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Price-gouging middlemen are why Arizonans can’t afford their prescriptions

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Price-gouging middlemen are why Arizonans can’t afford their prescriptions

Jun 13, 2024 | 2:58 pm ET
By Teresa Dickinson
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Price-gouging middlemen are why Arizonans can’t afford their prescriptions
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A Publix Super Markets pharmacy manager retrieves a a medication in Miami. Photo by Joe Raedle | Getty Images

As an independent pharmacy owner of more than 18 years, I started my business with one goal in mind: to help patients. Our commitment to patient care is just one of the many reasons that dealing with price-gouging middle men, better known as pharmacy benefit managers, or PBMs, has been one of the most frustrating and harmful aspects of the profession. 

Perhaps most frustrating is that policy solutions at the State Legislature already exist, they just haven’t been given a fair shot at a hearing or a vote by Republican leadership at the Capitol. 

PBMs are third-party companies that function as intermediaries between insurance providers and pharmaceutical manufacturers to negotiate drug prices and control which medications insurers will cover. Independent pharmacy owners like myself have taken to using the term “PBM abuse” to describe our experiences working with them. 

Over time, PBMs have changed the rules to enhance their profits at the expense of community pharmacies and patients everywhere. 

PBMs boast about their ability to streamline and expedite payment processing for smaller community pharmacies, but the reality looks more like small businesses getting strong-armed into toxic contracts that leave them and their patients with wildly inflated costs — with few to no options for recourse. 

These inflated costs aren’t always represented in copays for medications. Insurers often compensate for paying higher prices to pharmaceutical companies on the back end by raising premiums for patients, creating multiple avenues to protect their profits, all at the expense of sick people seeking health care. 

I paid hundreds of thousands of dollars in excessive and abusive “Direct and Indirect Remuneration” fees, all to ensure maximum profit for the PBMs and insurers. Such fees are driving independent pharmacies out of business and having a detrimental impact on public health. 

As many rural areas rely on independent pharmacies, people in these communities are disproportionately harmed, as they’re forced to travel longer distances and pay higher costs to fill their prescriptions. More than a quarter of Arizonans reported having stopped taking prescriptions due to cost alone. This is inhumane: No one should be forced to choose between essential medications and having money for bills or putting food on the table. 

Three major PBM corporations have consolidated with some of the country’s largest health insurers to dominate almost 90% of the health care market by vertically integrating with some of the largest pharmacy chains and medical care provider networks in the country. 

Our elected officials already have a number of tools at their disposal to help patients and small business owners alike avoid the financial strain and exploitation that happens at the hands of these greedy corporations. Policies have been passed to address these abuses before, but they haven’t been successful at curbing the issue as there isn’t a regulatory body enforcing compliance.

I was proud to appear alongside Gov. Katie Hobbs and state Sen. Eva Burch in January to speak about my experiences, and to support the plans already in motion at the State Capitol to help lower prescription drug costs for all Arizonans. 

Under Governor Hobbs’ plan, pharmaceutical companies will be required to provide justifications for price increases, and the newly established Prescription Drug Affordability Division will play a pivotal role in capping prices on commonly used drugs such as insulin — preventing outrageous price hikes that disproportionately burden patients — and protect independent pharmacy owners from being strong-armed by corporations. 

The crucial safeguards that would have been implemented by SB 1532 and SB 1533 could prevent Arizonans from being blindsided by unexpected costs and allow them to make informed decisions about their health care. 

Working to somehow implement these solutions to protect patients and small business owners is not a partisan issue — it’s a win for everyone involved. It’s time for our legislators to put petty political differences aside and ensure that every Arizonan can access affordable medication without sacrificing their health or financial stability.