EDWARDSVILLE — Today, Congresswoman Nikki Budzinski (IL-13) hosted a roundtable with independent pharmacists, pharmacy students and faculty at the Southern Illinois University Edwardsville (SIUE) School of Pharmacy to discuss the predatory practices of Pharmacy Benefit Managers (PBMs).
Under the current system, PBMs act as middlemen between manufacturers, insurers and pharmacies - inflating drug prices at the expense of patients with complex rebate and pricing structures. In Illinois and across the country, PBMs have forced independent pharmacies to close by steering patients to PBM-affiliated pharmacies and excluding in-network pharmacies from filling prescriptions.
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“Today’s conversation made clear that we must take action to rein in PBMs who have gone unchecked for far too long,” said Congresswoman Budzinski. “That’s exactly why I’m fighting to pass legislation to provide more transparency, accountability and guardrails to crack down on PBMs' predatory practices that rip off working people and squeeze out community pharmacies. Losing community pharmacies isn’t only bad for Main Street, it’s harmful to the folks who rely on access to their local pharmacy to fill their prescriptions. I’m so grateful to the pharmacists, pharmacy students and faculty who shared their stories at today’s roundtable and I look forward to many more productive discussions to come.”
In recent years, PBMs have consolidated with the “Big Three” – Express Scripts, CVS Caremark and OptumRx – controlling almost 90% of the market. PBMs operate with minimal oversight and limited transparency and often withhold important information from independent pharmacists.
“PBM’s anti-competitive business practices must come to an end,” said Michelle Dyer, R.Ph, owner of Michelle’s Pharmacy in Carlinville, IL. “In October 2022, multiple locations of my pharmacy were pushed out of business, leaving three rural towns in Macoupin County without access to a steadfast pharmacy with helpful staff. For too long, PBMs have put profits over patients and tilted the scale in their favor in every way possible. It’s time to pass legislation to regulate the PBM system and level up pharmacy reimbursements to ensure that independent pharmacies like mine can continue to serve our communities.”
Michelle Dyer has owned Michelle’s Pharmacy in Carlinville, IL, for 17 years. In 2009, she expanded her business to Gillespie and in 2016, she opened a pharmacy in Bunker Hill – a community that had been without pharmacy service for over 25 years. However, as PBMs consolidated and poached patients from independent pharmacies like hers, Michelle was forced to sell her businesses in 2021.
PBMs’ actions are also increasingly deterring pharmacy students and new graduates from entering community or independent pharmacy practice due to the financial instability PBM practices create. Following the roundtable, Congresswoman Budzinski toured the SIUE School of Pharmacy to learn about the recruitment and retention issues it is facing.
Congresswoman Budzinski is a cosponsor of the bipartisan Pharmacists Fight Back Act, which would remove the ability of PBMs to restrict patient choice through network exclusions and protects community pharmacists by prohibiting PBMs from steering patients toward PBM-affiliated pharmacies. She is also a cosponsor of the Drug Price Transparency in Medicaid Act and voted to help pass the Lower Costs, More Transparency Act, both of which would ban spread pricing and require price transparency for PBMs.
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