Arkansas Pharmacists, Legislators Call for Pharmacy Benefits Manager Licenses

Pharmacy Benefit Managers (PBMs) would be required to obtain a license from the state to do business in Arkansas, under proposed legislation announced Wednesday. The potential mandate is part of a law-making effort to provide oversight to prescription reimbursement practices that some pharmacists have said are threatening their businesses and the ability of patients to access needed care.

Hired by insurers, including health plans and employers, PBMs serve as fiscal intermediaries between their clients and pharmacies to manage prescription drug programs.¹ PBMs require pharmacy owners to sign a nonnegotiable contract to receive reimbursements for prescriptions, and over time, payments to pharmacies often drop.²

During a press conference on the matter Wednesday, Arkansas Pharmacists Association (APA) CEO Scott Pace explained that PBMs sometimes reduce reimbursements to small pharmacies to the point where they are taking monetary losses on some medications. He said that unlike larger pharmacies that can benefit from PBMs, community pharmacists are being faced with an unenviable challenge: accept a reimbursement that is less than what was paid to stock the drugs or turn away patients in need of unprofitable medications.

“It’s affecting patients and pharmacists throughout the state,” Pace added.

According to Arkansas Sen. Ronald Caldwell (R-Wynne), PBMs currently operate in the state with no government oversight. In addition to requiring licensure, the proposed legislation announced Wednesday would give “insurance permissioners specific rule-making authority to govern” the conduct of PBMs in Arkansas, according to Caldwell. He and Arkansas Rep. Michelle Gray (R-Melbourne) have introduced companion bills addressing the issue of PBMs.

In many rural areas of Arkansas, pharmacists serve as communities’ day-to-day health care providers, according to Pace, making the survival of pharmacies even more critical. During Wednesday’s press conference, he recalled the case of a rural patient with epilepsy who needed anti-seizure medication. Filling his prescription meant the pharmacy would have to take a $25 loss on the medication, but turning the patient away would put the man’s health at risk with possible hospitalization.

"There needs to be oversight,” said Caldwell. “Our health care system is too important and too large a part of our economy to allow large companies to intervene in patients care and not be overseen.”

Lt. Gov. Tim Griffin said drug pricing issues tied to PBMs have the potential to negatively impact many people. “We don’t have a fair and level playing field,” he said, during the press conference. “This issue impacts not only pharmacists and small businesses, but also every Arkansas household where prescription drugs are taken, and ultimately the cost of health care and insurance in our state.”

Wednesday’s press conference was streamed live by Pharmacy Times and the APA through Facebook with viewers watching from across the country.

References

• What to Know About Working with PBMs. Pharmacy Times. www.pharmacytimes.com/news/what-to-know-about-working-with-pbms. Published February 20, 2018. Accessed February 21, 2018.
• The Monster in the Closet. Log Cabin Democrat. http://digital.olivesoftware.com/Olive/ODN/LogCabinDemocrat/shared/ShowArticle.aspx?doc=LCD%2F2018%2F02%2F18&entity=Ar00401&sk=1840A4CF&mode=text. Published February 18, 2018. Accessed February 20, 2018.