Biden plan to save Medicare patients money on drugs risks empty shelves, pharmacists say

Published

2 years ago

June 11, 2024

admin

Jun 11 2024 KFF Health News

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they're struggling to afford to keep some prescription drugs in stock.

"It would not matter if the governor himself walked in and said, 'I need to get this prescription filled,'" said Clint Hopkins, a pharmacist and co-owner of Pucci's Pharmacy in Sacramento, California. "If I’m losing money on it, it's a no."

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. For years, prices included pharmacy performance incentives, possible rebates, and other adjustments made after the prescription was filled. Now the adjustments are made first, at the pharmacy counter, reducing the overall cost for patients and the government. But the new system means less money for pharmacies that acquire and stock medications, pharmacists say.

Pharmacies are already struggling with staff shortages, drug shortages, fallout from opioid lawsuits, and rising operating costs. While independent pharmacies are most vulnerable, some big chain pharmacies are also feeling a cash crunch — particularly those whose parent firms don't own a pharmacy benefit manager, companies that negotiate drug prices between insurers, drug manufacturers, and pharmacies.

A top official at the Centers for Medicare & Medicaid Services said it's a matter for pharmacies, Medicare insurance plans, and PBMs to resolve.

"We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers," Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. "We cannot tell a plan how much to pay a pharmacy or a PBM."

Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide the drugs and other benefits promised to beneficiaries.

Several independent pharmacists told KFF Health News they'll soon cut back on the number of medications they keep on shelves, particularly brand-name drugs. Some have even decided to stop accepting certain Medicare drug plans, they said.

As he campaigns for reelection, President Joe Biden has touted his administration's moves to make prescription drugs more affordable for Medicare patients, hoping to appeal to voters troubled by rising health care costs. His achievements include a law, the Inflation Reduction Act, that caps the price of insulin at $35 a month for Medicare patients; caps Medicare patients' drug spending at $2,000 a year, beginning next year; and allows the program to bargain down drug prices with manufacturers.

More than 51 million people have Medicare drug coverage. CMS officials estimated the new rule reducing pharmacy costs would save beneficiaries $26.5 billion from 2024 through 2032.

Medicare patients' prescriptions can account for at least 40% of pharmacy business, according to a February survey by the National Community Pharmacists Association.

Independent pharmacists say the new rule is causing them financial trouble and hardship for some Medicare patients. Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.

The crux of the problem is cash flow, the pharmacists say. Under the old system, pharmacies and PBMs reconciled rebates and other behind-the-scenes transactions a few times a year, resulting in pharmacies refunding any overpayments.

Now, PBM clawbacks happen immediately, with every filled prescription, reducing pharmacies' cash on hand. That has made it particularly difficult, pharmacists say, to stock brand-name drugs that can cost hundreds or thousands of dollars for a month's supply.

Some patients have been forced to choose between their pharmacy and their drug plan. Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans, said co-owner and pharmacist Scott Pace. He said the pharmacy made the change because the companies use Express Scripts, a PBM that has cut its reimbursements to pharmacies. Related StoriesCovid and Medicare payments spark remote patient monitoring boomAn Arm and a Leg: Attack of the Medicare machinesYour doctor or your insurer? Little-known rules may ease the choice in Medicare Advantage

"We had a lot of Wellcare patients in 2023 that either had to switch plans to remain with us, or they had to find a new provider," Pace said.

Pace said one patient's drug plan recently reimbursed him for a fentanyl patch $40 less than his cost to acquire the drug. "Because we’ve had a long-standing relationship with this particular patient, and they’re dying, we took a $40 loss to take care of the patient," he said.

Conceding that some pharmacies face cash-flow problems, Express Scripts recently decided to accelerate payment of bonuses for meeting the company's performance measures, said spokesperson Justine Sessions. She declined to answer questions about cuts in pharmacy payments.

Express Scripts, which is owned by The Cigna Group, managed 23% of prescription claims last year, second to CVS Health, which had 34% of the market.

In North Carolina, pharmacist Brent Talley said he recently lost $31 filling a prescription for a month's supply of a weight control and diabetes drug.

To try to cushion such losses, Talley's Hayes Barton Pharmacy sells CBD products and specialty items like reading glasses, bath products, and books about local history. "But that's not going to come close to making up the loss generated by the prescription sale," Talley said.

His pharmacy also delivers medicines packaged by the dose to Medicare patients at assisted living facilities and nursing homes. Reimbursement arrangements with PBMs for that business are more favorable than for filling prescriptions in person, he said.

When Congress added drug coverage to Medicare in 2003, lawmakers privatized the benefit by requiring the government to contract with commercial insurance companies to manage the program.

Insurers offer two options: Medicare Advantage plans, which usually cover medications, in addition to hospital care, doctor visits, and other services; as well as stand-alone drug plans for people with traditional Medicare. The insurers then contract with PBMs to negotiate drug prices and pharmacy costs with drug manufacturers and pharmacies.

The terms of PBM contracts are generally secret and restrict what pharmacists can tell patients — for example, if they're asked why a drug is out of stock. (It took an act of Congress in 2018 to eliminate restrictions on disclosing a drug's cash price, which can sometimes be less than an insurance plan's copayment.)

The Pharmaceutical Care Management Association, a trade group representing PBMs, warned CMS repeatedly "that pharmacies would likely receive lower payments under the new Medicare Part D rule," spokesperson Greg Lopes said. His group opposes the change.

Recognizing the new policy could cause cash-flow problems for pharmacies, Medicare officials had delayed implementation for a year before the rule took effect, giving them more time to adjust.

"We have heard pharmacies saying that they have concerns with their reimbursement," Seshamani said.

But the agency isn't doing enough to help now, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. "They haven't taken any action even after we brought potential violations to their attention," she said.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism. Source:

KFF Health News

US

At least two dead and eight critically injured in US university shooting

Published

49 mins ago

December 14, 2025

admin

At least two dead and eight critically injured in US university shooting

At least two people have been killed and eight others critically injured in a shooting on the campus of Brown University in Rhode Island, officials have said.

The incident is believed to be unfolding near an engineering building on the campus, according to the school’s alert system.

Providence Police and the Rhode Island State Police are responding.

It is unclear at the moment whether arrests have been made.

Brown University says no suspects are in custody and that additional shots may have been fired.

US President Donald Trump corrected an earlier post he shared online, clarifying that a suspect was not in custody. In his previous post, he had stated that a suspect was in custody.

University officials initially told students and staff that a suspect was in custody, but later said this was not the case and police were still searching for a suspect or suspects.

Officials noted that the information remained preliminary as investigators try to determine what has occurred.

Police are actively investigating and still gathering information from the scene, said Kristy DosReis, the chief public information officer for the city of Providence.

The shooting was reported near the Barus & Holley building, a seven-storey structure that houses the School of Engineering and Physics Department, according to the school’s website.

It includes 117 laboratories, 150 offices and 15 classrooms.

Brown is a private university with roughly 7,300 undergraduate students and more than 3,000 graduate students.

Providence Council member John Goncalves, whose ward includes the Brown campus, said: “We’re still getting information about what’s going on, but we’re just telling people to lock their doors and to stay vigilant.

“As a Brown alum, someone who loves the Brown community and represents this area, I’m heartbroken. My heart goes out to all the family members and the folks who’ve been impacted.”

This breaking news story is being updated and more details will be published shortly.

Please refresh the page for the latest version.

You can receive breaking news alerts on a smartphone or tablet via the Sky News app. You can also follow us on WhatsApp and subscribe to our YouTube channel to keep up with the latest news.

UK

Specialist teams and online investigators deployed across England and Wales to tackle ‘national emergency’ of violence against women and girls

Published

49 mins ago

December 14, 2025

admin

Specialist teams and online investigators deployed across England and Wales to tackle 'national emergency' of violence against women and girls

Specialist investigation teams for rape and sexual offences are to be created across England and Wales as the Home Secretary declares violence against women and girls a “national emergency”.

Shabana Mahmood said the dedicated units will be in place across every force by 2029 as part of Labour’s violence against women and girls (VAWG) strategy due to be launched later this week.

The use of Domestic Abuse Protection Orders (DAPOs), which had been trialled in several areas, will also be rolled out across England and Wales. They are designed to target abusers by imposing curfews, electronic tags and exclusion zones.

The orders cover all forms of domestic abuse, including economic abuse, coercive and controlling behaviour, stalking and ‘honour’-based abuse. Breaching the terms can carry a prison term of up to 5 years.

Nearly £2m will also be spent funding a network of officers to target offenders operating within the online space.

Teams will use covert and intelligence techniques to tackle violence against women and girls via apps and websites.

A similar undercover network funded by the Home Office to examine child sexual abuse has arrested over 1,700 perpetrators.

Abuse is ‘national emergency’

Home Secretary Shabana Mahmood said in a statement: “This government has declared violence against women and girls a national emergency.

“For too long, these crimes have been considered a fact of life. That’s not good enough. We will halve it in a decade.

“Today we announce a range of measures to bear down on abusers, stopping them in their tracks. Rapists, sex offenders and abusers will have nowhere to hide.”

The target to halve violence against women and girls in a decade is a Labour manifesto pledge.

The government said the measures build on existing policy, including facial recognition technology to identify offenders, improving protections for stalking victims, making strangulation a criminal offence and establishing domestic abuse specialists in 999 control rooms.

Labour has ‘failed women’

But the Conservatives said Labour had “failed women” and “broken its promises” by delaying the publication of the violence against women and girls strategy.

Shadow Home Secretary, Chris Philp, said that Labour “shrinks from uncomfortable truths, voting against tougher sentences and presiding over falling sex-offender convictions. At every turn, Labour has failed women.”