BY DAVID BELL
FOR THE OBSERVER
LEE COUNTY — Small independent pharmacies across Alabama have been facing a continuing challenge to offset losses incurred when prices they pay for prescription medicines are higher than the amounts reimbursed by insurance companies.
State Rep. Phillip Rigsby (R-Huntsville), who is himself a registered pharmacist, has introduced a bill in the state legislature that would require pharmacy benefit managers (PBMs), third parties that administer pharmacy benefits for health insurance plans, to pay insurers the price of a prescription set by the state, plus a dispensing fee of $10.64.
“This is not a tax or a surcharge, but rather a means to help those of us cover expenses that we’ve previously absorbed ourselves,” said Jeff Jerkins, registered pharmacist and owner of Bubba’s Medicine Shop in Opelika. “Many of the more expensive drugs, especially those prescribed for the treatment of diabetes, require an up-front payment in advance. But I don’t receive reimbursement until four weeks later, and then it’s not usually equal to what I originally paid. Meanwhile, I still have all the other necessary overhead of running a business.”
Currently, when reimbursement is less than the cost, pharmacies can’t pass on the difference to customers. They either continue dispensing the medication and absorb the loss or stop stocking it.
“All we want is full transparency on prescription costs,” said Ashley Hoyt, registered pharmacist and owner of The Drug Store in Auburn. “HB238 is not a new concept because it is exactly what the State Medicaid Program has used since 2007. This is not about pharmacies making more money. It’s about access to pharmacy care for our customers.”
As proposed, the legislation does not mandate any increased cost to consumers, but rather puts it on the PBMs to pay fair reimbursement to the pharmacies. The bill only applies to commercial insurance plans and does not affect Medicare or Medicaid prescriptions.
“I don’t know if this is the best approach or not, but something definitely needs to be done,” said Roger Burnett, registered pharmacist and owner of Thomas Pharmacy in Opelika. “You can’t charge health insurance plans one price for a medication and then pay pharmacies a different price for the same medication. The big chain drug stores can probably offset those kinds of losses, but it could eventually put a small store like mine out of business.”
The bill has passed the House Insurance committee and is now awaiting a vote by the full House of Representatives. If approved, it moves on to the State Senate for further debate.