On this episode of the podcast, Terry and Bob discuss the negative impact that pharmacy benefit managers (PBMs) have on community pharmacies. PBMs are middlemen between drug manufacturers, health insurers, and pharmacies. Through market monopolization and other aggressive pricing tactics, they demand that pharmacies charge patients their medications at prices that are often lower than what pharmacies purchased them for. PBMs further impact community pharmacy viability through monetary claw-backs and spread pricing.  

Ronna Hauser, Senior Vice President of Policy and Pharmacy Affairs at the National Community Pharmacy Association, joins the show to discuss how PBMs harm pharmacies. She points out how 90 percent of prescription drugs are now covered by insurance, so pharmacies must negotiate with PBMs for their business and are at the mercy of their pricing contracts. 

Ronna explains how many Americans are dependent on their rural, community pharmacies, yet PBM contracts tend to steer patients to big pharmacy chains they’re affiliated with. Affected patients lose out on access and personal relationships they’ve developed with their pharmacists. Ronna encourages patients to be savvy consumers to try to lower their costs.

Matthew Seiler, Vice President and General Counsel at NCPA, discusses efforts to rein in PBMs. He highlights the recent disappointing decision by the Federal Trade Commission to vote against studying them more closely. The FTC could act on PBMs’ steering of patients to affiliated mail-order pharmacies that threaten patients with temperature-controlled drugs. The agency can also crack down on distortionary rebates to PBMs that drive up the price of medications.

Kate Pecora speaks with Mason Milne on how he advocates for the autistic and Crohn’s disease communities. April kicks off World Autism Month, and Mason explains how his podcast helps raise awareness of this condition and boost the confidence of patients. He notes how he has expanded his podcast to discuss chronic diseases and mental health more generally.

Listen to How PBMs Raise Costs for Patients + Pharmacies