Low payments from pharmacy benefit managers (PBMs) have led to the closure of many pharmacies, including Walgreens and Rite Aid. In Pennsylvania, Rite Aid has closed 59 stores. Walgreens plans to shut down 25% of its stores over three years. One Pennsylvania pharmacy has closed every two days since January .

PBMs were created to simplify insurance claims, but instead, they charge health plans more than they pay pharmacies, keeping the difference -- called "spread pricing." This forces pharmacies to lose money, especially on brands like Ozempic, Paxlovid and Eliquis. If pharmacies aren't properly reimbursed, they cannot pay their staff or cover operating costs.

PBMs also get rebates from drug companies, incentivizing them to keep expensive brand-name drugs on their lists, ignoring cheaper generics. This steers patients to higher-cost medications and boosts PBM profits.

We need transparent drug pricing. According to data from Medicaid, a common blood pressure medication called lisinopril costs only 55 cents (30 days). Yet some drugs, like teriflunomide, have 30-day copays over $1,000 a month on Medicare but cost pharmacies $12. Most medications are inexpensive, but prices go way up when PBMs get involved.

At cost-plus pharmacies like mine, we buy medicine from wholesalers, add a small fee, and sell it to patients without going through insurance or PBMs. This keeps prices low, and patients know exactly how much their medicine costs.