Why fee-paying pharmacies are booming and what it means for healthcare

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As prescription drug prices continue to rise, more “cash” pharmacies, which sell generic drugs outside of insurance, are opening in the United States, saving some customers money hundreds of dollars on their prescriptions, Adiel Kaplan, Kenzi Abou-Sabe and Vicky Nguyen report for NBC News.

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Tackling high prescription drug costs

Prescription drug costs, which are somewhat controlled by Pharmacy Benefit Managers (PBMs) who negotiate prices for insurance companies, have been rising for more than a decade now, and many patients are struggling to pay for their medications.

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Currently, the Federal Trade Commission launched an investigation into the PBM sector, in particular the impact of vertical integration in the industry on access and pricing in the prescription drug market.

“An overconsolidated PBM industry depletes the resources pharmacists need to provide a high level of patient care and access,” said Ilisa Bernstein, interim CEO of the American Association of Pharmacists.

However, the PBM industry has argued that it helps reduce costs for patients, as well as insurers. PBM industry leaders say the high cost of prescription drugs is largely driven by pharmaceutical manufacturers.

“Our job is to drive down costs on behalf of the consumer and those who foot the health insurance bill,” said JC Scott, president of the Pharmaceutical Care Management Association. “Without us, there’s nothing standing between the consumer and the…drivers of high drug costs. I’m confident that once the FTC digs in and figures this out, they’ll come to the same conclusion.”

State and federal lawmakers have introduced bills to limit prescription drug costs, but progress so far has been slow. Notably, the Inflation Reduction Act, which recently took effect, includes several provisions aimed at reducing prescription drug costs, although they are largely limited to Medicare beneficiaries.

Paid pharmacies offer some patients cheaper drugs

To reduce the cost of some prescription drugs, some companies establish “cash” or “self-paying” pharmacies, which offer generic drugs at wholesale prices, plus a small markup. By exiting the insurance system, fee-paying pharmacies are able to avoid potential fees and rules that increase the cost of a drug.

For example, the Mark Cuban Cost Plus Drug Company (MCCPDC) is an online pharmacy that offers deep discounts on generic drugs. As of June, the MCCPDC offered more than 700 generic drugs, including those for cancer, diabetes, and gastrointestinal and heart disease, and the pharmacy said it was “working continuously to add new drugs as quickly as possible.” possible”.

According to a study published in the Annals of Internal Medicine, Medicare could have saved billions of dollars had it purchased generic drugs through the MCCPDC instead of through the existing generic drug distribution and reimbursement system. Overall, researchers found that Medicare could have saved $3.6 billion over a 90-day supply of 77 out of 89 different generic drugs in 2020 if it had purchased them through the MCCPDC instead of Medicare Part plans. d.

Local pharmacists have also opened their own small fee-paying pharmacies to help patients save money on prescription drugs. For example, Nate Hux, a pharmacist in Pickerington, Ohio, recently opened Liberty Pharmacya paying pharmacy next to his usual pharmacy that accepts insurance.

According to Hux, having two separate pharmacies allowed him to advise patients on the best place to fill their prescriptions. For drugs without generic alternatives, the Insurance Pharmacy would likely be the best choice, but for other drugs, including those that have recently gone generic, the all-cash Freedom Pharmacy would likely have better deals.

“Generic Viagra and generic Cialis, that kind of stuff, is way more expensive inside the system than just doing self-paid pharmacy,” Hux said. “That would be maybe $1,000 for a 30 day supply. And here [at Freedom]they’re about $15 for a 30-day supply.”

“For about 25% of people, it makes more sense to fill in at Freedom,” Hux added. “If I didn’t have both, I wouldn’t know. … While I’m dealing with claims, one of the best things I can see is which world is best for my patient. insurance? Or is it the non-insurance world?”

According Avalère Health, 91% of prescriptions in the United States are currently filled by insurance. However, fee-paying pharmacies are beginning to grow in number, and many pharmacists say they believe the savings offered and the ability to shop for different drugs will successfully attract customers.

“Right now, we have a system that relies entirely on artificially inflated drug prices,” said Antonio Ciaccia, president of 3 Axis Advisors. “What fee-paying pharmacies offer is the opposite – the antithesis. It’s a return to retail fundamentals.”

At Freedom Pharmacy, “sometimes it’s cheaper, sometimes maybe a little more. But at least they have a choice. They know exactly what the initial price is,” Hux said. “When consumers have a choice, it’s good for everyone.” (Kaplan et al., NBC News, 8/19)

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