June 17, 2019
Independent pharmacy runs through Byron Berry’s veins. Graduating from pharmacy school in 1974 and buying his first pharmacy in 1986, Berry has been steeped in the industry for the better part of his life. After spending the last 30 years growing his single location into a line of seven pharmacies across Illinois, he’s gained a clear-eyed view of the challenges facing independent pharmacy.
“Something needs to be done to save independent pharmacy for the future and healthcare for our patients,” Berry said, whose seven pharmacies include full-line remote dispensing and traditional pharmacy locations operating under the banner Pharmacy Plus. “Pharmacy has been good to me in the 47 years I have been involved, and I want it to be rewarding for future generations of pharmacists and for the patients they serve.”
For Berry, saving the future of independent pharmacy starts in Congress, where the country’s decision-makers control legislation without truly understanding the complex industry. Their views, he says, are informed by self-interested corporate entities rather than by patient-centered independent pharmacies.
“If independents don’t step up and educate legislators, the legislators only have lobbyists from PBMs, chains, and insurance companies to rely on for information,” Berry said. “Unfortunately, these giant corporations are primarily concerned with corporate profits and not our patients. If pharmacists and our patients aren’t calling or emailing, legislators are voting on what the PBM lobbyists are telling them. And the lobbyists are not telling them the true facts.”
Correcting this misinformation has been the primary focus of Berry’s persistent advocacy efforts. He’s always contacting and developing relationships with local, state, and federal legislators through any means—visiting them at their offices, inviting them to his store, speaking to them on the phone, writing them letters, and emailing. He’ll also take to the local news and his social media to spread awareness and prod other pharmacists to action.
“I try to encourage every pharmacist to get involved in the political process, not party politics,” he said. “Legislators need to hear from us. We are the ones on the front line. We are the ones that actually care for patients. We need to speak up and tell our story.”
The biggest problem standing in the way of a thriving future for independent pharmacy? Pharmacy benefits managers, Berry said. “PBMs are determining winners and losers. They are doing it cloaked in secrecy, while costing healthcare billions of dollars.”
Originally spun as an efficient way to help manage prescription drug claims, PBMs have come under increasing scrutiny in recent years. Just a few PBMs control more than three-quarters of pharmacy benefits in the United States, and critics say their lack of transparency affects everyone from patients to pharmacies to plan sponsors.
As one of their harshest critics, Berry has no qualms pointing out the laundry list of PBM schemes that have been harming patients and eroding the bottom line of independent pharmacies. These include “mandatory 90-day supplies with lower reimbursement formulas, forced mail order, preferred pharmacies, forced use of PBM-owned pharmacies,” among others.
Berry lists those in addition to the more well-known tactics, such as spread pricing, which inflates drug costs; “unconscionable reimbursements,” which have been plummeting since 2010, according to the 2018 NCPA Digest; DIR clawbacks, which were voted the top legislative or regulatory obstacle by community pharmacies in 2018; and audits, where the PBMs punish pharmacies for small administrative errors for their own financial gain.
The unrelenting carousel of PBM maneuvers takes a significant toll on pharmacy business. “All of these factors affect pharmacy’s bottom line,” Berry said. “DIR fees, low reimbursement, and audits are all destroying independent pharmacy.”
Although pharmacies face the brunt of PBM bullying, Berry’s concern extends to the patients he cares for every day, who suffer from increasingly high prescription drug costs. Among the many unsavory PBM dealings that affect patients—such as requiring pharmacies to charge copays that are higher than the cost of the drug—are the backdoor handouts that PBMs receive from manufacturers.
Critics have pointed out that rebates from drug manufacturers inflate the costs of drugs and incentivize PBMs to cover the more expensive drugs on their formularies. And the rebates are not shared equitably with the plan sponsors, who then charge patients higher premiums. Those factors mean prescription drugs are more costly for everyone except PBMs.
“The PBMs insulated the consumer from the price of prescription drugs and the pharmaceutical manufacturers saw an opportunity to inflate prices,” Berry said. “Most people in our communities can no longer afford any brand name drug if they were paying cash.”
And that’s only a small representation of the various tactics PBMs employ that burden both patients and pharmacies, which fuels Berry’s passion for advocacy.
Overcoming the entrenched giants may seem a distant dream, but there are signs that the tables are beginning to turn. Congress has recently begun to examine PBMs more closely, with politicians on both sides of the aisle advocating for regulation and transparency.
In April, executives from drug manufacturers and PBMs alike were brought in for oversight hearings in front of the House of Representatives’ Energy & Commerce Committee and the Senate Finance Committee. Both posed tough questions about industry pricing practices.
Radical changes have been proposed, including a suggestion from Maryland representative John Sarbanes to treat PBMs as public utilities or convert them into nonprofits. Senator Ron Wyden of Oregon brought up the possibility of a ban on spread pricing altogether.
PBMs have traditionally been adamant about playing their pricing decisions close to the vest, but under the scrutiny of Congress, executives expressed openness to moderate changes that would increase transparency.
The consensus that something must be done to change the PBM-run system and rapidly inflating prescription drug prices is a rare point of unity for Democrats and Republicans, with Georgia representative Buddy Carter promising at the Energy & Commerce hearing, “This is going to end.”
Though the light being shone on PBMs in Congress is promising, Berry said pharmacists shouldn’t be content to just wait for change. “No one can afford to stay behind the counter and not tell their legislators about the PBM corruption,” he said. “Look at your business and understand the effects the PBMs are having on your ability to serve your patients and stay profitable. Give legislators examples from your pharmacies and published facts that they can use to contradict the PBM lobbyists. Give them information to make an educated decision.”
He suggests crafting a personal story to tell legislators and then using various methods to connect with them, such as letters, phone calls, emails, and store visits. “There are few limits to your options. Use any method you can think of to get attention to facts.”
For Berry, advocacy is ultimately about enabling independent pharmacists to do what they got into the profession for in the first place. “I have enjoyed the ability to determine how I care for my patients, my community,” he said. “I want future generations of pharmacists to have that same opportunity. Now, more than ever before, is the time to be vocal. If you have never thought of advocacy as part of pharmacy, you must rethink what is required of your profession. We can make a difference, but it takes all independent pharmacies working together to educate our congressmen. Do it for yourself. Do it for your patients. Do it for the future of pharmacy and the future of healthcare for all.”
This article was published in our quarterly print magazine, which covers relevant topics in greater depth featuring leading experts in the industry. Subscribe to receive the quarterly print issue in your mailbox. All registered independent pharmacies in the U.S. are eligible to receive a free subscription.
Read more articles from the March issue:
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