By CRISTINA JANNEY
Hays Post
Independent pharmacies across Kansas will close on Wednesday, Feb.5, for a day of advocacy to raise awareness of what they call unfair business practices by pharmacy benefit managers.
Sloane Freeman, president of the Kansas Pharmacists Association, said the "Close for a Cause" event is meant to show customers what life would be like without independent pharmacies in Kansas.
Pharmacists and their employees will also gather in Topeka that day to lobby for legislation the association is introducing to level the playing field for independent pharmacies.
As of Wednesday, Jan. 26, 96 pharmacies in 55 counties have pledged to participate in "Close for a Cause."
Freeman is an owner of a group of pharmacies in Kansas, one of which is in Hill City.
The benefit pharmacy manager system arose in the 1990s to control insurance companies' costs.
However, since then, the benefit pharmacy managers have become part of vertical integration that also includes the ownership of insurance companies and pharmacies.
Three pharmacy benefit managers control about 85% of the market and rank in the top 20 companies in the U.S. They include Cigna, United Healthcare and CVS/Caremark.
"They are charging your insurance plan one cost, reimbursing the pharmacy another cost and then they're keeping everything in the middle," Freeman said.
Freeman said these companies require insured people to use the benefits manager's pharmacies or offer significant discounts as incentives.
Fred Schertz, pharmacist with Midwest Family Health of Russell, will be participating in lobbying efforts in Topeka on Feb. 5. Midwest Family Health will be closed Wednesday.
"[Mail-order pharmacies] not only drive revenue out of the state of Kansas and out of our local economy," he said, "but also it is a patient care thing. Patients are forced to fill out of state."
He said he sees patients who must fill prescriptions out of town or by mail.
"The patients that it really hurts are the ones who don't have the modes of transportation where they can make it to Hays every day to pick up medication," Schertz said.
Many scholarly articles have been written on the importance of community pharmacies in local health outcomes, including a July 23, 2020, article shared by the Centers for Disease Control that discusses the role of local pharmacies in dealing with COVID-19. It also touched on chronic illnesses such as cardiovascular disease.
The pharmacy benefit managers reimburse their pharmacies at a much higher rate than independent pharmacies, Freeman said.
She said independent pharmacies might be reimbursed 1 cent for the drug and $1 for filling the prescription, but the National Community Pharmacy of Association estimates it costs about $13.85 per prescription for an independent pharmacy to fill a prescription and break even.
That includes overhead costs like the container, label, lights and employees, but that doesn't include the cost of the drug.
"When we're not being paid for the drug or any of our employees, we're operating in the red," Freeman said.
Ten Kansas pharmacies closed within the last year, and Freeman said more will close if reforms are not implemented soon.
Two pharmacies in Russell recently merged to stay open.
"In certain pharmacies, up to one in every three prescriptions, they're getting paid below cost," Schertz said. "That's not taking into account overhead to run it."
There is an appeal system for reimbursements, but appeals are always denied, Freeman said.
"The [pharmacy benefits managers] don't have to play by any rules because there are no rules," Freeman said.
Freeman said the most important aspect of this debate is patient access to medications in a timely manner.
Independent pharmacies deliver to people who can't leave their homes. Pharmacists are available to answer questions in person and provide other special services, such as bubble packs.
Freeman said her pharmacies have even gone to people's homes to give flu shots.
"You won't find that in a mail-order pharmacy or in a chain pharmacy that is 60 to 75 miles away," she said.
Mail-order and chain pharmacies won't be able to handle the volume if more independent pharmacies close, Freeman said.
An independent pharmacy in Garden City closed, and the remaining pharmacies are swamped. Freeman said people are waiting up to five days to get prescriptions filled.
Mail service in rural Kansas is a barrier for patients who are being required to use mail-order pharmacies. Schertz said patients are seeing delays in receiving their medications.
"If something gets hung up half a state away with critical medications, it's not just a package from Amazon. It's lifesaving medication that can be held up," he said.
Climate control is also a concern. Temperature differences can harm medication efficacy, so pharmacies must maintain their medications at consistent temperatures.
Medication that comes through the mail may be sitting in a mail van or on a dock for hours to days in more than 100-degree temperatures or temperatures well below freezing, Freeman said.
The bill
The Kansas Pharmacists Association's bill would set a floor for the reimbursement rate to all pharamcies, Freeman said.
Paul Schiferl, pharmacist in Colby, said he did not think the bill would increase prices for consumers.
"We think that the pharmacies should be trued up," he said. ... "What we believe is that it will put everyone to the middle on a fair playing field."
He added, "You can't make a pharmacy run on a $2 dispensing fee."
The bill also encourages transparency. Employers and the state could see where their money goes for drug costs.
It would also reform the audit system. Freeman said the pharmacy benefit managers perform what she called "predatory audits" of independent pharmacies.
"It's common sense things," Freeman said. "We just want to level the playing field a little bit more instead of the three [pharmacy benefits managers] running us over and trying to close us."
Freeman said she and the other pharmacists did not want to close even for one day, but they need Kansans to understand the importance of this issue.
"Patients need to understand they may not have a pharmacy," she said. "Until people understand and feel the issue on themselves, they aren't going to fully understand what the impact could be.
"I can sit here and say until I'm blue in the face, 'If you don't have a pharmacy, you're not going to be able to get your medications.' But until you actually live in that world for a day, it's hard to comprehend."
Schiferl said he also did not want to close. He wants to serve his patients.
"We also want to have this visual representation. We believe our patients want us in their communities," he said, "and we're hoping that when they can see what this would be like if we were closed all of the time, they will want to support this and reach out to their legislators as well and [tell them] how important it is to have a community pharmacy in their town."
The pharmacies encourage their patients to contact local legislators to support the legislation. The independent pharmacies are also organizing letter-writing campaigns and will be taking letters written by patients to Topeka on Feb. 5
"Having the patient voice is what we really hope to have to help the legislators understand more," Freeman said.
Counties that will have pharmacies closed for "Closing for a Cause" on Feb. 5.
Anderson
Barber
Chase
Chautauqua
Clay
Coffey
Decatur
Dickinson
Doniphan
Edwards
Elk
Ellsworth
Gove
Graham
Grant
Gray
Greenwood
Harper
Hodgeman
Jewell
Kingman
Kiowa
Lane
Pawnee
Lincoln
Logan
Marion
Meade
Mitchell
Montgomery
Morris
Nemaha
Ness
Norton
Osage
Ottawa
Pawnee
Phillips
Pottawatomie
Rawlins
Republic
Rice
Rooks
Rush
Russell
Sheridan
Smith
Stafford
Stanton
Trego
Washington
Wichita
Woodson