Pharmacies have long faced "clawback fees" from pharmacy benefit managers, and a federal answer to the issue is causing another problem, KFF Health News reported Nov. 15.
A new rule set for Jan. 1 will require PBMs to capture most of their fees when prescriptions are filled — rather than clawing them back after months or years. In anticipation of this change, pharmacies say the PBM industry is pressuring them into new contracts with severe cuts to their dispensing payments.
For example, Cigna Evernorth's PBM Express Scripts told pharmacies it plans to pay them 10% less than what they typically pay to buy wholesale branded drugs in 2024, according to KFF Health News. Express Scripts said about 90% of the nation's 20,000 pharmacies have already signed the contract.
The consequence is affecting independent pharmacies and retail chains alike, according to the report.