Oliver Lackey opened a pharmacy in his hometown of Fairview, Oklahoma, so he could “provide the best patient care.” He set up shop a decade ago in the local grocery story with “zero prescriptions.” Before long, business took off — yet he was still struggling.
“I was getting more patients and was filling more prescriptions,” Lackey told Stateline. “But as I grew in revenues, my reimbursement from the insurance companies and PBMs every year was getting worse.”
PBMs are pharmacy benefit managers, the intermediaries in the drug supply chain that manage prescription drugs for health plans. PBMs determine which drugs are available under a person’s insurance plan, set copayments and decide how much pharmacies must pay to acquire drugs.
PBMs argue that they use their bargaining power to negotiate lower drug prices for consumers and pharmacists. But critics say PBMs, some of which are owned by the largest health care corporations in the nation, engage in anticompetitive practices that lead to higher prices and drive independent pharmacies like Lackey’s out of business.
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