Independent pharmacists urge audit of pharmacy benefits system

Pittsburgh Post-Gazette

Local independent pharmacists on Monday urged Pennsylvania Auditor General Eugene DePasquale to step in and fix what they described as “a broken system” that has resulted in reduced reimbursements and narrowed networks that put their pharmacies at risk.

“We’re here today because all of our businesses are endangered,” one pharmacist testified.

The pharmacists spoke at a forum convened by Pennsylvania Auditor Eugene DePasquale at the Penn State Beaver campus.

Mr. DePasquale has scheduled a series of similar forums around the state, looking at the impact pharmacy benefit managers (PBMs) have on the price that consumers pay for prescription medications. Pharmacy benefit managers such as Express Scripts, CVS Caremark and OptumRx contract with insurers to manage and administer their drug coverage plans.

At the close of Monday’s 90minute session, Mr. DePasquale said he is aiming to produce a report on his findings to state legislators late this year with the goal of “getting something done by spring of next year.”

Independent pharmacists have grumbled for some time that reimbursements they receive from PBMs keep getting cut back and, in some cases, don’t cover their expense for dispensing a medication. Because PBMs control such a large share of the market, though, pharmacists say they can’t afford not to sign the contracts.

More recently, states also have questioned how PBMs operate because of how much they spend for medication for Medicaid beneficiaries — in Pennsylvania’s case, $3.4 billion in 2017, compared with $1.8 billion spent in 2013.

Yet, Mr. DePasquale noted on Monday, he does not have authority to audit that process.

“Whether it’s me or the Department of Human Services, that has to change,” he said.

Prior to Monday’s forum, the Pharmaceutical Care Management Association, the Washington, D.C.-based trade association that represents pharmacy benefit managers, said in a statement that it estimates