Part IV: Prescription drug blame game

Aug 25, 2021
Key Points
  • Medicare prescription-drugs have skyrocketed 89% in Georgia from 2013 to 2019.
  • Prices for common medications in Georgia have also ballooned during that time.
  • Cost transparency is lacking even from state government as key prescription-drug players blame each other.

The inability of many people in Georgia to pay for prescription drugs also hits local independent pharmacists like Chelley Williams, who opened a pharmacy in Douglas County in 2015.

A constant source of trouble was penalties Williams faced when patients skipped picking up prescriptions because they could not afford them, she said. Each time that happened, she lost out on a chunk of the reimbursements that pharmacies receive to fill prescriptions, she said. The practice caused Williams’ pharmacy to hemorrhage money, forcing her to shut down in 2019.

“It was kind of a vicious cycle,” Williams said in a recent interview. “In the end, the patient loses. They’re paying more.”

This graph by the medication-assistance group NiceRx shows the annual average out-of-pocket medication spending per person for all states in 2018. (Credit: NiceRx)

Williams traced much of her pharmacy’s financial issues to companies called pharmacy benefit managers that act as intermediaries between health plans and drugmakers to negotiate medication costs. Critics argue most pharmacy benefit managers worsen drug prices rather than help lower them. They point to a complicated system of drug discounts and how medications are ranked on certain lists that pharmacy benefit managers influence as the root of recent rising prices.

Rebates that go to pharmacy benefit managers to help lower the overall costs of prescription drugs often never made it to patients’ pockets, offering little relief for Georgia patients when medication costs crop up that their plans don’t cover, said Greg Reybold, the general counsel with the Georgia Pharmacy Association.

“When (pharmacy benefit managers) are acting at their worst, they’re able to exploit drug markets at a massive scale,” Reybold said in a recent interview. “They’ve monetized every side of it.”

For their part, many pharmacy benefit managers point the finger right back at drugmakers who they claim set the initial cost for medications too high and push more expensive brand-name drugs when cheaper alternatives exist. Many pharmacy benefit managers also accuse independent pharmacies of being profit-driven when pushing for recent regulations in Georgia that they claim limit their ability to negotiate drug prices and secure discounts from drugmakers to drive down the final cost of medications.

“Any assertion that (pharmacy benefit managers) are raising drug costs is completely false,” said Greg Lopes, a senior vice president with Pharmaceutical Care Management Association. “(Pharmacy benefit managers) are the one member of the (prescription-drug) supply and payment chain working to reduce costs.”


Part V: Lawmakers push for transparency