At Congress and Legislature, steps should be taken to rein in the power of pharmacy benefit managers. For many rural Oregonians, picking up prescription medications is an exercise in patience — and frustration. Across our state, patients are forced to drive hundreds of miles to the closest pharmacy and sometimes wait several hours to pick up essential, life-saving medications.
Last year, Bi-Mart made the decision to close all 60 of its Pacific Northwest pharmacies. The impact it's had on wait times isn't just aggravating for patients. It's a "canary in the coal mine" for the future of our state's rural pharmacies. Today, there are fewer than two pharmacies per 10,000 residents in most Oregon counties and Wheeler and Sherman counties don't have any pharmacies. Demand is so high at the rural pharmacies still in operation that they can't keep up and frequently prescriptions can't be picked up for weeks. These "pharmacy deserts" pose a serious health risk to patients statewide — and if the situation doesn't change soon, it will only become more dire.
Oregon's independent pharmacies filled nearly 5 million prescriptions in 2020 and generated about $255 million in local economic impact, largely in rural communities. Those 5 million prescriptions are at risk of not being filled if independent pharmacies continue to face operational hardships due to pharmacy benefit managers (PBMs).
These middlemen reduce margins for Oregon's independent pharmacies to such a degree that they can't hire employees or, as with Bi-Mart, even stay in operation. Today, nearly 80% of prescriptions are controlled by large, out-of-state PBMs.
PBMs like CVS Health (Caremark), United Health (OptumRX) and Cigna (Express Scripts) purportedly negotiate discounts for health plans, employers and Medicaid/Medicare programs like Oregon Health Plan. In reality, they keep the bulk of the discounts they negotiate instead of passing them on to plan administrators and patients.
For example, a recent study from the Oregon State Pharmacy Association (OSPA) found that Oregon's Medicaid program was made to pay eight times the manufacturer's asking price for a multiple sclerosis drug, costing the state nearly $2 million extra.
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