Locally owned community pharmacies, which provide a high level of personal services to patients across Utah, are increasingly under pressure from anti-consumer practices of large companies that control prescription drug benefits. Fortunately, a bipartisan group of U.S. senators are shining a bright spotlight on how these companies impact citizens’ access to medications and needlessly raise drug costs.

Pharmacy benefit managers (PBMs) have a massive impact on not only what Utahns pay for prescription drugs but also on the ability of community pharmacies to remain financially viable and service their customers. While I and other Utah pharmacists deal with PBMs daily, very few consumers are even aware of PBMs and their long-standing lack of transparency that results in needlessly higher drug costs.

I urge our two U.S. senators — Mike Lee and Mitt Romney — to support S. 127, the Pharmacy Benefit Manager Transparency Act. This is a pro-patient, pro-small-business reform bill that deserves strong support.

PBMs control virtually every aspect of the pharmaceutical supply chain and the patients it serves. PBMs develop drug formularies that identify what drugs a beneficiary can access, determine how much a pharmacy is reimbursed for their services, define what a plan sponsor pays and even own their own pharmacies. PBMs also negotiate rebates with drug manufacturers that reduce what insurance companies pay for medications. These often substantial rebates are seldom passed onto consumers. When I tell patients this when they come to our pharmacy counter, they are surprised — and not happy.

The Senate legislation would shine a bright spotlight on several practices and institute reforms that would save patients money and help protect the viability of community pharmacies.

S. 127 targets two specific problematic PBM practices.

First, PBMs often will bill employers or health plans more than what they pay to pharmacies and then they retain that profit, essentially “charging high but paying low.” This practice, known as “spread pricing,” means that your plan is paying more than it should and that, in turn, can mean higher premiums. Spread pricing is a major money generator for PBMs, as studies have shown that ending this practice would save Medicaid alone nearly $1 billion over 10 years.

Second, PBMs’ payment practices are also a focus of the Senate legislation. It is not uncommon for a pharmacy to be reimbursed for a medication below what they paid for it, which is particularly harmful to locally owned community pharmacies like mine. We don’t have hundreds of locations like major corporate-owned chains in Utah; we have one. A hit to our revenue from PBMs has a much greater impact than on chain pharmacies.

PBMs also engage in “claw backs” of payments they have already made. This happens when a PBM tells us that they are rescinding a payment to our pharmacy, often with very arbitrary reasoning.

An additional challenge facing locally owned pharmacies is that PBMs will also steer patients to obtain their medication from pharmacies — including online pharmacies — that the PBMs own or with whom they have a financial relationship. Many community pharmacists have reported hearing from their longtime local customers that they were directed to another pharmacy without their knowledge, and certainly without choosing that new pharmacy. This is another arrow shot at the heart of local, community pharmacies.

Patients across Utah are rightfully concerned about the affordability and accessibility of their prescription drugs. Increasing transparency in the cost-drivers of medicines and ensuring consumers have the option of choosing a local, community pharmacy for their prescription drug needs is vitally important in our state and across our nation.

Kevin DeMass, R. Ph., is a licensed pharmacist in the state of Utah and is the owner of the Apothecary Shoppe in Salt Lake City. The pharmacy is celebrating 50 years of serving patient needs from Logan to St. George.