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'It’s a corrupt ballgame' Rural communities at risk of becoming pharmacy deserts

In rural areas, independent pharmacies are closing across the country.

South Side Drug Co. is a staple. It's been in Springfield for more than a century. "We’re not too big to fix you for a scrape or a bruise, or fit you for compression hose, or check your blood pressure, blood glucose, just those little things that bigger stores can’t and won’t do," said Ian Bradley, co-owner and pharmacist.

Bradley said independent pharmacies have been struggling for years. They do what it takes to stay afloat. "Even 30 years ago, we had eight independents in Springfield, we have one now," Bradley said.

When big national pharmacies came to town, main street drugstores were impacted. "No small communities can be immune to it," Bradley said.

Co-owner and pharmacist Drew Sloan said pharmacy benefit managers make it hard to survive. They serve as the middleman in the supply chain. "They are undercutting our costs," Sloan said. "Secondly, is patient steering, a lot of these, well we’ll just say CVS Caremark is owned by CVS and heavy patient steering happens there."

He expects a huge wave of independent pharmacies to dry up in the next year. "It’s a corrupt ballgame that just slowly whittles away at the competition," Sloan said.

While Springfield still has a drugstore, 41 million Americans live in a pharmacy desert. According to a GoodRx study, a lot of Americans have to drive more than 15 minutes to get to their nearest drug store. That's what experts call a pharmacy desert. In 40% of counties in the United States, a majority of people don't have adequate access to a pharmacy.

"When that happens, especially in these super rural towns with one pharmacy within miles of others, that’s going to be major, and the sad thing is, it’s going to be too late because the pharmacies will be gone," Sloan said.

The Tennessee Pharmacists Association Director the following email about the situation:

"This information below from our colleagues at the National Community Pharmacists Association (NCPA) that they compiled about Tennessee. As you can see, we have lost many community pharmacies in the past several years. While there has been an incremental growth in chain and mass merchant pharmacies, we have a decrease in independent pharmacies.

While local pharmacies have struggled with pharmacy benefit managers (PBMs) for decades, COVID-19 has laid bare the detrimental effects these largely unregulated middlemen also have on health care consumers. Utilizing anti-competitive and non-transparent practices, PBMs have reduced access and increased the price of healthcare for patients across Tennessee.

PBMs determine which pharmacies will be included in a prescription drug plan's network and how much those pharmacies will be paid for their services. PBMs also regulate which drugs are covered under a specific plan and set copays, negotiate rebates with drug manufacturers, and incentivize patients to use mail-order pharmacies operated by the PBM.

As an intermediary, the role of PBMs can go largely unnoticed, and the lack of transparency leads to hidden costs and higher drug prices. PBMs have been allowed to operate virtually unchecked, with three companies now controlling nearly 90% of all Americans' prescription drug insurance. While Express Scripts, one of the largest PBMs, reported gross profits of $8.76 billion in 2017, patients are paying more for their drugs and community pharmacies are struggling to keep their doors open.

Tennessee pharmacies are no stranger to the fight against PBMs. Our members have engaged in strong grassroots advocacy at the state level for many years, including this past year in ensuring Public Chapter 569 was signed into law. The road is still long with this legislation as PBMs continue to not comply with this law and many other laws developed to bring transparency into the practices of PBMs."


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