Local pharmacists play a vital role in America’s neighborhoods and communities—particularly in more rural areas in Northeast Georgia. They provide unparalleled guidance, assistance and resources for families, including my own. Today however, community pharmacists routinely incur losses of approximately $100- or in some cases much more- on individual prescriptions because insurance middlemen, known as pharmacy benefit managers (PBMs), reimburse pharmacies well below their cost to acquire and dispense generic prescription drugs that have skyrocketed in price. The PBMs may wait weeks or months to update the reimbursement benchmarks they use to compensate pharmacies while drug prices increase virtually overnight. This situation jeopardizes pharmacists' ability to continue to serve patients because it leaves community pharmacies with unsustainable losses. Preserving patient access to pharmacies is one of my top priorities in Congress.

PBMs like to talk about making healthcare affordable. But in doing so, they fail to realize that we must also make healthcare accessible. Unlike my local pharmacist in Hall County, and those across the nation, PBMs do not have to real relationship with patients. In fact, it is not uncommon for them to secretly retain most manufacturer payments – rebates, discounts and other fees – instead of passing the savings on to patients. Additionally, PBMs have been known to switch plan members from low-to-high cost drugs and manipulate generic pricing. This is why I support strong PBM transparency requirements. I believe they are the key to delivering real savings to patients.


Our community pharmacies should have access to up-to-date pricing information so when they dispense a drug they know their reimbursement rate reflects current market prices. PBMs have been padding their bottom lines at the expense of our local pharmacies. Predictability and transparency should exist in every industry, for every company, regardless of their size or market power. In Northeast Georgia and across the nation, many pharmacists have to choose between keeping their business open, or giving their patients the services and care they need. This isn’t a choice they should be forced to make. Supporting strong PBM transparency requirements is the key to delivering real savings to patients. To achieve this goal and return the focus of the prescription drug industry to patients, I introduced H.R. 244, the “MAC Transparency Act”. H.R. 244 would preserve pharmacy access for patients by requiring PBMs to update their "maximum allowable cost" (MAC) benchmarks every seven days to better reflect market costs and allow pharmacists to know the source by which PBMs set reimbursement for his or her community pharmacy. My legislation will also give patients greater choice of pharmacy, as patients would not be forced by PBMs to use a PBM-owned pharmacy – an obvious conflict of interest. According to Medicare data, PBM-owned mail order pharmacies may charge plans more – as much as 83 percent more – to fill prescriptions than community pharmacies.

But there is still work to be done. The attack on our local pharmacies by PBMs isn’t limited to the pricing mechanisms. Unfortunately, PBMs are leveraging their power to abuse the auditing process. They are singling out expensive drugs and using typographical and other trivial errors to recoup from pharmacies significant amounts of money—not to return to Medicare or other federal programs, but to line their own pockets.

For example, let’s say your local pharmacist fills a $500 prescription for you that you called in over the phone. The pharmacist dispensed the correct drug in the correct amount, and provided you with the correct directions for taking the drug. But the pharmacist made a mistake. In his personal records, instead of checking the “called in over the phone” box, he checked the “faxed in” box. A PBM could then audit the pharmacy, find the mistake, and then take back the entire $500. Not just the co-pay and not just the profit the pharmacy received. The PBM could pocket the entire cost of the correctly dispensed drug—even what the pharmacy paid wholesale. This leaves me baffled! Obviously auditing measures should be in place, but for transparency and accountability—not to financially penalize one’s competitors. Unfortunately the dozens of similar stories I hear from pharmacies across the nation every week come as no surprise—the data is clear that PBMs are looking to line their pockets, not care for patients. They don’t sponsor baseball teams, they don’t participate in the chili cook-offs, and they sure aren’t going to turn on their lights in the middle of the night to fill a needed prescription. When it comes to PBMs, patient care takes a back seat to profit margins.

Collins has represented Georgia‘s 9th Congressional District since 2013. He sits on the Judiciary and the Rules committees.