[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.