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Yahoo
01-07-2025
- Business
- Yahoo
Ohio pharmacy measure will make closures ‘explode,' group says
A pharmacy manager retrieves a bottle of antibiotics. (Photo by) Compromise budget language hashed out this week by an Ohio House-Senate committee will make problems hurting Ohio pharmacies infinitely worse, the leader of a group that represents them said Thursday. He added that the Ohio Chamber of Commerce — which advocated part of the legislation — seemed blind to the effect it would have on member businesses by making it more difficult for employees to access medicine. As it works against a June 30 budget deadline, a House-Senate conference committee approved an amendment that keeps part of a bill meant to help ailing pharmacies but slashes another. The result, said Dave Burke, a pharmacist, former state senator, and executive director of the Ohio Pharmacists Association, will be that pharmacies will go from earning scant profits to none at all. 'It's any pharmacist's suicide bill,' he said Thursday. Ohio pharmacies have been in trouble for years. They've complained of high fees and low reimbursements from huge middlemen known as pharmacy benefit managers, or PBMs. Last year, Ohio lost 215 pharmacies and their total number dropped below 2,000 for the first time in memory, according to an online tracker launched by the Ohio Board of Pharmacy. As pharmacies disappear, they create a lack of access that is particularly hard on the poor, elderly and disabled. Not only do they get their medicine at what are often main-street businesses. They also get professional medical advice about chronic conditions like diabetes and high blood pressure. PBMs, the middlemen, decide which drugs are covered, and they use a non-transparent system to decide how much to reimburse pharmacies that dispense them. The three biggest control nearly 80% of the marketplace. As pharmacies close, Ohio Chamber blasted for siding with middlemen Each of those companies is part of a Fortune 15 health conglomerate that also owns a top-10 health insurer. CVS owns the largest retail pharmacy chain and all three own mail-order pharmacies. So, when the big PBMs decide reimbursements, impose rules and charge fees, they're doing so for their own pharmacies and their competitors. That's a glaring conflict of interest, their critics say. There have been abuses in Ohio. In 2018, the Ohio Department of Medicaid peeled back the curtain and learned that a year earlier CVS and UnitedHealth's PBM, OptumRx, charged taxpayers $224 million more for drugs than they paid the pharmacies that had dispensed them. The Medicaid department fired the PBMs. In 2022 it got rid of their hidden, seemingly arbitrary system of reimbursement in which the same companies sometimes pay 500 different prices for the same drug. Instead, prices are determined by a public survey published by the U.S. Centers for Medicare and Medicaid Services — the National Drug Acquisition Cost, or NADAC. With pharmacies no longer losing money on some drugs and making it on others, the Medicaid department set a $10 per-prescription dispensing fee to cover pharmacies' overhead. Even with the increased dispensing fees, an analysis said the state saved $140 million from the reforms. Ohio state Rep. Tim Barhorst, R-Fort Laramie, this year proposed to use the same arrangement in many non-Medicaid transactions. That measure made it into the Ohio House budget, but then ran into opposition in the Ohio Senate, where the Ohio Chamber had been telling members the dispensing-fee requirement was a tax. What emerged from the conference committee late Wednesday might have seemed like a compromise to its members. It kept the provision that drug reimbursements would be based on NADAC, the publicly available price list, but it got rid of dispensing fees. To Burke and other Ohio pharmacists, it's the worst of both worlds. Not only couldn't they profit from over-reimbursements under the traditional, non-transparent system, they also couldn't cover overhead from a fixed dispensing fee. Of the measure agreed to by the conferees, Burke said, 'That proposition only works with a second proposition — the dispensing fee. Because the bag, the bottle, the lid, the pharmacist, the tech, the lights, the heat and the air conditioning all have a cost. In any business model, whether it's medications, pizzas or cars… you can't buy ingredients for a dollar and sell pizzas for a dollar and stay in business.' He predicted that if it becomes law, there will be a mass exodus from the already depleted ranks of Ohio pharmacies. 'If pharmacies can't make any money — this legislation makes it so that you're not making any money at all — it would probably force the closure of the overwhelming majority of pharmacies in this state,' Burke said. 'Even a child mowing yards is not going to buy a dollar's worth of gas and accept a dollar to mow your yard.' Once conferees agree on a budget, Gov. Mike DeWine has the power to veto line-items in it. Burke said he hoped the governor would consider such a move. 'I think the governor's office would be well placed to consider a veto and we will be expressing our concerns that the legislation is flawed, and that if he doesn't, the amount of pharmacy closures in Ohio in the next weeks if not months will explode,' Burke said. Dan Tierney, DeWine's press secretary, was non-committal when asked about the matter. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX 'We have not received final budget language but will be reviewing the final language when received,' he said in an email Thursday. Burke didn't accuse any of his former colleagues of ill-intent in agreeing to the measure. 'I think they believed that if they stepped in and said we'll make sure you get paid what you paid for the drug that will fix everything,' Burke said. 'But this legislation takes everything you made a profit on and brings it to zero.' However, he did say he was mystified about the Ohio Chamber's reasons for intervening in the matter. 'I don't know where the chamber adopted its stance from, but it's hard for me, as an independent business owner, to understand why major employers would want to increase their employees' difficulty getting medications.' Burke was incensed that the Ohio Chamber would call dispensing fees — payments to cover overhead — a tax. 'It's amazing to me that the chamber should take the position that business owners should not make a profit,' he said. 'I thought the Ohio Chamber was all about profit, pro-business and competitive markets. But they've adopted the position that this particular sector of business owners should not make any money. They consider the dispensing fee to be a tax. So apparently, any profit that any business makes is a tax. Maybe they've gone socialist over there. I don't understand. Maybe they're not looking at their own pharmacy benefit with any understanding.' The Ohio Chamber didn't immediately respond Thursday to a request for comment. But earlier this week, Senior Vice President Rick Carfagna said the goal was to protect Ohio businesses from paying too much to underwrite employees' drugs. There are, however, questions about the body's relationship with the giant conglomerates that own the PBMs. For example CVS Health was a 'presenting sponsor' of the Chamber's 2024 Healthcare Summit, Among the questions the Ohio Chamber didn't immediately respond to was how much CVS paid to sponsor the event — or how much the chamber had received from the big-three conglomerates over the past five years. In earlier responses, Carfagna didn't address the growing number of pharmacy deserts in Ohio, or that struggling independent and small-chain pharmacies are themselves small businesses that the Ohio Chamber says it wants to protect. Burke said all the Ohio Chamber's members will be harmed if the conference committee language becomes law and mass closures result. That would mean sicker employees with difficulties getting medicine. 'I hope the Chamber actually goes and speaks with the people they're supposed to represent and see if this policy position is reflective of the way they want to treat their employees,' Burke said. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
09-06-2025
- Business
- Yahoo
GoodRx Launches Community Link to Offer Independent Pharmacies Cost-Plus Pricing
Community Link allows independent pharmacies to direct contract with GoodRx, manage participation in the company's Integrated Savings Program, and access over 90 brand medication partnership offerings Cost-plus pricing is anchored on NADAC Starting July 1, all independent pharmacies will be opted out of GoodRx's Integrated Savings Program by default SANTA MONICA, Calif., June 09, 2025--(BUSINESS WIRE)--GoodRx (Nasdaq: GDRX), the leading platform for medication savings in the U.S., today announced the launch of GoodRx Community Link. Designed to address the industry challenges that independent community pharmacies face around complex reimbursement models and competitive pressures, Community Link leverages a cost-plus pricing model based on NADAC to provide predictable pricing and favorable economics. This announcement showcases GoodRx's commitment to helping independent pharmacies better manage pricing while continuing to provide consumers with affordable prices on their medications. "We know independent pharmacies are critical pillars in our communities that help millions of Americans access their medications and they need bespoke solutions to help address the industry problems they face," said Aaron Crittenden, President of Rx Marketplace at GoodRx. "GoodRx Community Link is the result of a multi-year journey to evolve the GoodRx business model and deliver solutions tailored to the specific needs of independent pharmacies. Ultimately, our goal with Community Link is to help improve the retail pharmacy business model and support a bright future for the sector." Community Link enables independent pharmacies to: Direct Contract with GoodRx: Leverages cost-plus pricing anchored on NADAC to provide independent pharmacies with direct control over pricing and favorable margins. A direct contract means the pricing relationship is entirely between GoodRx and the pharmacy, with no PBM involvement. Entering into a direct agreement with GoodRx does not waive a pharmacy's right to participate in ongoing litigation against GoodRx. Manage Participation in GoodRx's Integrated Savings Program (ISP): When a direct contract is signed, independent pharmacies will have the ability to opt-in to ISP as an additional benefit of working with GoodRx. Starting July 1, all independent pharmacies will be opted out of ISP by default. ISP participation may offer more favorable rates than traditional commercial insurance reimbursement. Access Over 90 Brand Medication Deals: A unique offering where the manufacturer buys down the price of a brand medication via GoodRx, making it more affordable for the consumer and economically beneficial for the pharmacy. Examples include Lantus, a Humira® biosimilar, and medical devices such as Dexcom. Starting today, independent pharmacies can use their NCPDP number to login to GoodRx Community Link and manage their relationship with GoodRx: To view a recording of the GoodRx Community Link webinar that was hosted last week, visit: For any questions, please reach out to: communitylink@ About GoodRx GoodRx is the leading platform for medication savings in the U.S., used by nearly 30 million consumers and over one million healthcare professionals annually. Uniquely situated at the center of the healthcare ecosystem, GoodRx connects consumers, healthcare professionals, payers, PBMs, pharma manufacturers, and retail pharmacies to make saving on medications easier. By reducing friction and inefficiencies, GoodRx helps consumers save time and money when filling prescriptions so they can get the care they deserve. Since 2011, GoodRx has helped Americans save over $85 billion on the cost of their medications. GoodRx periodically posts information that may be important to investors on its investor relations website at We intend to use our website as a means of disclosing material nonpublic information and for complying with our disclosure obligations under Regulation FD. Accordingly, investors and potential investors are encouraged to consult GoodRx's website regularly for important information, in addition to following GoodRx's press releases, filings with the Securities and Exchange Commission (the "SEC") and public conference calls and webcasts. The information contained on, or that may be accessed through, GoodRx's website is not incorporated by reference into, and is not a part of, this press release. GoodRx Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements contained in this press release that do not relate to matters of historical fact should be considered forward-looking statements, including, without limitation, statements regarding anticipated savings, convenience and accessibility; the expected benefits and value of GoodRx Community Link and our Integrated Savings Programs; and our plans, expectations and objectives. These statements are neither promises nor guarantees, but involve known and unknown risks, uncertainties and other important factors that may cause our actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements, including, but not limited to, risks relating to our ability to achieve broad market education and change consumer purchasing habits; changes in medication pricing and pricing structures; our reliance on a limited number of industry participants; and the important factors discussed under the caption "Risk Factors" in our Annual Report on Form 10-K for the year ended December 31, 2024, and our other filings with the SEC. Any such forward-looking statements are based on current expectations, projections and estimates as of the date of this press release. While we may elect to update such forward-looking statements at some point in the future, we disclaim any obligation to do so, even if subsequent events cause our views to change. View source version on Contacts Media Contact press@ Sign in to access your portfolio
Yahoo
26-05-2025
- Business
- Yahoo
Both sides urge Governor for action on PBM reform bill
DES MOINES, Iowa — Those arguing in favor and against the bill reforming Pharmacy Benefit Manager practices in Iowa are calling on the Governor for action. Pharmacy Benefit Managers (PBMs) are the middlemen between pharmacies and insurance companies. They determine the total drug costs for insurers, shape patients' access to medications, and determine how much pharmacies are paid. Pharmacists have supported this bill during the session because they say it will ensure they are paid at fair rates, resulting in them not having to close their doors. Last year was a historic year for pharmacy closures in Iowa, with another 30 of them. Many pharmacies told WHO 13 News this was the result of corrupt practices by PBMs, mainly not being reimbursed at fair rates. Pharmacists and pharmacy owners have advocated for similar reform legislation for the past three years, but were unsuccessful in getting it debated in the state senate. This year, the bill passed the legislature and now waits on the Governor's approval. However, when the bill was sent to the state's executive branch, key corporate players voiced their concerns and urged the Governor to veto the bill. This included companies like the Iowa Association of Business and Industry (ABI), the Iowa Bankers Association (IBA), the Iowa Business Council, and the National Federation of Independent Business (NFIB). They claimed the bill would negatively impact Iowans by costing them around $340 million annually. In a statement sent to WHO 13 News, the Iowa Association of Business and Industry shared how they reached their data: 'To determine the impact of this bill, we used data publicly available from the Centers for Medicare and Medicaid Services (CMS) and the National Average Drug Acquisition Cost (NADAC), along with the $10.68 dispensing fee in the bill. Here is a breakdown: The provision that contains the dispensing fee when paid to independent pharmacies and Iowa's largest pharmacy provider will cost $114,250,00 per year. Allowing any pharmacy to handle specialty drugs that require unique handling,, and administration eliminates the ability of employers to band together and get volume discounting on these drugs that now exists. This provision, which does not benefit small independent pharmacies will cost $135,750,000 per year. A provision that allows drug makers to provide copay assistance to drug purchasers pushes the costs from drug purchasers onto the health plans paid for by employee premiums. This provision does not benefit small independent pharmacies and will cost $66,250,00 per year. The bill contains a new process that allows pharmacies to change the reimbursement they get for drugs if they can show that their main wholesaler charges them more for a drug than had been established in the law. This provision will cost $23,500,000 per year. Taken together, these four provisions create $339,750,000 in new costs of pharmacy care in Iowa.' -Kelsey O'Connor, Marketing & Communications Director for the Iowa Association of Business and Industry However, several small independent pharmacies in Central Iowa have previously told WHO 13 News that this bill would help them because it would ban PBMs from paying pharmacies less money than it costs for the pharmacy to purchase drugs and distribute prescriptions. This includes pharmacies in Oskaloosa, Minden, Colfax, and Eagle Grove. They say this unfair reimbursement rate has been the primary cause of increasing pharmacy closures in Iowa. Brad Magg, the owner of the Spring City Pharmacy in Colfax, Iowa disagrees with the Iowa Association of Business and Industry. He said, 'Every state that's passed legislation like this has seen their health insurance cost and prescription drug cost decrease, so for them to keep saying these astronomical numbers for what it's going to cost, they're not true. And they keep changing. Every time they say numbers, they're different. The bill hasn't changed.' Magg said Spring City Pharmacy will be closed in six to eight weeks if the bill doesn't become law. The future of the bill is ultimately up to the state's executive branch. Governor Kim Reynolds has not indicated whether she will sign the bill into law or veto it. WHO 13 News has reached out to her office, but hasn't heard back. She has until June 11th to sign the bill. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
