Understanding supply chain will help to lower drug costs

Even before the COVID-19 pandemic hit, one of the most significant issues facing Wisconsinites was the high cost of prescription medications. With routine health care and medication being vital to a patient’s well-being, increases in medication costs can create untenable, unsustainable situations for our most vulnerable — including deciding between medications and other daily necessities. This is completely unacceptable.

The good news is that recently our state lawmakers reached across party lines to find a solution for all Wisconsinites to have better access to affordable quality health care, especially in the face of a global pandemic. Lawmakers passed and Gov. Tony Evers signed into law a bipartisan bill that will benefit all Wisconsinites and lower prescription medication costs for patients at the pharmacy counter.

The new law is an important step to improving patients’ ability to access affordable care, increasing transparency in the prescription drug pricing process and reining in the power of pharmacy benefit managers (PBMs).

For too long, we have witnessed pharmacies and patients struggle with medication costs resulting from the one-sided nature of PBMs. It will help the health care system greatly now that lawmakers are finally beginning to hold them accountable.

Few people outside of the health care industry understand the role of PBMs. Until a recent Supreme Court ruling, PBMs flew under the radar of state and federal regulation, abdicating government oversight. Unfortunately, it has led to PBMs gaining significant influence in the prescription drug market, with PBMs deciding which medications are covered by insurance plans, where patients can pick up prescriptions and how much pharmacy providers will be reimbursed.

Making matters worse, as the predatory practices of PBMs become exposed and they receive more scrutiny, like here in Wisconsin, they are trying to divert attention. Unfortunately for pharmacists, PBMs have begun attacking and mischaracterizing the only advocates we have to try and level the playing field – pharmacy services administrative organizations (PSAOs).

With PBMs having so much influence, their contracts are often take it or leave it. How can a Wisconsin small business owner take on corporations worth billions of dollars? Whether they want to or not, pharmacies are often forced into contractual relationships with PBMs so we are able to serve patients. PSAOs help give pharmacies an amplified voice during PBM contract negotiations and ease time-consuming administrative burdens.

PSAOs certainly do not solve all of the problems, but they help independent pharmacies navigate the complex market PBMs have created and give us a seat at the table that we would not otherwise have. It is crucial to our businesses that PSAOs do not become collateral damage to increased PBM scrutiny.

Understanding the prescription drug supply chain is the only way we will lower the cost of medication meaningfully and permanently for patients. Yes, it is complex, but Band-Aids on the health care system are no longer acceptable. Our new PBM law in Wisconsin is a step in the right direction, and I hope lawmakers continue to hold PBMs accountable without buying into their diversion tactics.

Shane Resch is a pharmacist and co-owner of pharmacies in Wittenberg, Oconto Falls, Manitowoc and Pulaski.