Rockville Centre pharmacist pleads for Gov. Hochul’s help amid battle with PBMs

Rockville Centre pharmacist Howard Jacobson is among the many independent pharmacy owners who have struggled over the years due to the influence of pharmacy benefit managers, and have urged Gov. Kathy Hochul to sign into law the Pharmacy Rescue Package. The bill was passed overwhelmingly by the State Assembly and Senate in June.

PBMs act as middlemen between pharmacies, on one side, and drug manufacturers and insurance companies, on the other. A lack of oversight of the managers costs independent pharmacies across the state, which often face financial hardship because of low reimbursement rates from the managers, which are not legally required to disclose their revenue streams in New York.

Currently, PBMs such as OptumRx, Express Scripts and CVS Caremark have the power to determine how much money pharmacies are reimbursed for the prescriptions they dispense. A survey of more than 300 independent pharmacies earlier this year, conducted by the Pharmacists Society of the State of New York, found that 98 percent of respondents had their reimbursements cut during the pandemic, and 97 percent feared they would have to lay off employees, reduce store hours or close due to those cuts. At the same time, PBMs have seen record-breaking revenue increases.

“It’s alarming what’s happening in our state, on our island and in our own little Nassau County,” said Jacobson, the owner of Rockville Centre Pharmacy. “RVC Pharmacy, a tiny little location, we’re doing over 100 vaccinations every day, and that’s on top of our testing and trying to get our regular business and prescriptions out to our patients, and it’s been overwhelming.”

Requests for comment from Hochul were not returned at press time. Jacobson said he was hopeful that she would sign the Pharmacy Rescue Package before the end of the year, because if she doesn’t, or vetoes it, the Senate and Assembly will have to pass the law again next year, which could extend the timeline by another six months to a year. Pharmacists, Jacobson added, can’t survive another year with PBMs.

While the pandemic has helped him stay afloat, given the need for tests, vaccinations, medication and other services, he finds no joy in it, he said, and he hopes it will end soon, and give way to a sense of normalcy. When that happens, however, he said, he will struggle even more, which is why he has pushed for Hochul to sign the rescue package.

Jacobson explained that he can’t just ignore PBMs because they control networks of prescription patients, and he would ultimately lose business because the system is “very manipulated,” and he would get “blacklisted.” He added that his reimbursements have gone down during the pandemic.

“We’re offered one-sided contracts, and it’s take it or leave it,” he said, “and if you leave it, then not only are you telling your patients you don’t care about them, [but] you’re [also] leaving a network. You’re not going to see those people anymore.”

The bill, Jacobson said, would protect thousands of independent pharmacies across the state from losing money filling prescriptions amid unregulated PBMs, who have been widely criticized for keeping drug prices high, eliminating patient choice and access, and thus destroying those pharmacies. With Covid-19 hospitalizations in New York increasing dramatically since Thanksgiving, he said, it’s important for independent pharmacies to remain in business.

Jacobson has been a pharmacist for 42 years and has owned Rockville Centre Pharmacy for 35. He expanded his business to another location on Mercy Hospital’s campus, but he plans to close it down in the next month amid financial struggles brought on by PBMs.

“I can’t afford to keep running it,” he said. “It’s part and parcel because I’ve been living this trend for 32 or 33 of the 35 years that I’ve been in my own business. We have a yoke around our necks put upon on us by these PBMs. Our patients rely on us for their health care, [but] . . . based on what we’re reimbursed, I just can’t afford to run it . . .”

Hochul signed one part of the Pharmacy Rescue Package bill into law earlier this year, which enables pharmacies to administer vaccinations recommended by the Centers for Disease Control and Prevention. The three other parts of the legislation set a minimum reimbursement level for prescriptions, so pharmacies don’t lose money taking care of patients; create oversight and regulation of pharmacy benefit managers; and prevent them from forcing patients to use mail-order pharmacies.

“Pharmacists are truly front-line healthcare heroes who put their lives and businesses on the line every day for the past two years to keep their communities healthy,” Pharmacists Society President Karl Williams said in a statement. “Millions of New Yorkers are counting on Governor Hochul to step up for patients, pharmacists and taxpayers by signing the Pharmacy Rescue Package before the end of the year.”

After the Pharmacy Rescue Package passed the Senate and Assembly, Gov. Andrew Cuomo opted not to sign it. With Hochul now at the helm, Jacobson said, pharmacists are hopeful for a different outcome.

The independent pharmacies that PBMs’ practices endanger, Jacobson said, offer the kind of care that many big chains can’t provide. “There’s a significant part of the population that wants to use an independent community pharmacy, doesn’t like patronizing only the big guys,” he said. “They feel like a number when they walk in there. From us they get very personalized attention, not just by me, but by most of my colleagues who are independent pharmacists.”