A recent visit by Congressman Rodney Davis to Greene County was an opportunity for a local pharmacy owner to voice concerns about the pharmaceutical industry.
Byron Berry, who owns Pharmacy Plus in Carrollton with his wife, visited for about a half hour with Congressman Davis several weeks ago. Berry had contacted his office specifically about concerns he had with Medicare reimbursement, which is adversely impacting small pharmacies across the country.
Berry says Davis explained to him how the Affordable Care Act is causing some reductions in Medicare reimbursement. For example, he talks about diabetic test strips, explaining that because of competitive bidding, he’s not getting a reasonable amount of reimbursement, stating it’s been cut significantly.
He says one of the problems in Medicare is fraud, waste and abuse, with mail order being the primary catalyst.
“They send out the maximum number of supplies as soon as they possibly can to individuals so that they’re getting as much money for Medicare as they possibly can, where we only give our patients supplies when they need them,” says Berry.
“I’ve had people walk in here with bags full of diabetic test strips because the companies just keep sending things to them. I’ve had them come in with meters and strips that they say, ‘I’ve told the people at the mailer place I don’t want these, and they send them to me anyway’.”
Berry says part of the discussion focused specifically on Pharmacy Benefit Managers, which are primarily responsible for processing and paying prescription drug claims.
“They take money out of the health care market and they make money off of the people that they sell their services to and reduce our reimbursement, sometimes extremely,” he says.
Berry says he’s seen other small operators in the area struggle because of competitive bidding, and he says bigger drug suppliers aren’t seeing patients as often.
“My belief is- and I’m sure that PBM managers would disagree with this- but they don’t really see the people. They don’t really provide any significant service other than handling the bills, yet they’re charging for additional services and getting paid for them,” states Berry.
“It reduces the contact with the patient and possibility of picking up something that may be wrong with them.”
Berry also notes that the buying group his pharmacy is a part of was recently shut out of being a preferred provider in Medicare Part D, and that he’s unable to negotiate with benefit management companies.
He notes that some segments of reimbursements do need to be monitored and reduced, but that reducing service to save dollars isn’t a good approach.