or communities left without any local pharmacy care, across the U.S.

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Head below to learn more about PBM abuse and how you can help keep pharmacies like us alive.

PBMs do...
a whole lot of nothing
for a high price

Pharmacy Benefit Managers are “companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers” (The Commonwealth Fund, 2019). They're now responsible (by their own design) for handling several elements of the prescription supply chain, including:

  • The automated processing of prescription claims

  • Creating the "formulary" of covered drugs for payers

  • Negotiating rebates with drug manufacturers

  • Creating pharmacy networks

  • Reviewing drug utilization

  • Managing mail order specialty pharmacies

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However, the duties listed above are administrative tasks that in other industries would earn cents on the dollar or a flat-rate fee, and PBMs have turned all of them into very profitable endeavors, ultimately funneling money from patients, providers, payers, and drug manufacturers directly back into their own pockets. Many of the tactics they use are anticompetitive or involve vertical integration, as well as are ethically questionable or outright illegal. It's no surprise that we've come to call them the #PBMafia, with the biggest three, which are responsible for ~80% of the entire market, netting

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tens of billions of dollars a year in profit.

CVS Caremark
Express Scripts
OptumRx
Humana
MedImpact
Prime Therapeutics
& more...

01

Contact your legislators

The reality is that PBM abuse will require legislative reform at both the state and federal level if community-based pharmacy is to survive in the U.S. Currently, there are several proposed bills at both levels that, if passed, would positively impact independent pharmacies like us and help address systemic issues present within our industry. Contacting your state and federal representatives makes a BIG impact, both alerting them to this problem and letting them that know this issue matters to their constituents. This can be done using online grassroots tools (see buttons to the right, which are listed in order of priority), giving their office a call, sending them an email, or mailing a letter. Because of the way that legislators’ aides log the number of communications sent in by constituents about any particular political issue, reaching out via multiple methods makes it more likely that they’ll deem the issue as something they should focus their efforts on. More helpful tools for contacting your legislators can be found on the Advocacy page of our friends at St. Paul Corner Drug.

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In particular, we and other pharmacy advocates we're working closely with are focusing our energy on passing the Pharmacists Fight Back Act (H.R.9096), which was recently introduced in the U.S. House of Representatives. This bill is is currently the most comprehensive PBM reform legislation ever introduced at the federal level. It prohibits large PBMs from manipulating drug prices and restricting network access and patient choice in federal healthcare plans, and also protects pharmacies, patients, and taxpayers from other unfair PBM practices. Additionally, it is the ONLY bill that specifically addresses reimbursements from PBMs to pharmacies like us. 

 

We're currently collecting signatures for a petition urging our own U.S. Representative, Thomas P. Tiffany (R—WI—7), to sign on as a co-sponsor! You can also use the materials linked to the right to start your own petition (use the template petition and signature pages together) with your church group, book club, sports teams, etc., and/or spread the word about this bill to your friends and family (the email template also makes a great framework for a social media post!).

Grassroots tools

H.R.9096 materials

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Spread the word

  • Instagram
  • Facebook
  • X (formerly Twitter)

A big part of why the problem of PBM abuse has grown so pervasive is because, outside of community pharmacy employees, most people—even healthcare workers—don't even know what a PBM is, let alone how they're harming patients, payers, and providers. Once you've learned a bit about it, share our site and additional resources you find with others so that they can learn about it, too! We recommend checking out the Get Educated page by our friends at St. Paul Corner Drug, where you'll find their curated, growing list of web pages, articles, videos, podcasts, news articles, and more (these educational resources are great things to share with others, including your legislators!). If you're on social media, sharing posts from us and other pharmacies about PBM abuse also helps spread the word. Click on one of the icons to the left to check out our accounts! 

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Share your story

If you've got a story about how your plan's PBM has negatively impacted your pharmacy care, or how your independent pharmacy has cared for you, legislators, organizers, and even the government want to hear from you! Visit the Share Your Story page from our friends at St. Paul Corner Drug for detailed instructions of ways to share your story and help contribute to the insurance reform movement.

Modern
Medical Mafia

A deep look inside the crime ring
running American healthcare

A docuseries telling the true story of PBM abuse.
Made by pharmacists, endorsed by patients.

This soon-to-be released docuseries is being produced by our friends at Patient Protector.

Mobster

Chet Johnson
in the news

Check out this recent article about PBMs from the Amery Free Press, featuring our pharmacy.

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