Q&A: An Independent Pharmacist’s Hopes for PBM Reform

The role pharmacy benefit managers (PBMs) play within the pharmaceutical supply chain was once misunderstood by the general public. But as more and more vertical integration occurred and independent pharmacies began shutting their doors, eyes started moving toward PBMs as the root of the issue.

Amidst an ongoing Federal Trade Commission (FTC) investigation into the 3 major PBMs and continuous movement within Congress for reform, the pharmaceutical industry’s so-called “middlemen” have launched independent pharmacies into a dire situation of decreasing reimbursements and rising drug costs.

In this part of his interview, DePietro touched on the present and future of the independent pharmacy space. | image credit: Pixel-Shot / stock.adobe.com

Tom DePietro, PharmD, owner of DePietro’s Pharmacy in Dunmore, Pennsylvania, sat down with Drug Topics on the most recent episode of Over the Counter to discuss PBMs and his hopes for pharmacy in the future. In this part of his interview, DePietro touched on the present and future of the independent pharmacy space amidst ongoing turmoil between several entities within the drug supply chain.

In part 2 of his interview with Drug Topics, which will be available on Over the Counter, DePietro focused on patient care and how it is affected by the behind-the-scenes dealings of PBMs.

Drug Topics: In the past year alone, there’s been an immense amount of movement toward PBM reform on the state and national levels. What do you think has been the most impactful news or legislation in the past few months regarding PBM reform?

Tom DePietro: I can't point to a specific topic. I can't point to a specific piece of legislation. But [I’m] seeing that mostly all of the states are taking some sort of action or putting some sort of attention to pharmacy benefit managers. And now we have our federal government, Congress, holding hearings about them. The Federal Trade Commission [is] looking into them. I think, in general, we just have to look at this traction and momentum as a win. If you were to ask me how to solve this problem, I can't give you that answer. I'm not sure how we get out of this mess. It's complex, multi-layered; it's like peeling an onion but we don't even have visibility of how big that onion is. I just think, looking at the momentum and the attention that this topic is getting, I think we're on the right track to finding a solution out of here.

But I guess my most hopeful thing was that congressional hearing, seeing the bipartisan support and the frustration of our elected officials. I don't care if you're an elected official and you don't support our mission, that's fine. But if your community is asking you to support it, you're getting elected for that. I'd point to Georgia, where the governor vetoes the bill. You have a bill that went through the state house and then the state Senate. In my eyes, you're not a dictator. You're there because you have elected officials that were elected by the people to pass a bill in majority and [they] know that we're going to hold them accountable for standing up for what's right.

What really bothers me is drug prices [are] a dinner table topic, and we only hear about it every 4 years when there's a presidential election. You look at the ads that are coming out now: cap insulin prices, drug prices. Every 4 years, we hear how you're going to control drug prices, but then it goes away. If you want to eat the elephant in this room, we can't just fix insulin. We have to fix the problem. There’s a root cause analysis that needs to get done, and unfortunately, I think it's going to point at the PBMs as the reason why drug prices are out of control. If it's not them, that's fine. Let's figure out who is to blame. Why are drug prices so out of control? Why can't our patients afford their medicines? Why does a patient have to go get their drug in the mail when they want to use a local pharmacy or they want to use a retail pharmacy? I think those are the questions our citizens, our community deserves answers to. If it's not the PBMs, let's figure out who it is.

It was a beautiful sentiment by one of the congressmen that said, “Pharmacists are saying you're the problem. Drug manufacturers are saying you're the problem. Community members are saying you're the problem. If you're not the problem, who is?” So, I think as this evolves, we can't let the topic just disappear once the election’s over. It’s something that needs to be fixed and it can't just be briefly touched on every 4 years when there is an election to get our seniors excited that drug prices might actually come down when, in reality, we're just toying with them.

Drug Topics: What are your hopes for the future of independent pharmacy and what are some necessary changes that you would like to see within the industry in the next few years?

Tom DePietro: Unfortunately, I think it's going to take the federal government to impose some sort of regulation and oversight into pharmacy benefit managers. Pharmacies need to get paid a fair dispensing fee on the actual drug cost. I think for far too long, there's been this cat and mouse game of [the] pharmacy is going to submit a price for X amount even though we know we paid this amount. The drug costs should be very transparent. I'm not saying the government should control the drug costs but, at the end of the day, the pharmacy should be paid a fair dispensing fee.

If we have a national study that's objective, it's not done by pharmacists and it's not done by insurance companies, but they say that the cost to dispense the medications is $11.40-something cents, that should just be the cost that we're given. I'm not looking for 50 bucks. If you're telling me the cost to dispense a prescription is $11 and change, just give me the $11 and change and let's call it fair.

There’s no pharmacy owner that decided to open a pharmacy to get rich because we operate on a profit margin of 3% to 5%. So, if you're in this business to get rich, it's the wrong business to be in. We just want to serve our community with fair prices. I think fair reimbursement, I think patient choice; there should never be an instance where a patient is forced to go to a mail-order pharmacy for a cheaper copay. There should never be an instance where a patient is forced to use a chain pharmacy.

This is America. We have to have a fair and level playing field where the focus is on the consumer. It can't be on the pockets of PBMs, the pockets of insurance companies, the pockets of drug manufacturers, the pockets of pharmacy owners. This is about patients and it's got to be about patients first and always. And that's what's so frustrating to me: the patients are just in the crossfire. I think, at the end of the day, if we could just get some sort of fair system where the pharmacy operates in, the insurance company operates in, and the patient is served, I'm hopeful that we'll see some change. I just don't know how you get there. It’s kind of above my paygrade.

READ MORE: Q&A: Unveiling the Current State of PBMs’ Role in Independent Pharmacy

Stay tuned for a full-length version of Drug Topics’ conversation with Tom DePietro available on Over the Counter.

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