To: Monopolistic PHARMACY BENEFIT MANAGERS., CEO
Patients and pharmacy's protection from PBM's
PBM's must negotiate with all pharmacists and/or their representatives and associations to assure fair reimbursement for drugs and services, and must cease forcing patients to mail-order pharmacies.
Why is this important?
Most people don't realize it, but their insurance card that they use to pay for prescriptions generates incredible profits for the issuers of the cards, the Pharmacy Benefit Managers (PBM's)
How do they do this? By reimbursing your pharmacist less than it costs him to fill your prescriptions! In many cases, the reimbursement received from the PBM (plus the patient's copay) total less than the acquisition cost to the pharmacy for the drug, not to mention any consideration for pharmacy overhead expenses. The pharmacy's ability to negotiate with the PBM stops before the point at which the pharmacy breaks even on the transaction. Reimbursement for extra services provided by the pharmacy (emergency service, delivery, time spent on the phone with PBM's who won't authorize refills of a patient's prescripton, is totally absent and non-negotiable. Additionally, often after your pharmacist has spent his non-reimbursed time and effort to assure that you get your medication, the PBM will notify the patient that henceforth they will be required to use the PBM's own pharmacy, and receive their medication by mail, which results in the patient receiving their refills too late, and having heat and cold sensitive drugs exposed to harmful weather conditions. This is an impingement on patients' rights, a danger to their health and can result in the pharmacy losing core business to the PBM's, who still must rely on the neighborhood pharmacy to be around when the patient requires a new medication quickly.
Call on Congress to pass legislation to assure fair reimbursement to the pharmacists who have for years, provided prompt and effective service, even in emergency situations. Stop
PBM's from mandating mail-order prescriptions.
How do they do this? By reimbursing your pharmacist less than it costs him to fill your prescriptions! In many cases, the reimbursement received from the PBM (plus the patient's copay) total less than the acquisition cost to the pharmacy for the drug, not to mention any consideration for pharmacy overhead expenses. The pharmacy's ability to negotiate with the PBM stops before the point at which the pharmacy breaks even on the transaction. Reimbursement for extra services provided by the pharmacy (emergency service, delivery, time spent on the phone with PBM's who won't authorize refills of a patient's prescripton, is totally absent and non-negotiable. Additionally, often after your pharmacist has spent his non-reimbursed time and effort to assure that you get your medication, the PBM will notify the patient that henceforth they will be required to use the PBM's own pharmacy, and receive their medication by mail, which results in the patient receiving their refills too late, and having heat and cold sensitive drugs exposed to harmful weather conditions. This is an impingement on patients' rights, a danger to their health and can result in the pharmacy losing core business to the PBM's, who still must rely on the neighborhood pharmacy to be around when the patient requires a new medication quickly.
Call on Congress to pass legislation to assure fair reimbursement to the pharmacists who have for years, provided prompt and effective service, even in emergency situations. Stop
PBM's from mandating mail-order prescriptions.