Hundreds of Kansas pharmacists in white coats rallied at the Capitol in Topeka on Wednesday to meet with legislators and advocate for restrictions on pharmacy benefit managers, or PBMs.
Meanwhile, they temporarily closed their pharmacies – more than 100 of them across the state – to show lawmakers and clients what a world without local pharmacies would look like, they said.
“I truly hope that we are able to educate and make a difference and that the future of pharmacy in Kansas and across the nation looks up from here,” said Christian Williams, a pharmacist from Osawatomie.
Williams used to work at Rockers Pharmacy, an independently owned pharmacy in Paola with a retro soda and ice cream fountain. Last year, Williams became a co-owner of Rocker’s. Her goal was to eventually become full owner.
But over the past five years, the pharmacy market and the way pharmacies are reimbursed by insurance companies made it hard for them to keep their doors open, she said.
In December, Williams said Rockers had to close its doors for good.
“It hurt a lot. It hurt our patients. It hurt us as pharmacists,” she said. “But without fair reimbursement that allows us to keep the lights on and pay for our staff, we can’t provide pharmacy service that is safe and appropriate.”
Pharmacy closures are becoming more common, making it harder for people in Kansas to access care. Pharmacists and pharmacy employees that took part in the rally blame PBMs, saying their practices force them to operate at a loss.
What is a PBM?
PBMs work behind the scenes and broker deals between drug manufacturers, insurance companies and pharmacies. They play a big role in determining what you pay for prescription medication, how much insurance pays and what drugs they cover, and what pharmacies earn off of prescription drug sales.
The top three pharmacy benefit managers are CVS Caremark, Express Scripts and Optum Rx. They’re owned by big insurance companies. And two of them also own major pharmacies, including CVS Pharmacy and Express Scripts Pharmacy, a mail-order pharmacy.
Gordon Carroll, who works with AuBurn Pharmacy, said PBMs were designed to save insurance companies and employers money on prescription drugs.
“But what really happens is they sort of put a bunch of funds into a black box, have no regulation, no oversight, no accountability, and they end up washing their hands in a lot of money,” Carroll said.
Carroll said PBMs are paying pharmacies like his below cost, making it difficult to operate. He attended the rally with a handful of other AuBurn Pharmacy staff members. AuBurn has about 30 locations, mostly based in Kansas.
“We’re advocating for our way of life, essentially, to keep our operations afloat in a sustainable and fair environment,” he said.
The Pharmaceutical Care Management Association, or PCMA, a trade group that advocates on behalf of PBMs, said PBMs value their partnerships with “quality, low-cost pharmacies” in Kansas.
“When Kansas patients have access to affordable pharmacies in our members' networks, every Kansan benefits. There are many factors for pharmacy closures including population sizes,” Greg Lopes, a spokesperson for PCMA, said in an email to the Kansas News Service.
Lopes said they support local pharmacies in rural areas through programs to increase reimbursements.
“We remain committed to the ongoing partnership with rural pharmacies to support Kansas families," he said.
What other pharmacists said
Tessa Schnelle is the immediate past president for the Kansas Pharmacists Association, the advocacy group that hosted the rally.
She said over the past 10 years, 52 pharmacies have closed in Kansas.
“At this point in time for our members, it’s like go or die,” Schnelle said.
Schnelle said chain pharmacies that aren’t connected to the top PBMs are struggling, too, but independent pharmacies are being hit the hardest.
“They are losing from a financial standpoint, but the whole entire safety net of delivery of medication access in Kansas is sitting on top of independent pharmacies,” Schnelle said.
Schnelle said the closures are concerning to the future of pharmacy.
“No one wants to buy a pharmacy and continue the next generation of pharmacy when they don’t know whether or not they’re going to be able to keep their doors open,” she said. “That’s scary.”
Ellie Flynn is a student pharmacist at the University of Kansas. She attended the rally with several other pharmacists-in-training and pharmacy technicians.
Flynn said she’s concerned for the future of pharmacy if things don’t change.
“It can be daunting, but I think there’s also an element of excitement thinking we can be the ones to change this, not only for ourselves and for our professions, but to get better care for our patients as well,” Flynn said.
Flynn said a big piece of PBM reform they are asking state legislators to help with is transparency. She said PBMs need to disclose to patients, pharmacies and insurance companies how much everyone is paying and where the money goes.
“If the pharmacy is not making enough money to stay open and the patients are having to pay all the money, who’s getting the money?” she said.
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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