#nc-02: Weekend at Nee-Nee’s

The N&O was hard at work this weekend with a puff piece propping up Renee Ellmers a lot like those two idiots in “Weekend at Bernies” propped up and carried around their dead boss.  According to that money-bleeding, slowly-dying McClatchy property, Renee is saving small pharmacies: 

Some small-town pharmacists in North Carolina are hoping for new regulations that many say would protect them from losing money just by filling prescriptions.

At issue are transactions that happen behind the counters at more than 720 independently run pharmacies in North Carolina and at small drug stores across the country. The process is largely out of sight and unfamiliar to customers.

Pharmacies of all sizes buy medicines and rely on reimbursements from patients’ insurance companies to break even or make money on dispensing drugs. Chain stores often fare better because they have higher volumes of other merchandise sales which subsidize any losses on the pharmaceutical side.

The small, independently owned pharmacies stuck selling drugs below cost have little recourse to challenge the firms that control reimbursements, said Paige Thomas Houston, a third-generation pharmacist at the family-operated Thomas Drug Store in Dunn.

Of ALL the pharmacies they could have picked, HOW did they find their way to lil’ ol’ Dunn? Let’s read on: 

The system, Houston said, is causing some small drug stores to go out of business. Proposed regulations in Congress would benefit the nation’s more than 24,000 independently owned pharmacies by introducing new rules for pharmacy benefit manager corporations.

These PBMs, as they are called, are the middlemen that process prescription drug claims on behalf of insurance companies and Medicare. They decide which drug stores are in-network for customers and how much those pharmacies are reimbursed. Pharmacy benefit managers also act on behalf of insurance payers to negotiate prices and rebates from drug companies.

Generally, the proposed legislation would require PBMs to update their cost lists, explain the rationale behind their reimbursement maximums and offer an appeals process to pharmacists to recover losses when drug costs exceed reimbursements.

[…]

The number of independent pharmacies in North Carolina has actually grown about 6 percent over the past five years, according to the N.C. Board of Pharmacy. Some are finding other ways to make money, including medication therapy management where the pharmacists provide a variety of wellness and clinical services for a fee.

But that’s not an option for all independent drug stores. In Harnett County, four small pharmacies have shut down or sold out in the past two years, Houston said. She suspects a contributing factor was declining profit margins on prescription reimbursements.

“You’re going to continue to see that happen,” she said in an interview, adding that when independent pharmacies go out of business, customers lose access, choice and “personalized” service that may not be found at a larger store.

For example, this month, Houston paid $343 to a wholesale drug company for a month supply of generic pills used to treat respiratory problems. The customer got his medication. The drug store was reimbursed $4 from the pharmacy benefit manager.

“I know before I hand it to the patient that I’ve lost money,” Houston said. But there’s no option to not dispense – pharmacies that are under contract to be in-network are obligated by PBM agreements to fill customers’ prescriptions.

Houston described the contract options with PBMs as “take it or leave it” for small drug stores such as the one that’s been in her family since 1954.

“Take” the contract, and pharmacists brace for unpredictable changes in how much they pay for medicine and how much they’ll be reimbursed, she said. “Leave it,” and pharmacists can expect to see a drop-off in customers because they’ll be dropped from a pharmacy benefit manager’s in-network or preferred pharmacy list.

“I don’t hate PBMs, I just want a fair price,” Houston said. “I’m filing prescriptions and losing money. You cannot run a business and survive by losing money.”

That’s the scenario Houston and other pharmacists in U.S. Rep. Renee Ellmers’ district have described over recent years as small business owners ask for scrutiny of the PBM market.

[…]  Ellmers is the only North Carolina representative co-sponsoring the proposal for new regulations, called the Maximum Allowable Cost Transparency Law. The bipartisan bill was introduced last January by Reps. Doug Collins, R-Ga., and Dave Loebsack, D-Iowa. […]