Independent pharmacist Odette Leonelli owns a small pharmacy in Redondo Beach. Like many small businesses, the pharmacy has struggled in recent years due to economic hardship, but they have survived. The bigger threat to small pharmacies, according to Leonelli, is not the economy, but the abusive auditing practices of large pharmacy benefit managers (PBMs), the companies who control a large portion of the prescription drug industry in this country, including pricing and pharmacy reimbursement rates.
According to Leonelli's opinion piece in the Redondo Beach Patch this week:
Small, independent pharmacies like mine have survived many economic downturns-including the Great Recession-and have adapted to technology and the changing needs of our customers. But we face a formidable foe in the large pharmacy benefit management companies (PBMs) that manage prescription drug benefits for more than 215 million Americans. PBMs manage prescription insurance claims, and pharmacies of all sizes must enter into contracts with them in order to serve patients.
Leonelli goes on to describe the frequently unfair PBM auditing process, which has a direct impact on the pharmacy business, particularly smaller, independent pharmacies. Leonelli argues that PBMs use this process to "bully" smaller pharmacies:
Right now, there are no uniform auditing standards, so pharmacies are subject to whatever "rules" a PBM sets up. Because the PBMs keep the money they recover from a denied claim, they have a strong financial incentive to deny every claim.
As a result of abusive audits, pharmacies are required to spend excessive amounts of time documenting each pharmacy claim and surviving the audits. This is time that would be much better spent on patient counseling and care.
So, for relief, we are asking our state legislators to support state Sen. Curren Price's bill to establish fair standards for pharmacy audits and prevent claims from being denied based on minor technicalities. SB1195 maintains the right of a PBM to audit the claims of pharmacies to identify fraud and invalid prescriptions, but takes away the incentive for the PBMs to deny as many claims as possible. It brings fairness to the audit process.
This legislation is pro-small business, pro-patient, and will not cost taxpayers a dime. It deserves the full support of the Legislature.
To learn more about how PBM's are hurting California's independent pharmacies, and find out what you can do to help, please visit Pharmacy Choice and Access Now.