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03/03/2022

NCPA survey finds patients disapprove of PBMs

A majority of consumers surveyed said that PBMs should reimburse pharmacies at least enough to cover costs for COVID-19 treatments and other drugs.
Sandra Levy
Senior Editor
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A majority of consumers believe that insurance plans and their pharmacy benefit managers should pay pharmacies fairly for COVID-19 drugs and other life-saving medicines.

This same group of consumers also believes that pharmacy benefit managers shouldn’t tell patients which pharmacies to use or steer them into their own pharmacies, according to a new national consumer survey released by the National Community Pharmacists Association.

In the survey of 716 registered voters, conducted from Feb. 14 to 15 by Public Policy Polling, 84% of respondents say that health insurance plans and their PBMs shouldn’t tell patients which pharmacies to use, a practice known as “patient steering.”

[Read more: NCPA files lawsuit against to eliminate pharmacy DIR fees]

More specifically, the survey found that 78% say insurance plans and PBMs shouldn’t require patients to use pharmacies owned by insurance plans and PBMs or be allowed to require patients get their medicines through the insurance company’s mail-order pharmacy. When asked if insurance plans and PBMs should require patients to use more expensive medicines when there is a less expensive alternative, 83% said no.

“Being able to choose their pharmacy continues to be a patient priority,” Douglas Hoey, NCPA CEO said. “Despite the pandemic having changed other consumer behaviors, they want access to a local health care provider who knows them and will help them find the best, most affordable treatments.”

The survey also revealed that nearly 60% say it isn’t fair that low health insurance and PBM reimbursements to pharmacies for buying and safely dispensing drugs often means the pharmacy loses money on prescriptions.

[Read more: Seeking reform: DIR fees in the spotlight amid push to rein in drug costs]

When asked about "pharmacies losing money when dispensing new COVID-19 oral antiviral medicines due to stingy fees paid by health insurance companies," 50% think these companies and PBMs should reimburse pharmacies enough for the pharmacy to cover the cost of the drug, the costs to dispense the drug and to make a small profit.

An additional 32% say they should reimburse at least enough for the pharmacy to just cover its costs, which is roughly $40. Nearly three-quarters say that the $1 reimbursements sometimes being seen by pharmacists are not fair.

“Patients understand that pharmacies are unlikely to be able to offer these vital therapies if miserly insurance companies hoard the patient’s monthly premiums for their own corporate gain rather than acknowledging the pharmacist’s extra time and coordination that goes into making sure patients are safe and get the most benefit from these potent drugs,” Hoey said. “They know intuitively that access to drugs will dry up and pharmacies will close. Policymakers must acknowledge this too, and they should take action. These are important treatments that can prevent costly hospital stays and save lives, and they should be available to the patients who need and are appropriate for them.” 

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