Local pharmacists: Pharmacy benefit manager regulation law step in the right direction

The bill sets restrictions on pharmacy benefit managers, third-party intermediaries that work with drug manufacturers, pharmacies and insurance providers

Gov. Josh Shapiro signed a bill last week that regulates pharmacy benefit managers (PBM’s) and local pharmacists are saying it’s a step in the right direction.

The bill regulates benefit managers who are third-party companies that act as intermediaries between pharmacies, drug manufacturers and insurance providers. The bill restricts clawbacks, patient steering, network adequacy and additional fees that can be charged by benefit managers after drugs are sold to customers.

Pharmacists like Joe Janosik, owner of Janosik Pharmacy in Monessen, say the bill is great but there’s still things that need to be addressed.

“These bills are way overdue, the PBM’s have been crushing us for a long time right now. So it’s been long overdue that they’re finally starting to do something,” Janosik said.

According to the ACT Pharmacy Collaborative, more than 140 pharmacies have closed in the state of Pennsylvania since the beginning of 2024.

For independent pharmacists like Janosik, this is just the beginning and there is more work to be done when it comes to PBM reform in Pa.

“It is a good start, because they have to start doing something to help us to even the playing field for us. Let’s just put it that way,” Janosik said.

A study by the Federal Trade Commission states that PBM’s have been profiting by making drugs more expensive and constricting independent pharmacies.

“PBMs also exert substantial influence over independent pharmacies, who struggle to navigate contractual terms imposed by PBMs that they find confusing, unfair, arbitrary, and harmful to their businesses. Between 2013 and 2022, about ten percent of independent retail pharmacies in rural America closed,” says the FTC study.

David Marchewka, the owner of Mon Valley Pharmacy and Compounding in Rostraver Township, also believes the bill was a good step but expects to see more movement towards PBM reform.

“We’re not going to stop with just this bill, we’re gonna keep fighting, and then keep really trying to advocate for not only independent pharmacies, but just the field of pharmacy in general,” Marchewka said. “Because it’s more than just they’re not paying us and we’re crying about it. It’s they’re not paying us but they’re also really messing up the patient’s copays and access to care.”

Both Janosik and Marchewka say that the state government needs to eventually address DIR fees, which have been hard to pay for pharmacies. According to Janosik, his pharmacy has been charged up to $20,000 in one month over DIR fees.

“When you talk about hits like that it’s really hard for independents to survive if they’re going to be taken that much out for a DIR fee,” Janosik said. “And like I said, it doesn’t happen every month, but it has, it does happen. And you know, that’s just a huge hit for us independents to take when they do something like that.”

Marchewka added that he also wishes there was more transparency when dealing with PBM’s, and the rates they pull from reimbursements pharmacies receive for drug sales.

“So just trying to eliminate the clawbacks once and for all, and just have full transparency, that’s basically all that we want as business owners and as independent pharmacies,” Marchewka said.

When it comes to the pricing of drugs the bill will not allow pharmacies to charge more than what the customer would pay if they used cash or charge more than what the pharmacy would receive from an insurer or PBM.

The bill will also require PBM’s to meet federal medicare access standards, which will allow consumers to access more pharmacies closer to them.

Shapiro called for PBM reform earlier this year in his budget address to the General Assembly as a way to cut costs to pharmacies and consumers.

“Pennsylvanians are getting screwed by the high cost of prescription drugs and too many rural pharmacies have been forced to close their doors, while the few PBMs that dominate the market are raking in billions. My Administration is doing everything in our power to cut costs and put money back in their pockets so they can receive the medication they need to live healthy lives while supporting our communities,” Shapiro stated.

Marchewka says that he hopes these kinds of bills will inspire younger upcoming pharmacists to advocate for better practices with PBMs and pharmacies.

Advocacy within the field of pharmacy is something new for Marchewka, but he sees it has become more prominent in recent years and is needed for the creation of bills like the one just passed.

“The next generation are going to be even bigger advocates, because they already have a head start on it, too,” Marchewka said. “So I think the more that we can get the word out and see what kind of voice that we have as pharmacists is going to be greatly benefited from this next generation of pharmacists.”