Shane Abbott: Rural communities most affected by predatory PBM middlemen

Over the past year, I’ve made the drive from my small pharmacy in DeFuniak Springs to Tallahassee dozens of times to advocate for one priority: PBM reform.

Unless significant reforms are made to Florida’s broken PBM system, patients will be put at risk due to lack of access to prescription drugs — especially those who live in smaller, more rural communities like mine.

Local pharmacies have been under attack for some time by predatory middlemen called pharmacy benefit managers or PBMs. The three largest PBMs control 85% of the prescription drug market and, together, these operators are driving neighborhood pharmacies out of business.

This is not a situation like Blockbuster and Netflix where local pharmacists simply aren’t adapting to the new market and changing times. Our prices are competitive and the services we offer to patients are oftentimes more desirable than our competitors. We’re closing because the system is broken and the game is being rigged by a handful of powerful companies.

In a free market, different businesses should be able to compete and if my product or service isn’t as good or convenient as the CVS Pharmacy across the street, then I deserve to close down. I could live with that. What I can’t live with is a system where the companies managing the health care options for millions of Floridians also own PBMs who sets my prices and the prices of my competitors. Those same companies also happen to own their own pharmacies and often require patients to fill their prescriptions there — even if the prices paid are significantly higher.

This startling situation is something pharmacists have known about for years, but now a new independent study uses data from the state’s Medicaid program to highlight exactly how bad the problem is in Florida.

Since 2016, more than 270 independent pharmacies have closed down in Florida. Just last month, a local pharmacy that had served its customers for 40 years went out of business in Deland, a city with less than 35,000 residents. According to the owner, the reason was “below-cost reimbursements from insurers” because PBMs are setting the prices of drugs and regularly paying their own pharmacies more than they pay unaffiliated ones. The study highlights an example from less than an hour away from this pharmacy where a CVS pharmacy was reimbursed 20 times more for the same drug than a local pharmacy. How is that fair?

It’s clear Florida’s current system is not working for the patient, but unfortunately it will be rural patients who have to bear the biggest burden if legislators don’t act soon.

Here’s an example of how patients who rely on their local pharmacies pay the price. I recently spoke with a pharmacist who lives on the other side of the state. One of her patients came in with a letter from the managed care organization Staywell/WellCare. The letter said the patient can no longer fill her prescription for a particular chronic illness at the local pharmacy she’s used for years. Instead, the letter gave her four different “in-network” pharmacies she could go to — the closest one was 148 miles away! They were even so audacious as to suggest the patient try filling her prescription at a pharmacy more than 1,000 miles away, in Pennsylvania. Letters just like that are causing chaos for countless patients across our state.

One thing is clear: This situation has spiraled out of control, and real Floridians — including rural pharmacists and their patients — are suffering. We understand the problem and we know what solutions have worked in other states. The only question that remains is whether state lawmakers will embrace meaningful PBM reform that puts patients above PBM profits.

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Shane Abbott is a local pharmacist in DeFuniak Springs.