For the future of New York’s healthcare system, it’s crucial to pass The Patient Access to Pharmacy Act
As you drive around the Capital Region, you’ll witness shuttered storefronts with signs bearing the faded logos of the businesses that once occupied them: CVS, Rite-Aid, Walgreens. The dozens of chain pharmacies that have closed in recent years don’t just represent the loss of jobs and an eyesore in our districts, but a growing healthcare crisis that we must proactively address.
For many in our community, pharmacists are the most accessible, familiar, and frequently visited healthcare providers. In New York, we have recognized the essential role of pharmacists and are working to expand their scope of practice. And as chain pharmacies have closed, independent community pharmacies have stepped up to fill the void. But at a time when these pharmacies are absorbing new patients and taking on more responsibilities, they also are being forced to reduce hours and lay off key employees. More troubling, these pharmacies are at risk of closing, and for the very same reason that chain pharmacies are consolidating: pharmacy benefit managers.
Pharmacy benefit managers, or PBMs, are middlemen that are owned by insurance companies, own their own pharmacies, and control healthcare in New York and across the country. PBMs aren’t doctors, pharmacists, or medical experts, yet they have an outsized say in patient care through their ability to decide what medications are covered by insurance.
PBMs also have complete control over pharmacies, which operate unlike any other business. Pharmacies don’t set prices or recoup their costs when they fill prescriptions. Instead, they are reimbursed after the fact by PBMs. But it is the PBMs that decide how much they will reimburse the pharmacies. Think about it, the PBM can and has decided to reimburse their pharmacies more than their competition. One has to question what country we are living in that allows this predatory reimbursement. The result is that every day, PBMs reimburse pharmacies for less than the cost the pharmacy paid for the drug. Because of PBMs, pharmacies can lose upwards of $100 every time they dispense many name-brand and popular prescriptions, a practice that we’ve forced pharmacies to deal with even though no other business would accept it.
PBMs have long been a problem across the country. In New York, we’ve proactively passed legislation to protect access to prescription drugs and reduce the power of PBMs in Medicaid, all with bipartisan support. But there’s still work to do. Many New Yorkers get their insurance through their jobs, and PBMs still have unchecked power when it comes to commercial insurance plans. That’s why this year, I introduced the Patient Access to Pharmacy Act (S5939 Skoufis / A5882 McDonald) to ensure pharmacies can’t be reimbursed the same as the New York Medicaid program. For the future of New York’s healthcare system, it’s crucial that this act is passed before the end of the 2025 legislative session.
As a practicing pharmacist, I know first-hand the impact that PBMs have on our healthcare system. Left unchecked, they will create pharmacy deserts throughout New York and force our sick and aging neighbors to travel distances and wait in long lines to receive necessary care. All this bill asks for is greater transparency and fairness. All patients should be able to choose their own pharmacy and all pharmacies should be paid the same, even if it is the Medicaid rate.
This year, Rite Aid will shut down 178 pharmacies in New York. Eleven of those locations are in the Capital Region. Walgreens is being purchased by a private equity firm, a deal that will likely impact the number of stores. We can’t afford to have any more pharmacies close. The Patient Access to Pharmacy Act will keep local pharmacies in business but more importantly ensure access to care for patients.
John T. McDonald III, RPh
108th NY Assembly District
