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Opinion: Push to mail-order prescriptions impacts patients and pharmacies


The Missouri Pharmacy Association has been working for years to sound the alarm and raise awareness of the harmful effects that Pharmacy Benefit Managers, or PBMs, are having on patients across the state.

These invisible middlemen, who act as go-betweens for insurance companies and pharmacies, determine which prescription drugs are covered by insurance — which they can change at any time, without notice.

Missouri Pharmacy Association CEO Ron Fitzwater

Over the last few weeks, one of our concerns about covert PBM practices — that of redirecting patients to specialty or mail-order pharmacies — has emerged as a critical issue for patients across the state. Pushing to mail-order (which puts more money in the PBMs’ pocket) limits patient choice and drives business away from independent pharmacies. But now, given the growing challenges surrounding the U.S. Postal Service delivery, this has literally become a matter of life or death for patients who rely on their medications.

This and other deceptive practices come at great expense to patients — both monetarily and worse, their health. Our pharmacists have watched even insured patients put their health at risk — some cutting their medically-prescribed dosages in half to make their prescriptions last longer, others paying for just one or two medications at a time instead of the four or five that they need, and longtime patients being pushed to mail-order prescriptions (that may or may not arrive on time) in order to get needed relief or treatment.

It should not be so challenging to access the medication that patients need.

This spring, Gov. Mike Parson signed HB 1682 into law which, in part, will require additional licensing for PBMs and transparency about any conflicts of interest.

While we applaud the state for this step in the right direction, more must be done to protect patients from these harmful practices — including redirecting patients away from their preferred pharmacy to one of the PBM’s choosing, often mail-order; siphoning money from rebates out of patients’ pockets; and more.

We must continue to rein in PBMs. Let’s get back to letting pharmacists do their jobs — helping patients across the state access the medicine they need and deserve.