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Letter to the Editor: Another look at prescription drug prices

After reading Sen. Amy Klobuchar’s letter, “Prescription drug help coming,” I felt compelled to clarify some misconceptions on prescription drug (medication) pricing.

I have been a pharmacist for over 32 years of which I have spent over 30 years as a pharmacist in Pipestone. Our country’s healthcare system has changed immensely over those 30+ years with huge developments happening every year. New treatment guidelines, new medications and new disease classifications happen on a regular basis. There isn’t much that surprises me when it comes to healthcare anymore.

One thing that has been in the spotlight for decades is the price of medication in the U.S. We, as U.S. citizens, pay twice as much for medications as other comparable wealthy nations. Having a medication increase in price at a rate that exceeded the cost of inflation was a common occurrence from the 90’s through the early 2010’s. That rate has slowed down largely due to more generic medications being available that are produced at a lower cost than the brand name medications that Big Pharma manufactures.

My pharmacy uses generic medications whenever possible to help our customers lower their out-of-pocket costs for their prescriptions. We could be doing even more to lower prices if it wasn’t for an unseen factor that people don’t realize even exists: Pharmacy Benefit Managers (PBMs). PBMs are a middle-man that largely controls the distribution of prescription medications in the U.S. They do what their name says, manage pharmacy benefits, for insurance plans across the country. They are the determining factor on whether your insurance will cover your prescription or not.

PBMs claim that they save consumers billions of dollars by negotiating prices with pharmacies and manufacturers. I say “claim” because they are the actual cause of why prescription medications are so expensive in the U.S. PBMs are only found in the U.S. No other country. PBMs became entrenched in the pharmacy process of filling prescriptions in the 80’s and 90’s. The same time that medication prices started to drastically increase. Coincidence or not? Anytime you add another step into a distribution process the cost of that item is going to increase. Simple economics in practice.

Sen. Klobuchar references “Big Pharma shaking down seniors” and “federal law written by the big drug companies” in her letter. My governmental legislative knowledge is quite old but I believe legislation is written by Senators and Representatives and not big companies. It is most certainly a shake down, however I believe Sen. Klobuchar is largely going after the wrong people. Several Congressional hearings have proven that PBMs are largely the cause of the high medication prices. Epi-pens and insulin testimonies have proven that PBMs are making more money off of each unit sold than the manufacturer. How is that possible? Rebates.

Rebates are what PBMs get from manufacturers to get their medications on the PBMs “formulary”: a formulary is a list of medications that the PBM “allows” pharmacies to dispense to their patients. This is also why a generic could be available to the pharmacy but the insurance/PBM won’t allow it to be dispensed to the patient. The PBM doesn’t get rebates from generic companies. PBMs decide whether a medication is covered by an insurance company or not.

If Sen. Klobuchar truly wants to lower prices for all U.S. citizens, she needs to support legislation that is designed to bring the PBMs under control. The pharmacy profession has been trying to work with legislators for decades to do this however PBM lobbyists have deep pockets with a lot of money to go around.


Jay Norberg, Pharmacist/Owner

A and S Drugs

Pipestone, MN

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