‘We’re facing a crisis’: Utah pharmacists ask lawmakers, federal officials for help

SALT LAKE CITY — A group of Utah Pharmacists met with local and federal leaders Tuesday asking for help with pricing. 

These Utah pharmacists said pharmacy benefit managers, or PBMs, control the cost of medicine, making it really expensive for the customer and the owners who run these pharmacies. 

“Our control of our practice in terms of what we pay, what we charge people, is really delegated now to these large companies that we call pharmacy benefit managers,” said pharmacist Benjamin Jolley, of Jolley’s Compounding Pharmacy. 

He was joined by pharmacists from Magna down to Beaver at The Apothecary Shoppe. They told state and federal leaders they know prescriptions are costing way too much, but they don’t have a way to fix it. 

They say PBMs are to blame. 

“This is CVS Caremark, this is Express Scripts, part of Cigna, this is Optum Rx,” Jolley said. “There are lots of smaller ones here in Salt Lake.” 

Santaquin Pharmacy owner Kevin Marchant said the PBMs act as the middleman between sponsored plans and pharmacies.”What is happening is money is being siphoned away and it’s affecting not just pharmacies, but ultimately patients in the long run because they’re not able to get their medications,” Marchant said. 

Control pricing

He said the PBMs control pricing.  

“They will cover certain meds, and in some instances they’re getting a rebate or a kickback from the manufacturer, which causes them to put it on their formulary,” Marchant said. 

He said they also control which medications are given. 

Apothecary Shoppe owner Kevin Demass used an example of an anti-viral drug. He said the brand name for the medicine costs $2,210, but he has a substitution in his pharmacy that’s only $7.63. Demass said the PBMs can block the substitution, forcing him to give a patient the more expensive option. 

“We don’t know what a price is going to be for medicines until you walk in the door with your insurance card and a prescription,” Jolley said. “I put that prescription in my computer and then I say, ‘Hi, insurance, I would like this much money.’ And then the insurance says, ‘nice try, we’ll pay you this much.’ But they’re able to set that pricing based on many different factors.” 

At the event, Demass said showed a video that told the story of a young man who died because he couldn’t afford his prescription and chose to go without. 

Not making ends meet

Marchant said pharmacies like his aren’t seeing reimbursements high enough to make ends meet. 

“As you see profits go down, it hurts every pharmacy because you can no longer employ your employees,” he said. ” You can’t give them raises.” 

Pharmacies like the Apothecary Shoppe sell other items to stay afloat. 

“They’re losing money on prescriptions, but they’re selling floral arrangements and birthday cards and toys and candy bars and ice cream sandwiches,” said Rep. Celeste Maloy, who represents Utah’s 2nd District. 

Marchant said PBMs can also force patients to go elsewhere to fill their prescription. 

“I had a patient come in the other day that needed to get a prescription filled,” he said. “When I tried to transmit the claim, it came back with the rejection saying ‘they must fill at our specialty pharmacy.’ I can’t even fill the prescription for the patient, but yet the patient isn’t able to get their drug.” 

He and other pharmacists said several of these factors make it nearly impossible to make ends meet, forcing some businesses to close. 

Changing Utah’s healthcare

Jolley collected data on the issue. 

“I took a list of all the pharmacies in the country, community pharmacies, not mail order, just pharmacies that you can walk in to get a prescription filled,” he said. “At the first of the year, there were 60,000 and change pharmacies. As of September 1st, there are 2,275 fewer pharmacies in the country. They’ve closed.” 

They said this could drastically impact Utahn’s healthcare. They fear parts of the state will become pharmacy deserts. 

“If my friend Scott, his pharmacy down in Beaver were to close, those patients would have to drive over 70 miles to get to the nearest pharmacy,” Jolley said. 

Looking to find answers

Leaders said they’re investigating the issue and inviting all players to the table to find solutions.  

“The pharmacists are doing a good job of sharing information, sharing resources to help us understand the problem, and now we’ve got to have the legislative branch, the executive branch, the state, the feds all working together to solve it because it’s not simple,” Maloy said.

She was joined by Federal Trade Commission Commissioner Melissa Holyoak. 

“We had a hearing just a few months ago talking about some of the issues related to PBMs and their practices,” Holyoak said. “We started a study relating to PBMs and their practices.” 

Holyoak said she encourages the FTC to finish the report and make decisions based on economic evidence. 

Maloy said she’s involved in making several legislative changes, including authoring a bill. 

“I’ve reached out to the PBMs and told them if they want to be part of the solution, they better get to the table because people are talking about this,” she said. “I’m working with a lot of my colleagues who have more experience in pharmacy and in health care than I do.” 

Maloy said she thinks the PBMs want to work with them. She said this issue doesn’t just impact independent or rural pharmacies. 

“So are the big chain pharmacies,” she said. “I think it’s a problem of the middleman. The middleman is making money right now, and the people that they’re brokering between are not. And we’ve got to address that.”