Tim’s Pharmacy & Gift Shop owner Will Quinby is passionate about the role of independent pharmacies in the healthcare industry.
He, along with his wife and store co-owner, Courtney, pride themselves on the Yelm shop standing up for other pharmacies in the state and country and giving customers the care they deserve.
The Quinbys visited Capitol Hill in Washington D.C., from April 17 to April 18, as part of the annual National Community Pharmacists Association (NCPA) Congressional Pharmacy Fly-In, where hundreds of independent community pharmacists around the country spoke with members of Congress or staffers about the issues impacting the industry.
This year’s primary objective was to educate legislators about the challenges patients and local independent pharmacies face at the hands of pharmacy benefit managers (PBMs), a middleman entity that works between insurance providers and pharmaceutical manufacturers to create formularies and negotiate rebates, among other functions.
The Quinbys, along with more than 300 other pharmacists, provided insight as to how complex the payment system is for pharmacies and called for PBM reform. They met with Sen. Maria Cantwell (D-WA), Rep. Dan Newhouse (R-WA 04), Rep. Derek Kilmer (D-WA 06), Rep. Marie Gluesenkamp Perez (D-WA 3), and Rep. Marilyn Strickland’s (D-WA 10) staff. Will Quinby said the congressional members were receptive to the issues that the pharmacists brought to their attention.
“The industry is unnecessarily complex. When most people come to a pharmacy, they come to a counter and we tell them their medication is $200. The reason why it’s $200 is pretty complex,” Quinby said. “It’s often involving the insurance companies getting rebates from the manufacturers, and what’s happened over the years is that there’s fewer and fewer payers who own insurance companies. We call it vertical integration, where the same company owns, top to bottom, the insurance company, the PBMs and often their own pharmacies. You now have three companies that control about 80% of the entire pharmacy market.”
He added that the conglomeration doesn’t leave room for local independent pharmacies to have a say in the cost of products such as name-brand inhalers or diabetes medications. Quinby said congressional members often believe they can just fix the price or put a price cap on products, but he believes that’s only a temporary fix to a much deeper issue.
“The prices of brand-name medications are artificially inflated. It doesn’t cost $500 to make that drug because you can clearly make it for a lot cheaper. It’s not the drug manufacturers that are just overcharging. That’s a common misconception,” he said. “The PBMs are forcing a rebate from the manufacturer where they want them to give them a $300 rebate on a $500 item. That’s why these prices keep going up and up.”
The Quinbys are optimistic that PBM reform will soon be enforced as there are two pieces of legislation making their way to Congress. The first is the Drug Price Transparency in Medicaid Act, which would prohibit the use of spread pricing in Medicaid-managed care programs and move to a fair and transparent pharmacy reimbursement system based on average acquisition costs. In other words, PBMs would be required to submit data to the Health Care Authority regarding certain drug prices and rebates. This act passed the House of Representatives by a vote of 320-71 and the Senate Finance Committee, 26-1.
The Neighborhood Options for Patients Buying Medicines (NO PBMs) Act, which unanimously passed the Senate Finance Committee, would require centers for Medicare and Medicaid services to define and enforce “reasonable and relevant” Medicare Part D contract terms and allow pharmacies to report contract violations.
Quinby believes the era of unregulated health care that he described as “the wild West” will soon come to an end because of this legislation. According to a survey conducted by the NCPA, one independent pharmacy in the nation has closed every day over the last six months, and 32% of independent pharmacies are considering closing in the next year.
“Hopefully, our message within Washington D.C. has resonated with legislators and they push for this legislation. Then the job’s not done,” he said. “They have to continue to understand how important and how critical independent pharmacies are to health care. They need to have that in the forefront of their mind. If next year I walk into a legislator’s office and they remember us and they have that understanding of how critical we are, I’d feel pretty great at that point.”
