The war of words over pharmacy benefit managers has moved from Congress and regulatory agencies to the streets. Late last week, dozens of demonstrators protested outside the headquarters of Express Scripts in St. Louis.
Protestors waved signs, shouted slogans and gave speeches at a makeshift podium across the street from the nation’s second-largest PBM. Protestors argued that patients are being harmed by PBM practices that prevent them from using their preferred pharmacies or require them to first try less-expensive drugs before approving the ones their physicians want to prescribe, even if those less expensive drugs are inappropriate.
“So many patients are not getting their medications on time,” said Loretta Boesing, founder of the patient advocacy group Unite for Safe Medications and organizer of the protest. “We need options to use their local pharmacies in our coverage. We need Express Scripts to stop being so greedy. This has to stop. We cannot allow this to happen to our pharmacy and medication access here in America.”
Congress tried but failed earlier this year to pass reforms intended to level the playing field. The Federal Trade Commission also has launched an inquiry into PBM practices, which is ongoing.
“We need Congress to finish its job and pass payment reform legislation, and we need the clients of PBMs to be aware that when they hire companies like Express Scripts, they are killing small businesses and hurting the most vulnerable people,” said B. Douglas Hoey, CEO of the National Community Pharmacists Association, who participated in the protest.
Hoey said Express Scripts reimburses independent pharmacists at a loss on eight of every 10 prescriptions they dispense. As a result, he said, more than 500 independent pharmacies have closed in the past year alone. An average of one pharmacy closes every day in United States, said Ilisa Bernstein, senior vice president of the American Pharmacists Association, the industry’s largest professional organization.
“We represent pharmacists in all practice settings, and we get calls every day from people crying about the abysmal practices, the contracting, the underwater payments and all the different antics happening today,” said Bernstein, who also participated in the protest “This has to stop.”
Express Scripts denied protestor claims. Company representatives said most prescriptions in the United States are filled at retail or chain pharmacies, and 98% of customers in St. Louis have an in-network pharmacy within a short drive of their home. They also emphasized that health plans, employers and other clients have a say in what drugs are included in the list of medications insurers cover and are free to design their own prescription drug plans.
“The health of our customers is at the center of all we do,” a company spokesperson said in a statement. “We work relentlessly to ensure our customers can access their medications at the lowest possible cost and in the way that is most convenient for them.”