Health advocates raise awareness of unfair practices

ALBANY, Ga. (WALB) — Many people, especially in smaller, rural areas, rely on their local pharmacies to meet their needs. But many pharmacists and health care advocates say it’s made difficult because of Pharmacy Benefit Managers (PBMs).

Greg Raybold is general counsel and director of health care policy at American Pharmacy Cooperative. He says PBMs are often hired by insurers and government entities to administer prescription drug benefits.

“They’re creating networks, they’re setting reimbursement amounts that pharmacies are going to be reimbursed,” Raybold said. “They set the reimbursement amounts that patients will have to pay at the drug counter. Some of them are among the biggest companies on the planet.

However, he says many of them do not perform their role ethically and often target demographic groups like the elderly and people with chronic conditions like cancer or HIV.

Greg Raybold is the general counsel and director of health care policy at American Pharmacy Cooperative. He says that many unfair practices are carried out by PBMs.(WALB)

“There was a study that came out earlier this year, and it looked at Medicare Part D. And what it found was that it looked at your generic drugs in Medicare Part D, and while that generic drugs deflated over a 36 month period, about 9%, they inflated the price for seniors about 51%,” Raybold said.

He says that’s not the only way patients are exploited.

“Another example we see is recovery. There are PBMs gaining practice where they charge patients a certain price over the counter from the pharmacy for a medicine and then they get a significant portion of that money back,” he said.

He says another way is what is called “direction”.

“Where a patient, you know, who is battling cancer may want to get their medicine from their trusted oncologist, they are instead told, ‘Oops, sorry. Even if the drugs are at the oncology office, you can get them today. Now you have to wait two or three weeks. And sometimes they even pay more for it,” Raybold said.

He says these practices have huge negative impacts on local pharmacies and patients. But he says action is starting to be taken through things like the Pharmacy Benefits Manager Transparency Act.

Ashley Kunkle is Pharmacy Manager at U Save It Pharmacy.

“Most Medicare Part D plans have intermediaries they call Pharmacy Benefit Managers and they own pharmacies,” Kunkle said. “A lot of big chain pharmacies have these pharmacy benefit managers and they also have mail-order pharmacies. Most plans are managed by these people.

She says she’s seen a huge number of patients take advantage of these PBMs, even after one patient said they didn’t want mail-order medication.

Ashley Kunkle is Pharmacy Manager at U Save It Pharmacy.  She says she has seen patients...
Ashley Kunkle is Pharmacy Manager at U Save It Pharmacy. She says she has seen patients bring trash bags filled with expired medication.(WALB)

“Sometimes they call community pharmacies to have prescriptions transferred. Other times, they call the doctor’s office directly and say “this patient wants his prescriptions dropped off through us, so I need you to send me prescriptions,” she said.

Not only are people like the elderly community overburdened and coerced or “steered” into using the PBM pharmacy, but they are also sending out unnecessary medications.

“The biggest problem I’ve seen with my patients is often, they send prescriptions that the patient is no longer taking,” Kunkle said. “Or they send a prescription 90 days before you need it. So after 68 days, they send another 90 days of that same order.

Kunkle says they do this so community pharmacists can’t step in and refill the prescription for their regular patients.

She says these practices often leave patients with excessive amounts of medication that usually expires, which she says and the Albany coroner have often seen. She even told me that patients had already brought trash bags full of expired insulin.

Greg Raybold says PBMs will even overcharge the customer and under-reimburse pharmacies.

“Community pharmacies are there because they care about their patients, and in many cases they will continue to dispense and care for those patients. Even if it puts them out of business to do so,” he said.

Kunkle says she must have done it already. She adds that this is not about losing patients to PBM, but about advocating for the terrible treatment she sees in disadvantaged communities like the elderly, low-income and chronically ill.

Raybold tells me that if people believe they are being treated unfairly, they can contact the Georgia Commissioner of Insurance to file a complaint.

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