Most pharmacists just want to sell medicine to sick people at reasonable prices. If a patient would end up paying less out-of-pocket for a drug than by using their insurance, they'd like to be able to say so.
But right now, many pharmacists are bound by contracts with insurance companies and pharmacy benefit managers (PBM) to keep their mouths shut and watch folks overspend. Even if patients show up well-researched and fully aware that they could pay less in cash, pharmacists are prohibited from selling them drugs at those lower rates if they are insured.
Piss off the PBMs, and a pharmacist could get kicked out of network. Only three PBM companies -- Express Scripts, CVS Health, and OptumRx -- manage the pharmacy benefits for the vast majority of Americans, so getting blacklisted could cut pharmacists off from patients entirely.
An American Medical Association study based on 9.5 million claims found that people were overpaying nearly 25 percent of the time. PBMs pocket the difference between patients' copays and the actual cost of the drug.
Pharmacists have had enough. They're getting bills passed in several states to improve patients' access to medication -- and to remove their unwilling role in the scam.
"The best part of my job is communicating, counseling, and listening to patients," says Eric Slendee, a pharmacist from Harmony who serves a number of small towns in southwestern Minnesota. He testified in favor of both bills earlier this month.
"We know most of our patients personally and their extended families as well. We need to provide them with the best healthcare advice possible, including affordable medication options. Want to charge patients the lowest possible price. Being prohibited from price discussion erodes our relationships with our patients."
Slendee said he believes that if pharmacists were free to discuss the real cost of drugs, that public knowledge would force insurers to decrease their negotiated rates to match free market rates.
"There are so many things that have been put into these contracts that really have nothing to do with patient care," said Marsha Millonig, executive director of the Minnesota Pharmacists Association.
Another clause, she says, prevents pharmacists from mailing prescriptions to rural patients who live far away from the drug store, or to snowbirds while they're out of town, because some PBMs own their own mail order pharmacies and view any delivery service as competition.
"As pharmacists, we don't want our patients to discontinue their healthcare when they go on vacation to Florida for a month in the winter. It's that kind of stuff that's going on," Millonig says. "And if [pharmacists] exercise their legal rights to complain about these practices, these companies will say that they violated their contract and they'll be kicked out."
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