Only a few minutes south of downtown Opelika on Marvyn Parkway is Beauregard Drugs, an independent pharmacy which is owned and operated by pharmacist Tucker D. Simmons and his wife Tiffany. Serving as a beacon of hope and caring for this rural community, Simmons dispenses life saving prescriptions and medical supplies in a cutthroat business market that has become increasingly hostile to independent pharmacies such as his. Sky high prescription drug prices are a well documented ill of our modern society, however, the main culprit in this tragic equation remains shrouded in mystery for the average citizen.
Enter the largely unknown and oft misrepresented phenomenon of the Pharmacy Benefit Manager or PBM for short. Described by wikipedia as follows;
a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
As of 2016, PBMs managed pharmacy benefits for 266 million Americans. In 2017, the largest PBMs had higher revenue than the largest pharmaceutical manufacturers, indicating their increasingly large role in healthcare in the United States. However, in 2016 there were fewer than 30 major PBM companies in this category in the US, and three major PBMs (Express Scripts, CVS Caremark, and OptumRx of UnitedHealth Group) comprise 78% of the market and cover 180 million enrollees.
Long story short, an entire medical-industrial complex industry known as PBMs has arisen to act as shadowy middlemen due to the decadent desire of health insurance companies to outsource their administrative responsibilities to third parties. This has become a national plague of medical profiteering to be sure, however, Alabama has suffered much worse than the majority of the other states due to this private sector malfeasance abetted by their cronies in DC. According to the American Medical Association, Blue Cross Blue Shield of Alabama has more than 90% of the commercial and exchange insurance market share in three cities in the state, the most highly concentrated markets in the U.S.
All ten of the top ten least competitive commercial insurance markets are located in Alabama, with the Auburn-Opelika area unfortunately making that list of shame. What this equates to is a rigged market for BCBS of Alabama and their PBM accomplices to keep all the profits for themselves and force independent pharmacies such as Beauregard Drugs to take a loss on prescriptions that they fill. This disastrous trend has led to the shuttering of hundreds of independently owned pharmacies across Alabama, some of which had been in business for well over a century. Patients suffer as their rural communities become prescription drug deserts, forcing them to drive longer distances to obtain their critical medications.
Alabama Representative Phillip Rigsby for District 25 in Huntsville, a pharmacist by trade himself, recently introduced HB 238 also known as the FAIR Meds Act which was passed unanimously by the House Insurance Committee on March 6th of 2024 and is slated to be voted upon by the entire legislature. Alabama Pharmacy Association Government Affairs Director Bob Giles along with Tucker and Tiffany sat down with the Examiner at the pharmacy to help explain the sorely needed legislation that seeks to reign in the highway robbery being perpetrated by the PBMs upon independent pharmacies.
According to a March 8th press release from the APA;
the legislation proposes to ensure fair reimbursement for Alabama pharmacies, safeguard access to pharmacy services for patients, provide truth and transparency in prescription drug pricing, and enhance free market competition.
Since passing out of the Insurance Committee, the opposition to this legislation has begun a misinformation campaign to frighten the public and halt support in the legislature.
This is not a tax. HB238 will require Pharmacy Benefit Managers (PBMs) to pay community pharmacies the cost of dispensing the prescription to a patient. That’s it – nothing else.
HB238 does not mandate any increased cost to patients/consumers – This legislation puts it on the PBM to pay fair reimbursement to the pharmacy. This bill only applies to commercial insurance plans and does not affect Medicare or Medicaid prescriptions.
Pharmacists want full transparency on prescription costs and want to be able to talk with their patients without restrictions. HB238 will require PBMs to allow this. Why are PBMs fighting so hard to keep things secret? The more the way these middlemen operate is exposed, the clearer it is that lawmakers must address PBM abuses if they want to solve the access challenges patients are facing. Patients and employers deserve to know the truth.
The payment model in HB238 is exactly what the State Medicaid Program has used since 2007, this is not a new concept. Their records show savings of over $53 million annually and no additional costs to patients. Alabama was the first state to implement index-based pricing and since then, the U.S. Government has mandated all states to follow in their Medicaid programs.
Reasonable folks who have actually read the bill will find it to be very well written and entirely appropriate, however, the PBMs and their greedy accomplices in downtown Birmingham are crying bloody murder with a full court press of media falsehoods aimed at whipping up a frenzy of hysteria over the legislation. Predictably, the usual suspects in Birmingham have assembled under a euphemistically named banner organization entitled the Alliance of Alabama Healthcare Consumers or AAHC for short to derail the righteous legislation.
As legendary Alabamian Jim Nabors famously said...
Of course, the glow in the dark media shills weren't far behind...
Downtowners even managed to resuscitate Miss America 2013, Opelika's very own washed up Ron Burgundy aspirant and two-time loser democrat party candidate, to push their false narrative on social media...
It is highly encouraged that you, dear reader, inform and educate yourself on this topic expeditiously, get involved and reach out to show solidarity with the small business owners in your community who serve the public through our cherished independent pharmacies that they operate before we lose one more of these vital institutions at the altar corporate greed and the modern materialists in Birmingham. Please click on the links below to read the bill in its entirety and supporting documents for full context.
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