To the editor:

My father opened Daniel Pharmacy back in the 1960s, and I’m proud to be a second-generation pharmacist who’s served his community for decades. Over the years, however, working with insurers and pharmacy benefit managers (PBMs) has become an increasingly challenging ordeal, particularly watching the harmful effect they have on patients and my business.

PBM policies like patient steering have been devastating for independent pharmacies like mine. Through these policies, insurers and PBMs restrict patients to purchasing their doctor-prescribed prescriptions and treatments from the larger chain pharmacies they own or with which they are affiliated. That steers patients away from the local pharmacies they have always gone to as well as business away from independent pharmacies across the state.

Many local pharmacies also fall victim to reimbursement costs lower than the cost to fill the prescription. On top of this, additional fees, known as DIR fees, are often charged to the pharmacy long after the patient has picked up their medication, leaving the pharmacy responsible for paying them. Both tactics are employed by PBMs to boost their own profits but result in a net loss for the pharmacy, losses many pharmacies cannot afford. Fair reimbursement rates and DIR fees charged only at the point-of-sale should be required of all PBMs.

Other PBM practices, like the all-too-common one of absorbing or withholding prescription drug savings and rebates from patients to further boost profits, force patients to pay higher out-of-pocket expenses. PBM policies also often result in patients being forced to purchase higher-cost medications, even in cases where a lower-cost generic or alternative may be just as effective.

It’s disappointing that Congress was unable to include meaningful PBM reform in the budget package recently passed. This is a pressing issue that has real negative impacts for both patients and independent pharmacists. Senators Grassley and Ernst should work to pass meaningful PBM reform. If action is not taken soon, independent pharmacies all over Iowa will continue to suffer and prescription medications will become less and less accessible to the patients who need them.

John Daniel III

Fort Dodge