[Congressional Record Volume 170, Number 94 (Monday, June 3, 2024)]
[Senate]
[Pages S3919-S3920]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Independent and Community Pharmacies
Mr. MORAN. Madam President, I am here on the Senate floor today to
call attention to my colleagues. I want them to recognize--and, really,
Americans to recognize--the significant crisis that is happening not
only in my home State of Kansas but across the country. All of us face
this in our home States. The independent and community pharmacies in
our Nation have been struggling for years to survive, and their
situation, unfortunately, is deteriorating rapidly.
Independent and community pharmacies play an invaluable role in the
healthcare of our country and especially in rural communities, like
those in my home State. For many Americans, the local pharmacist is not
just a convenient healthcare provider, but it is also someone with whom
they feel
[[Page S3920]]
most comfortable in receiving medical advice.
I remember my dad, into his nineties, declined to go see the doctor
because he knew they would find something wrong with him. But when he
had a cup of coffee at the drugstore, he talked with the pharmacist,
who provided him with healthcare, occasionally putting a blood pressure
cuff on his arm and suggesting to my dad: Ray, you need to go to the
doctor.
They are really important people in our communities, and they are
highly trusted; and their advice is invaluable as we try to make
certain that all Americans are more healthy. Local pharmacists know
their patients, their health situations, and even their families, as is
the norm in tight-knit rural communities.
The service occurring at a local pharmacy is not simply one for
physical medication but offers the relational aspect so often missing
in today's healthcare system and, in fact, in today's world. Community
pharmacies do not just dispense medications. They build relationships
with their patients, and they offer a familiar face and trusted
adviser, extending value far beyond their role as just a provider of
medication and prescription drugs, although that is their profession.
But despite their irreplaceable role in America's rural communities,
from 2003 to 2021, the number of independently owned retail pharmacies
declined in rural areas by 16 percent. Through the COVID pandemic and
in its aftermath, local pharmacies have been hit hard by the same
difficulties our entire healthcare system and infrastructure are
facing: high inflation, nonexistent workforce, and supply chain
shortages.
However, in addition to these factors experienced by many, pharmacies
face additional significant challenges that threaten their solvency and
are forcing an increasing number of independent and community
pharmacies to close. The growing challenges with the 340B Drug Pricing
Program and actions of participating manufacturers are reducing the
revenues for contract pharmacies. While 340B was created to ensure low-
income and uninsured patients have access to discounted drugs,
pharmacies have relied upon the program for revenue via contract
pharmacy arrangements, a policy that Congress ought to codify within
the 340B statute.
Another factor is the actions of pharmacy benefit managers, or PBMs.
We have three committees in the U.S. Senate, all which have passed
legislation dealing with PBMs, but none of those pieces of legislation
has come to the Senate floor--PBMs that, unlike any other sector of the
healthcare industry, have operated without oversight and regulation for
years.
The obscurity of their industry allows PBMs to argue that they are
helping to keep prescription costs lower for patients while ensuring a
higher reimbursement for pharmacies. Recent studies, investigations,
and real-life experiences of our independent and community pharmacies
and their patients tell us the exact opposite is true.
I hear this from my pharmacists across Kansas. It used to be, early
in my days in the U.S. Senate and even in Congress, that the gathering
place in the community and a nice enjoyable place to visit was the
community pharmacy, the community's drugstore. Today, if you enter the
drugstore as an elected official, you will hear the difficulties those
pharmacists are facing in their profession and in their business. Part
of that is the story of PBMs and the PBMs' clawbacks from
reimbursements already made to the pharmacists, rebates that did not
reach patients and went instead to the PBMs. Vertical integration and
unfavorable terms offered to 340B contract pharmacies have become
increasingly frequent and the common practice of PBMs.
In addition to actions taken by the PBMs, local pharmacies also
recently have been forced out of or are unable to serve TRICARE
beneficiaries. Two years ago, TRICARE began a new contract with Express
Scripts, the subsidiary owned by Cigna. The new Express Scripts
contract offered to interested pharmacy participants offered
reimbursement rates that were far too low for many of our pharmacies or
pharmacists to accept. The pharmacists did not have the ability to
negotiate the reimbursement rates with Express Scripts. It was a ``take
it or leave it.''
Without negotiations and unable to afford the offered reimbursement
rates, countless numbers of local pharmacies in Kansas could not
participate in the new TRICARE network with Express Scripts. In
addition to the community pharmacies' desire to serve veterans, Active-
Duty military members, and their families, the costs associated with
TRICARE prevented them from doing so.
When the costs of acquiring and dispensing a drug are higher than the
reimbursement rates, a business--a pharmacy--simply cannot make that
math work and stay solvent. Yet we continue to ask our community
pharmacists across the Nation to do that each and every year, to make
that situation work year after year.
While perhaps you can get by for a year or maybe two, you can't get
by year after year after year. It is not an exaggeration to say that
the Nation's independent and community pharmacies are facing a crisis,
and if Congress does not act, a significant number of local pharmacies
will be forced to close. We frequently discuss the high rate of rural
hospital closures, but rarely do we ever discuss the parallel crisis of
losing rural pharmacies at this increasingly alarming rate.
I am told by the Kansas Pharmacists Association that 32 percent of
community pharmacies across the country are considering closing this
year. Unfortunately, I know that 32 percent includes a vast number of
Kansas pharmacies. As of 2021, Kansas is one of four States with the
most counties lacking sufficient access to a pharmacy.
What I am saying is that there is already a problem of access. But
with the trend that now presents itself, more and more Kansans--more
and more Americans--will have less access or no access to a pharmacy.
Today, many of our healthcare needs are met by prescription drugs,
and yet that will not be an option for many Americans.
So often we take for granted the healthcare infrastructure we have in
our Nation, from hospitals and community health centers to specialists
and pediatricians and primary care practices. No matter where an
individual is seeking care, one place that is a common denominator for
the entire healthcare system is the pharmacy. Independent and community
pharmacies in Kansas and across the Nation are the one place where a
patient can go to fill their medication, see a friendly face, and know
that local access to care is there for them when they need it.
We are asking for miracles from the community and independent
pharmacies to remain solvent through a barrage of unfair situations,
none of their own making. They deserve better than what we are asking
from them. And just as they offer lifesaving services to Americans,
Congress ought to heed the warnings from community pharmacists and
offer lifesaving policies and legislation to them.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Iowa.