Independent Pharmacies Seek Government Assistance with PBM Reimbursements

BUFFALO, N.Y. — Independent pharmacies nationwide are facing significant challenges.

A recent investigation by the New York Times revealed that nearly 800 zip codes that had at least one pharmacy in 2015 now have none. Bretta Grinsteinner, who works with the Epic Pharmacy Network, an organization that provides administrative support and advocacy for these small businesses, emphasizes the importance of these pharmacies.

“Oftentimes, the pharmacy is the last healthcare provider in the area. When an independent or community pharmacy is removed, it creates a healthcare desert where access to professionals becomes severely limited,” Grinsteinner noted.

She highlighted that the wholesale costs of many brand-name medications often exceed the reimbursement rates that Pharmacy Benefit Managers (PBMs)—the intermediaries for insurance companies—offer to these pharmacies. As a result, pharmacists are faced with the difficult decision of either incurring losses or failing to meet their customers’ needs, especially in rural and low-income areas.

“They find themselves in challenging positions where they cannot secure the medications required by patients because they would be losing hundreds of dollars in the process,” Grinsteinner explained.

The Pharmaceutical Care Management Association (PCMA), which advocates for PBMs nationally, asserts that independent pharmacies receive higher reimbursement rates than chain pharmacies, attributing the challenges faced by these businesses to broader economic issues unrelated to PBMs. New York State Assembly Health Committee Chair Amy Paulin disagrees, stating that PBMs play a significant role in these challenges.

“They lack transparency,” she remarked. “They receive rebates from manufacturers, but we have no insight into what those amounts are or whether they are passed on to consumers, which is what we would ideally want.”

Paulin indicated that her committee will be reviewing multiple bills in the upcoming session, including one proposed by Assemblyman and pharmacist John McDonald, which would mandate that PBMs reimburse pharmacies at least at a rate determined by a national monthly survey of retail pharmacies and impose additional fees.

“If there is any possibility to implement state-level interventions, we will be looking into it this session,” she stated.

In response, PCMA opposes government measures that would enforce higher reimbursement rates, warning that such policies could ultimately lead to increased costs for consumers and employers regarding prescription medications.

At Mediserv Pharmacy, a local pharmacy store in the Bronx, New York, we understand the critical role independent pharmacies play in providing essential healthcare services to our communities. As discussions around PBM reimbursements continue, we remain committed to ensuring that our customers have access to affordable medications and quality care. Your health is our priority, and we are here to serve you.