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The Voice of the Black Community

Opinion

Pharmacy benefit managers pose risk to equitable NC healthcare
Bill protects independent pharmacies
 
Published Wednesday, July 7, 2021 12:00 pm
by Sen. Mujtaba Mohammed

NC GENERAL ASSEMBLY
North Carolina Sen. Mujtaba Mohammed is co-sponsor of S. 257, the Medication Cost Transparency Act.

North Carolinians deserve a healthcare system that prioritizes patients and equity.


Everyone should be able to receive the best, most cost-efficient care regardless of socio-economic status. Independent pharmacies are a crucial part of that patient-centered care, providing access and personalized services to communities across the state. But like many small business, independent pharmacies need our help.


I co-sponsored S. 257, the Medication Cost Transparency Act to protect independent pharmacists and, by extension, the health and well-being of North Carolinians. This bill ensures all patients get the best, most accessible care at the most transparent pricing possible.


The COVID-19 pandemic only further proved the value of care pharmacies provide. At the height of the pandemic, independent pharmacies were testing for COVID-19, providing medical advice, shifting operations to comply with new government guidelines, and alleviating the stress on hospitals — all while practicing routine duties.


Now, they have eagerly taken on another role to finally overcome this pandemic, administering vaccine doses and providing crucial information about the vaccines as trusted members of the community.


Despite their critical place in the healthcare ecosystem, the survival of independent pharmacies is threatened by major pharmaceutical middlemen, called pharmacy benefit managers. Because of their size and influence, PBMs determine what pharmacies are in an insurance network and the medications covered by an insurance plan.


PBMs dictate a pharmacy’s prescription medication reimbursement rate, often paying them less than they administer the drug for. And PBMs cozy relationships with manufacturers are known to drive up medication prices for patients.


Unfortunately for them, independent pharmacies must work with PBMs – they are too powerful to simply work around. As a result, independent pharmacists are often pushed into bad deals with unsustainable reimbursements. They are losing out on needed revenue, tied down by unnecessary red tape, and struggling to stay in business.


There are those in the healthcare ecosystem who do prioritize independent pharmacies and their survival, like pharmacy services administrative organization. PSAOs assist pharmacies with administrative, back-office tasks and negotiations with PBMs, so that pharmacists can focus on patient care.


Still, PBMs are too powerful, and pharmacies need legislative help.


S. 257 is a step in the right direction to right the wrongs of PBMs. The Medication Cost Transparency Act requires PBMs to have licenses and holds them accountable under the North Carolina Department of Insurance. The Insurance Commissioner will be able to investigate PBMs and can penalize them for forcing pharmacies into bad deals that ultimately harm North Carolinians.


With their money and influence, PBMs should not be able to threaten the fate of independent pharmacies. I am cosponsoring this bill because compassionate, community-based healthcare advocates must be protected, not squeezed out of healthcare by big corporations. Who knows where we’d be had independent pharmacists not stepped up in the fight against COVID-19, often risking employee health and to the detriment of their business?


And while we’ve made progress against the pandemic, we aren’t out of the woods yet – we need all hands on deck to achievable an equitable recovery and provide equitable care after the pandemic is over.


S.257 advocates for those who advocate for us.


Mujtaba A. Mohammed of Charlotte represents District 38 in the North Carolina Senate.

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