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Rep. Rigsby: A serious conversation about the future of pharmacies in Alabama is needed

If your pharmacy closed tomorrow, where would you go for your prescription and pharmacy needs? That question is one that Alabamians may have to answer soon if they are not facing it already. 

Being the most accessible provider to patients, pharmacists desire to serve their patients. This service doesn’t stop with providing medications, that is where service begins.

The problem pharmacists are facing in today’s insurance-dominated market is how to continue to serve patients when operating at a loss. Many times, pharmacists are reimbursed less than the cost they pay for medications. What other business is asked to do this? 

Pharmacies across Alabama are closing. We have lost 300 pharmacies over the last six years and more closures are expected. With every closure, 5,000 Alabamians are left without a critically important health care provider. This is a major issue for every community in our state, but rural Alabama is hit the hardest. In many cases, that local pharmacy is the only healthcare provider in that rural community.

In other businesses, if an operating cost increases, the company’s prices increase to compensate. In pharmacy, that just is not possible. A pharmacy cannot pass on that cost to a patient because the contract doesn’t allow for that.

Why not just negotiate a better contract? Well, the pharmacy is often put in an impossible position to “take it or leave it” when presented with a contract and never given a chance to negotiate. Big pharmacy insurance companies, called pharmacy benefit managers (PBMs), present these contracts which control the poor reimbursements paid to a pharmacy. 

When the Alabama Pharmacy Association and the American Pharmacy Cooperative approached me about sponsoring The Fair Meds Act (HB238), I knew that this was a step in the right direction to decrease healthcare costs, maintain access to care, and help pharmacies continue serving patients.

Just as other representatives sponsor legislation regarding their occupations, it only made since that a pharmacist carry HB238, and since my current pharmacy does not accept commercial insurance, this bill would not benefit me professionally. However, I knew that the pharmacy insurance industry and its allies would be totally against it.

The narrative that this legislation is a “tax on every prescription” is entirely false. I would never support legislation that passes an additional monetary burden to patients. This false narrative, however, has created confusion and fear among Alabamians.

Patients need further understanding of the reimbursement practices of PBMs. We need to educate people on why pharmacies can no longer stock certain medications due to underpayment, why the costs of their medication continue to increase, why their premiums seem to climb endlessly, and why the PBMs are posting billions of dollars in profits each year.

I want all Alabamians to have the opportunity to be served by pharmacists, and I want the service they provide to be affordable. 

To be clear, pharmacies will not be able to remain open if the PBMs are allowed to continue paying them less than the cost of providing those needed and desired services.

Since more discussions must be had between pharmacy, patients, and other concerned industry, I will not be pursuing the passage of HB238. These discussions must dive into evaluating the practices of PBMs, look at solutions for fighting the ever-rising cost of drugs, and assess the reimbursement structure currently in place that is failing to allow pharmacies the opportunity to continue to serve patients.

As a pharmacist, my desire is to always serve the needs of my patients in my practice, and that same desire to serve is what propels me in my elected position.

I challenge each of you to get to know your pharmacist if you haven’t already done so. Ask them questions regarding how pharmacies are being affected. Then ask yourself, what should be done to allow that pharmacist the continued opportunity to serve you?

Phil Rigsby is a Republican state representative and pharmacist from Huntsville.

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